Reducing Dysfunctional Beliefs about Sleep Does Not Significantly Improve Insomnia in Cognitive Behavioral Therapy
The present study examined to examine whether improvement of insomnia is mediated by a reduction in sleep-related dysfunctional beliefs through cognitive behavioral therapy for insomnia. In total, 64 patients with chronic insomnia received cognitive behavioral therapy for insomnia consisting of 6 biweekly individual treatment sessions of 50 minutes in length. Participants were asked to complete the Athens Insomnia Scale and the Dysfunctional Beliefs and Attitudes about Sleep scale both at the baseline and at the end of treatment. The results showed that although cognitive behavioral therapy for insomnia greatly reduced individuals’ scores on both scales, the decrease in dysfunctional beliefs and attitudes about sleep with treatment did not seem to mediate improvement in insomnia. The findings suggest that sleep-related dysfunctional beliefs endorsed by patients with chronic insomnia may be attenuated by cognitive behavioral therapy for insomnia, but changes in such beliefs are not likely to play a crucial role in reducing the severity of insomnia.
Drowsy Driving and Risk Behaviors — 10 States and Puerto Rico, 2011–2012
Source: Morbidity and Mortality Weekly Report (CDC)
Findings in published reports have suggested that drowsy driving is a factor each year in as many as 7,500 fatal motor vehicle crashes (approximately 25%) in the United States (1,2). CDC previously reported that, in 2009–2010, 4.2% of adult respondents in 19 states and the District of Columbia reported having fallen asleep while driving at least once during the previous 30 days (3). Adults who reported usually sleeping ≤6 hours per day, snoring, or unintentionally falling asleep during the day were more likely to report falling asleep while driving compared with adults who did not report these sleep patterns (3). However, limited information has been published on the association between drowsy driving and other risk behaviors that might contribute to crash injuries or fatalities. Therefore, CDC analyzed responses to survey questions regarding drowsy driving among 92,102 respondents in 10 states and Puerto Rico to the 2011–2012 Behavioral Risk Factor Surveillance System (BRFSS) surveys. The results showed that 4.0% reported falling asleep while driving during the previous 30 days. In addition to known risk factors, drowsy driving was more prevalent among binge drinkers than non-binge drinkers or abstainers and also more prevalent among drivers who sometimes, seldom, or never wear seatbelts while driving or riding in a car, compared with those who always or almost always wear seatbelts. Drowsy driving did not vary significantly by self-reported smoking status. Interventions designed to reduce binge drinking and alcohol-impaired driving, to increase enforcement of seatbelt use, and to encourage adequate sleep and seeking treatment for sleep disorders might contribute to reductions in drowsy driving crashes and related injuries.
Typologies of sleep problems have usually relied on identifying underlying causes or symptom clusters. In this study the value of using the patient’s own reasons for sleep disturbance are explored. Using secondary data analysis of a nationally representative psychiatric survey the patterning of the various reasons respondents provided for self-reported sleep problems were examined. Over two thirds (69.3%) of respondents could identify a specific reason for their sleep problem with worry (37.9%) and illness (20.1%) representing the most commonly reported reasons. And while women reported more sleep problems for almost every reason compared with men, the patterning of reasons by age showed marked variability. Sleep problem symptoms such as difficulty getting to sleep or waking early also showed variability by different reasons as did the association with major correlates such as worry, depression, anxiety and poor health. While prevalence surveys of ‘insomnia’ or ‘poor sleep’ often assume the identification of an underlying homogeneous construct there may be grounds for recognising the existence of different sleep problem types particularly in the context of the patient’s perceived reason for the problem.
Melatonin: What You Need To Know
Source: National Center for Complimentary and Alternative Medicine
What’s the Bottom Line?
How much do we know about melatonin supplements?
Researchers have conducted many studies on whether melatonin supplements may help people with various sleep disorders; however, important questions remain about its usefulness, how much to take and when to take it, and long-term safety.
What do we know about the usefulness of melatonin supplements?
Melatonin supplements may help some people with certain sleep disorders, including jet lag, sleep problems related to shift work, and delayed sleep phase disorder (one in which people go to bed but can’t fall asleep until hours later), and insomnia.
What do we know about the safety of melatonin supplements?
Melatonin supplements appear to be safe when used short-term; less is known about long-term safety.
FDA requiring lower starting dose for sleep drug Lunesta
Source: U.S. Food and Drug Administration
The U.S. Food and Drug Administration today announced it required the manufacturer of the sleep drug Lunesta (eszopiclone) to change the drug label and lower the current recommended starting dose. Data show that eszopiclone levels in some patients may be high enough the morning after use to impair activities that require alertness, including driving, even if they feel fully awake.
Taken at bedtime, the recommended starting dose of Lunesta (eszopiclone) has been decreased from 2 milligrams to 1 mg for both men and women. The 1 mg dose can be increased to 2 mg or 3 mg if needed, but the higher doses are more likely to result in next-day impairment of driving and other activities that require full alertness. Using lower doses means less drug will remain in the body in the morning hours.
Patients currently taking the 2 mg and 3 mg doses of Lunesta should contact their health care professional to ask for instructions on how to continue to take their medicine safely at a dose that is best for them.
Restless Legs Syndrome and the Law (PDF)
Source: Journal of Law Enforcement
Restless legs syndrome or RLS is a common neurological disorder prevalent in both adults and children and is often detrimental to regulatory sleep processes. RLS is subdivided into primary/idiopathic RLS and secondary RLS that is due to a related medical condition. Risk factors associated with the development of RLS include: pregnancy, iron deficiency, genetic heritability, and Attention Deficit Hyperactivity Disorder (ADHD). Additionally, RLS has high comorbidity with periodic limb movements during sleep (PLMS), insomnia, and nocturnal eating. Iron replacement and behavior therapy can be successful treatment approaches initially; however drug therapy (e.g., dopaminergic agents, opiates, and antiepileptic medications, and benzodiazepine receptor agonists) can be used in severe cases of RLS. The long-term prognosis of idiopathic RLS is not fatal; however, chronic secondary RLS can exacerbate associated medical conditions and present significant health risks. The symptoms of RLS have not been presented as detrimental to individual judgment and/or psyche. Thus, the Court has maintained the position that individuals with RLS are liable for any and all committed offenses.
Sleep Disorders and Complementary Health Approaches: What the Science Says
Source: National Center for Complementary and Alternative Medicine
Discusses Mind and Body Techniques, Dietary Supplements
Optimal Schedules of Light Exposure for Rapidly Correcting Circadian Misalignment
Source: PLoS Computational Biology
Jet lag arises from a misalignment of circadian biological timing with the timing of human activity, and is caused by rapid transmeridian travel. Jet lag’s symptoms, such as depressed cognitive alertness, also arise from work and social schedules misaligned with the timing of the circadian clock. Using experimentally validated mathematical models, we develop a new methodology to find mathematically optimal schedules of light exposure and avoidance for rapidly re-entraining the human circadian system. In simulations, our schedules are found to significantly outperform other recently proposed schedules. Moreover, our schedules appear to be significantly more robust to both noise in light and to inter-individual variations in endogenous circadian period than other proposed schedules. By comparing the optimal schedules for thousands of different situations, and by using general mathematical arguments, we are also able to translate our findings into general principles of optimal circadian re-entrainment. These principles include: 1) a class of schedules where circadian amplitude is only slightly perturbed, optimal for dim light and for small shifts 2) another class of schedules where shifting occurs along the shortest path in phase-space, optimal for bright light and for large shifts 3) the determination that short light pulses are less effective than sustained light if the goal is to re-entrain quickly, and 4) the determination that length of daytime should be significantly shorter when delaying the clock than when advancing it.
See: Using mathematics to beat jetlag effectively (Science Daily)
Daytime sleepiness: associations with alcohol use and sleep duration in americans
Source: Sleep Disorders
The aim of the current analysis was to investigate the relationship of daytime sleepiness with alcohol consumption and sleep duration using a population sample of adult Americans. Data was analyzed from adult respondents of the National Health and Nutritional Examination Survey (NHANES) 2007-2008 (N = 2919) using self-reported variables for sleepiness, sleep duration, and alcohol consumption (quantity and frequency of alcohol use). A heavy drinking episode was defined as the consumption of ≥5 standard alcoholic beverages in a day. Logistic regression models adjusted for sociodemographic variables and insomnia covariates were used to evaluate the relationship between daytime sleepiness and an interaction of alcohol consumption variables with sleep duration. The results showed that daytime sleepiness was reported by 15.07% of the subjects. In univariate analyses adjusted for covariates, an increased probability of daytime sleepiness was predicted by decreased log drinks per day [OR = 0.74 (95% CI, 0.58–0.95)], a decreased log drinking frequency [0.90 (95% CI, 0.83–0.98)], and lower sleep duration [OR = 0.75 (95% CI, 0.67–0.84)]. An interaction between decreased sleep duration and an increased log heavy drinking frequency predicted increased daytime sleepiness (P = 0.004). Thus, the effect of sleep duration should be considered when evaluating the relationship between daytime sleepiness and heavy drinking.
Timing and Intensity of Light Correlate with Body Weight in Adults
Source: PLoS ONE
Light exposure can influence sleep and circadian timing, both of which have been shown to influence weight regulation. The goal of this study was to evaluate the relationship between ambient light, sleep and body mass index. Participants included 54 individuals (26 males, mean age 30.6, SD = 11.7 years). Light levels, sleep midpoint and duration were measured with wrist actigraphy (Actiwatch-L) for 7 days. BMI was derived from self-reported height and weight. Caloric intake was determined from 7 days of food logs. For each participant, light and activity data were output in 2 minute epochs, smoothed using a 5 point (10 minute) moving average and then aggregated over 24 hours. The mean light timing above 500 lux (MLiT500) was defined as the average clock time of all aggregated data points above 500 lux. MLiT500 was positively correlated with BMI (r = 0.51, p<0.001), and midpoint of sleep (r = 0.47, p<0.01). In a multivariable linear regression model including MLiT500 and midpoint of sleep, MLiT500 was a significant predictor of BMI (B = 1.26 SE = 0.34, β = 0.53 p = 0.001, r2Δ = 0.22). Adjusting for covariates, MLiT500 remained an independent predictor of BMI (B = 1.28 SE = 0.36, β = 0.54, p = 0.002, r2Δ = 0.20). The full model accounted for 34.7% of the variance in BMI (p = 0.01). Exposure to moderate levels of light at biologically appropriate times can influence weight, independent of sleep timing and duration.
Zolpidem-induced suicide attempt: a case report
Source: DARU Journal of Pharmaceutical Sciences
Zolpidem is a popular drug indicated for the short-term treatment of insomnia. Side effects are not uncommon with zolpidem. Herein we describe an Iranian 27-year-old man with no known mood disorder or neuropsychological disease who attempted suicide upon taking zolpidem. There are two interesting facts about this case: Firstly, the patient had not history of suicide attempt or thinking. Secondly, this case had experienced suicide ideation after taking 20 mg of zolpidem, suggesting a possible correlation between zolpidem psychological effects and dangerous psychological behaviors.
Questionable Billing for Polysomnography Services
Source: U.S. Department of Health and Human Services, Office of Inspector General
WHY WE DID THIS STUDY
Increased Medicare spending on polysomnography (a type of sleep study), along with growing concerns about fraud and abuse, prompted OIG to conduct this study. From 2005 to 2011, Medicare spending for polysomnography services rose from $407 million to $565 million, an increase of 39 percent. In addition, fraud investigators and sleep medicine professionals have identified specific vulnerabilities regarding polysomnography services. In January 2013, a provider agreed to pay $15.3 million to settle allegations of false polysomnography claims billed to Medicare and other Federal payers.
HOW WE DID THIS STUDY
We analyzed Medicare payments for polysomnography claims for 2011. The claims were from hospital outpatient departments and nonhospital providers, such as physician owned sleep laboratories and independent diagnostic testing facilities. We identified polysomnography claims that did not meet one or more of three Medicare requirements. We also identified providers with patterns of questionable billing using 11 measures of questionable billing, which included the 3 Medicare requirements and 8 additional measures developed in consultation with fraud investigators and sleep medicine professionals within and outside of OIG.
WHAT WE FOUND
Medicare paid nearly $17 million for polysomnography services that did not meet one or more of three Medicare requirements. Payments for services with inappropriate diagnosis codes composed a majority of these payments. Eighty five percent of claims with inappropriate diagnosis codes came from hospital outpatient departments. Inappropriate payments might have been averted with effective electronic edits that automatically deny claims or suspend them for manual review.
Further, 180 providers exhibited patterns of questionable billing for polysomnography services. Most of these providers submitted an unusually high percentage of claims for beneficiaries with another polysomnography claim on the same day, which is questionable because beneficiaries can undergo only one polysomnography service in a day, as the process requires an overnight stay.
WHAT WE RECOMMEND
To strengthen safeguards for polysomnography services, we recommend that CMS implement or improve claims processing edits and consider using measures of questionable billing from this study to identify providers for further investigation. We also recommend that CMS take appropriate action regarding inappropriate payments and providers that exhibited patterns of questionable billing. CMS concurred with all four of our recommendations.
Prescription Sleep Aid Use Among Adults: United States, 2005–2010
Source: National Center for Health Statistics
Data from the National Health and Nutrition Examination Survey, 2005–2010
- About 4% of U.S. adults aged 20 and over used prescription sleep aids in the past month.
- The percentage of adults using a prescription sleep aid increased with age and education. More adult women (5.0%) used prescription sleep aids than adult men (3.1%).
- Non-Hispanic white adults were more likely to use sleep aids (4.7%) than non-Hispanic black (2.5%) and Mexican-American (2.0%) adults.
- Prescription sleep aid use varied by sleep duration and was highest among adults who sleep less than 5 hours (6.0%) or sleep 9 or more hours (5.3%).
- One in six adults with a diagnosed sleep disorder and one in eight adults with trouble sleeping reported using sleep aids.
Zolpidem and Driving Impairment — Identifying Persons at Risk
Source: New England Journal of Medicine
Zolpidem (Ambien, Sanofi) is the most widely used prescription drug for insomnia and one of the most commonly used drugs in the United States. Treatment of insomnia, which has important effects on patients’ quality of life, may also have larger public health benefits. In its 2006 report, the Institute of Medicine (IOM) Committee on Sleep Medicine and Research concluded that sleep deprivation and sleep disorders represent an unaddressed public health problem that has substantial health consequences and leads to high health care costs.1 The IOM noted that one of every five serious injuries from driving accidents can be attributed to driver sleepiness. Numerous sleep drugs are available for treating insomnia and are also used to reduce next-day somnolence. But it is widely recognized that these drugs themselves can sometimes contribute to next-day somnolence, depending on such factors as drug dose, dosage form, and individual patient characteristics.
FDA approves the first non-hormonal treatment for hot flashes associated with menopause
Source: U.S. Food and Drug Administration
The U.S. Food and Drug Administration today approved Brisdelle (paroxetine)to treat moderate to severe hot flashes (vasomotor symptoms) associated with menopause. Brisdelle, which contains the selective serotonin reuptake inhibitor paroxetine mesylate, is currently the only non-hormonal treatment for hot flashes approved by the FDA.
There are a variety of FDA-approved treatments for hot flashes, but all contain either estrogen alone or estrogen plus a progestin.
Hot flashes associated with menopause occur in up to 75 percent of women and can persist for up to five years, or even longer in some women. Hot flashes are not life-threatening, but the symptoms can be very bothersome, causing discomfort, embarrassment and disruption of sleep.
Replacement Schedules for Medicare Continuous Positive Airway Pressure Supplies
Source: U.S. Department of Health and Human Services, Office of Inspector General
WHY WE DID THIS STUDY
Since 2009, OIG has identified reducing waste in health care services as a top management challenge for the Department of Health and Human Services (HHS). In 2012, HHS’s CMS found that beneficiaries receiving continuous positive airway pressure (CPAP) treatment for obstructive sleep apnea may have received more supplies (e.g., masks, tubing) than medically necessary; however, the quantities did not exceed the established replacement schedule. Providing more supplies than necessary may lead to wasteful spending.
HOW WE DID THIS STUDY
We requested CPAP replacement supply schedules in effect as of January 1, 2012, from 50 fee for-service State Medicaid programs and from 4 fee-for-service Federal Employees Health Benefits (FEHB) plans. We compared the replacement schedules for 15 types of CPAP supplies with Medicare’s schedules. Additionally, we collected recommended replacement schedules from five sleep disorder clinicians and four manufacturers.
WHAT WE FOUND
For supplies for which State Medicaid programs specified frequency schedules, 39 percent of frequencies were less than those under Medicare and 51 percent equaled those under Medicare. Only 10 percent of frequencies exceeded those under Medicare. Additionally, many State Medicaid programs have either recently changed their schedules or have initiatives underway to do so. Two FEHB plans had no specific replacement schedules; the plans determined coverage on the basis of medical necessity. Sleep medicine clinicians emphasized the importance of proper mask fit, but research suggested that once proper mask fit is established, replacement of masks is less frequent than Medicare allows. Finally, manufacturers recommended specific replacement frequencies for only a few types of supplies, but those recommendations were often to replace those supplies on an as needed basis and potentially less frequently than under Medicare’s replacement schedule.
WHAT WE RECOMMEND
We recommend that CMS review the CPAP supply replacement schedule and revise the national coverage determination or request that the Durable Medical Equipment Medicare Administrative Contractors revise their local coverage determinations as appropriate. CMS did not concur with our recommendation. CMS stated that failure to consider noncompliance or the potential impact of supplier fraud or abuse would bias the estimate of a clinically appropriate refill rate. Although our report does not include this specific information, we continue to believe that our evidence is sufficient to warrant the recommendation that CMS review the supply replacement schedule and make revisions as appropriate.
Source: Centers for Disease Control and Prevention
Fact sheets on insufficient sleep are available for all 50 states, the District of Columbia, and three U.S. territories (Puerto Rico, Guam, and the Virgin Islands). Each fact sheet includes a table with the prevalence of insufficient rest or sleep (≥ 14 days in past 30 days) among adults in the state or territory by sex, age, race/ethnicity, education, employment status, marital status, presence of children in the home, and body mass index (a measure of excess weight). The fact sheet also includes a map that presents the prevalence of insufficient sleep among adults of the state or territory by region.
Select a state or territory from the drop-down menu or from the map to open that state’s or territory’s fact sheet (in PDF format).