Sleep Restriction Therapy for Insomnia is Associated with Reduced Objective Total Sleep Time, Increased Daytime Somnolence, and Objectively Impaired Vigilance: Implications for the Clinical Management of Insomnia Disorder

Kyle, Simon D.; Miller, Claramae H.; Rogers, Zoe; Siriwardena, Aloysius Niroshan; Macmahon, Kenneth; Espie, Colin A.

doi:10.5665/sleep.3386

Cited by 164 publications

(125 citation statements)

References 52 publications

(84 reference statements)

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“…However, a common component of traditional CBT-I is sleep restriction; this technique promotes sleepiness at bedtime, thereby reducing sleep latency and increasing sleep efficiency. Given the inflammatory effects of sleep restriction, as well as possible short-term increases in daytime sleepiness and decreases in psychomotor vigilance, 64 the potential risks of sleep restriction should be weighed against the benefits in pregnant women. Components of CBT-I including stimulus-control therapy, relaxation training, and cognitive restructuring can be effective without the addition of sleep restriction.…”

Section: Discussionmentioning

confidence: 99%

Poor Sleep Quality and Associated Inflammation Predict Preterm Birth: Heightened Risk among African Americans

Blair

Porter

Leblebicioğlu

et al. 2015

Sleep

156

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1259Sleep and Preterm Birth-Blair et al. INTRODUCTIONIn the United States, preterm birth affects 11.5% of deliveries and is the underlying cause of more than one third of infant deaths.1 A high proportion of surviving preterm infants suffer from severe physical and cognitive consequences, potentially requiring intensive medical and/or educational support throughout the lifespan.2 The morbidity and mortality associated with preterm birth pose significant drains on the financial and emotional resources of afflicted families, and on the nation as a whole, costing more than $26 billion annually in the United States. 3Inflammation is a causal mechanism in the initiation of preterm as well as term labor. 4 Inflammatory mediators can initiate contractions, encourage cervical ripening, and cause rupture of the membranes.4,5 Via these mechanisms, inflammation induced by infection or psychological stress may trigger early parturition. 6,7Importantly, poor sleep promotes inflammation.8 For example, in a population-based cohort of more than 5,000 adults, shorter sleep duration was associated with elevations in Study Objectives: Poor sleep promotes inflammation. In turn, inflammation is a causal mechanism in term as well as preterm parturition. In the United States, a persistent racial disparity in preterm birth exists, with African Americans showing ~1.5 times greater risk. This study examined associations among sleep quality, serum proinflammatory cytokines, and length of gestation in a racially diverse sample of 138 pregnant women. Design: Observational. Measurements: Women completed the Pittsburgh Sleep Quality Index (PSQI) and other psychosocial and behavioral measures during midpregnancy. Serum levels of interleukin (IL)-6, IL-8, IL-1β, and tumor necrosis factor (TNF)-α were determined by high-sensitivity assays. Birth outcomes were determined via medical record review. Results: Among African American women (n = 79), shorter gestation was predicted by poorer overall sleep (r s = −0.35, P = 0.002) as well the following PSQI subscales: subjective sleep quality (r s = −0.34, P = 0.002), sleep latency (r s = −0.27, P = 0.02), and sleep efficiency (r s = −0.27, P = 0.02). African American women with poor sleep quality (PSQI > 5) had 10.2 times the odds of preterm birth compared to those with good sleep quality. In contrast, among European American women (n = 53), gestational length was not significantly predicted by sleep quality (Ps > 0.12). Bootstrapping analyses showed that, among African Americans, IL-8 significantly mediated the association between sleep quality and length of gestation (indirect effect estimate −0.029; 95% confidence interval −0.06, −0.002). Conclusions:The data provide novel evidence that African American women exhibit greater inflammation in response to sleep disturbance than European American women and these effects correspond with length of gestation. Racial differences in susceptibility to sleep induced immune dysregulation may contribute to marked racial disparities in preterm birth.

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Section: Discussionmentioning

confidence: 99%

Poor Sleep Quality and Associated Inflammation Predict Preterm Birth: Heightened Risk among African Americans

Blair

Porter

Leblebicioğlu

et al. 2015

Sleep

156

View full text Add to dashboard Cite

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“…Second, in the present study TST increased in a way comparable to what is expected for TST after sleep restriction therapy for day workers. In fact, with a population sleeping by night, TST is expected to diminish in the first weeks of treatment and increase again later after treatment [31,52]. Furthermore, although sleepiness is a known side effect of sleep restriction [30,31,52], nearly all our participants improved on sleepiness.…”

Section: Discussionmentioning

confidence: 94%

“…In fact, with a population sleeping by night, TST is expected to diminish in the first weeks of treatment and increase again later after treatment [31,52]. Furthermore, although sleepiness is a known side effect of sleep restriction [30,31,52], nearly all our participants improved on sleepiness. Taken together, these results suggest that insomnia responds faster to sleep restriction therapy in SWD than in day workers.…”

Section: Discussionmentioning

confidence: 94%

Exploring a Behavioural Therapy for Insomnia in Shift Workers

Roy¹

2015

J Sleep Disord Ther

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About 30% of Canadian workers are on shift work schedules, and 8% to 32% of them suffer from Shift Work Disorder (SWD). Only a few behavioural treatments exist to treat this population. This study explores the efficacy and feasibility of sleep restriction therapy for insomnia in a group of night shift workers. Six participants (3 women) meeting SWD criteria were recruited. Mean age was 45.7 years old (SD=8.2). A multiple baseline design was used. After baseline, each participant received six to eight weekly treatment sessions. They completed several self reported questionnaires and a daily sleep diary throughout the study. For each sleep period, sleep variables were calculated from the sleep diary. Two participants had a high treatment response and all others participants had a moderate response. Moreover, all participants presented at least two significant clinical improvements. Five participants presented a decreased in both sleepiness scores. The study suggests that sleep restriction therapy is effective, feasible, and reliable. Sleep restriction therapy for insomnia could improve sleep and diminish sleepiness in shift workers suffering from SWD. The present study opens new possibilities of treatment for shift workers that deserve greater attention in the future.

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“…Some have called for greater attention to emotion regulation in insomnia etiology and management, 22,23 and indeed Dr. Sawyer recognized its importance in 1878. 1 Building on recent trends to dismantle CBT-I and assess the relative efficacy of cognitive and behavioral elements, 24,25 the field should now formally assess whether the addition of emotion regulation strategies and a focus on physical activity (perhaps, also, as a countermeasure to SRT-related sleepiness 26 ) can enhance CBT-I response. While trials cannot comprehensively inform on mechanisms, it is worth speculating on what may have accounted for the reduction in CRP in the report by Irwin and colleagues.…”

mentioning

confidence: 99%