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Publication analysis on insomnia: how much has been done in the past two decades?

March 30, 2015 Comments off

Publication analysis on insomnia: how much has been done in the past two decades?
Source: Sleep Medicine

Insomnia has been a rising public concern in recent years. As one example of a multidisciplinary topic, the theme of insomnia research has gradually shifted over time; however, there is very little quantitative characterization of the research trends in insomnia. The current study aims to quantitatively analyze trends in insomnia publications for the past 20 years. We retrospectively analyzed insomnia-related publications retrieved from PubMed and Google Scholar between 1994 and 2013, and to analyze insomnia-related publications from different perspectives. We investigated the major areas of research focus for insomnia, journal characteristics, as well as trends in clinical management and treatment modalities. The resulting 5,841 publications presented an exponential growth trend over the past two decades, with mean annual growth rates at nearly 10% for each publication type. Analysis of major research focuses indicated that depression, hypnotics and sedatives, questionnaires, and polysomnography are the most common topics at present. Furthermore, we found that while studies on drug therapy and adverse effects decreased in the most recent 5 years, the greatest expansion of insomnia publications were in the areas of cognitive behavioral therapy for insomnia and alternative therapies. Collectively, insomnia publications present a continuous trend of increase. While sedative and hypnotic drugs dominated the treatment of insomnia, non-pharmacological therapies may have great potential for advancement in future years. Future research effort is warranted for novel tools and clinical trials, especially on insomnia treatments with inadequate evidence or not-yet-clear efficacy and side effects.

Comparison of Two Watch Schedules for Personnel at the White House Military Office President’s Emergency Operations Center

March 30, 2015 Comments off

Comparison of Two Watch Schedules for Personnel at the White House Military Office President’s Emergency Operations Center
Source: Human Factors

Objective
The aim of this study was to assess effectiveness of an alternative, 24-hr-on/72-hr-off watchstanding schedule on sleep and morale of personnel assigned to the President’s Emergency Operations Center (PEOC).

Background
As part of the White House Military Office, PEOC personnel historically worked a 12-hr “Panama” watch schedule. Personnel reported experiencing chronic insufficient and disrupted sleep patterns and sought advice for improving their watchstanding schedule.

Method
Participants (N = 14 active-duty military members, ages 29 to 42 years) completed the Profile of Mood State (POMS) three times: before, during, and after switching to the alternative schedule with 5-hr sleep periods built into their workday. Participants completed a poststudy questionnaire to assess individual schedule preferences. Sleep was measured actigraphically, supplemented by activity logs.

Results
As indicated by POMS scores, mood improved significantly on the new schedule. Although average total sleep amount did not change substantively, the timing of sleep was more consistent on the new schedule, resulting in better sleep hygiene. PEOC personnel overwhelmingly preferred the new schedule, reporting not only that they felt more rested but that the new schedule was more conducive to the demands of family life.

Conclusions
Demands of family life and time spent commuting were found to be critical factors for acceptance of the alternative schedule. This new schedule will be most effective if personnel adhere to the scheduled rest periods assigned during their 24-hr duty.

Application
A successful schedule should avoid conflicts between social life and operational demands. Results may lead to changes in the work schedules of other departments with similar 24/7 responsibilities.

National Sleep Foundation’s sleep time duration recommendations: methodology and results summary

February 4, 2015 Comments off

National Sleep Foundation’s sleep time duration recommendations: methodology and results summary
Source: Sleep Health

Objective
The objective was to conduct a scientifically rigorous update to the National Sleep Foundation’s sleep duration recommendations.

Methods
The National Sleep Foundation convened an 18-member multidisciplinary expert panel, representing 12 stakeholder organizations, to evaluate scientific literature concerning sleep duration recommendations. We determined expert recommendations for sufficient sleep durations across the lifespan using the RAND/UCLA Appropriateness Method.

Results
The panel agreed that, for healthy individuals with normal sleep, the appropriate sleep duration for newborns is between 14 and 17 hours, infants between 12 and 15 hours, toddlers between 11 and 14 hours, preschoolers between 10 and 13 hours, and school-aged children between 9 and 11 hours. For teenagers, 8 to 10 hours was considered appropriate, 7 to 9 hours for young adults and adults, and 7 to 8 hours of sleep for older adults.

Conclusions
Sufficient sleep duration requirements vary across the lifespan and from person to person. The recommendations reported here represent guidelines for healthy individuals and those not suffering from a sleep disorder. Sleep durations outside the recommended range may be appropriate, but deviating far from the normal range is rare. Individuals who habitually sleep outside the normal range may be exhibiting signs or symptoms of serious health problems or, if done volitionally, may be compromising their health and well-being.

Fatigued Nurses: Assessing the Risk, Implementing the Defenses

February 2, 2015 Comments off

Fatigued Nurses: Assessing the Risk, Implementing the Defenses (PDF)
Source: Circadian

Sleep deprivation and fatigue are an ever-present challenge for health care workers. Thus far, most of the attention has been paid to sleep-deprived resident physicians and their increased risks of diagnostic errors, 1 needlestick injuries2 and complications in post-surgical patients, 3 which culminated in the 2011 decision by the Accreditation Council for Graduate Medical Education to limit resident duty hours. 4 However, fatigue represents a similar high-risk occupational health and safety exposure for nurses.

Many factors are converging today to increase fatigue risks and costs in the nursing profession, and the need to address nurse fatigue has never been more urgent. The increasing cognitive skill demands of medical technology, the rapidly expanding patient loads resulting from the enactment of national health care, and the need to retain experienced nurses in the workforce make addressing fatigue, and sustaining nurse alertness and job performance around-the–clock, a vitally important issue.

Hat tip: IWS Documented News Service

Caffeine improves reaction time, vigilance and logical reasoning during extended periods with restricted opportunities for sleep

December 31, 2014 Comments off

Caffeine improves reaction time, vigilance and logical reasoning during extended periods with restricted opportunities for sleep
Source: Psychopharmacology

Rationale
Various occupational groups are required to maintain optimal physical and cognitive function during overnight periods of wakefulness, often with less than optimal sleep. Strategies are required to help mitigate the impairments in cognitive function to help sustain workplace safety and productivity.

Objectives
To test the effectiveness of repeated 200 mg doses of caffeine on cognitive function and live-fire marksmanship with soldiers during three successive nights of sustained wakefulness followed by 4-h afternoon sleep periods.

Methods
Twenty Special Forces personnel (28.6 ± 4.7 years, 177.6 ± 7.5 cm and 81.2 ± 8.0 kg) were randomly assigned to receive four 200-mg doses of caffeine (n = 10) or placebo (n = 10) during the late evening and early morning hours during three successive days. An afternoon 4-h sleep period followed. The psychomotor (PVT) and field (FVT) vigilance, logical reasoning (LRT) tests and a vigilance monitor assessed cognitive function throughout the study. Live-fire marksmanship requiring friend–foe discrimination was assessed.

Results
Caffeine maintained speed on the PVT (p < 0.02), improved detection of events during FVT (p < 0.001), increased number of correct responses to stimuli as assessed by the vigilance monitor (p < 0.001) and increased response speed during the LRT (p < 0.001) throughout the three overnight testing periods. Live-fire marksmanship was not altered by caffeine.

Conclusions
A total daily dose of 800 mg caffeine during successive overnight periods of wakefulness is an effective strategy to maintain cognitive function when optimal sleep periods during the day are not available.

Evening use of light-emitting eReaders negatively affects sleep, circadian timing, and next-morning alertness

December 24, 2014 Comments off

Evening use of light-emitting eReaders negatively affects sleep, circadian timing, and next-morning alertness
Source: Proceedings of the National Academy of Sciences

In the past 50 y, there has been a decline in average sleep duration and quality, with adverse consequences on general health. A representative survey of 1,508 American adults recently revealed that 90% of Americans used some type of electronics at least a few nights per week within 1 h before bedtime. Mounting evidence from countries around the world shows the negative impact of such technology use on sleep. This negative impact on sleep may be due to the short-wavelength–enriched light emitted by these electronic devices, given that artificial-light exposure has been shown experimentally to produce alerting effects, suppress melatonin, and phase-shift the biological clock. A few reports have shown that these devices suppress melatonin levels, but little is known about the effects on circadian phase or the following sleep episode, exposing a substantial gap in our knowledge of how this increasingly popular technology affects sleep. Here we compare the biological effects of reading an electronic book on a light-emitting device (LE-eBook) with reading a printed book in the hours before bedtime. Participants reading an LE-eBook took longer to fall asleep and had reduced evening sleepiness, reduced melatonin secretion, later timing of their circadian clock, and reduced next-morning alertness than when reading a printed book. These results demonstrate that evening exposure to an LE-eBook phase-delays the circadian clock, acutely suppresses melatonin, and has important implications for understanding the impact of such technologies on sleep, performance, health, and safety.

Association of Poor Subjective Sleep Quality With Risk for Death by Suicide During a 10-Year Period: A Longitudinal, Population-Based Study of Late Life

September 8, 2014 Comments off

Association of Poor Subjective Sleep Quality With Risk for Death by Suicide During a 10-Year Period: A Longitudinal, Population-Based Study of Late Life
Source: JAMA Psychiatry

Importance
Older adults have high rates of sleep disturbance, die by suicide at disproportionately higher rates compared with other age groups, and tend to visit their physician in the weeks preceding suicide death. To our knowledge, to date, no study has examined disturbed sleep as an independent risk factor for late-life suicide.

Objective
To examine the relative independent risk for suicide associated with poor subjective sleep quality in a population-based study of older adults during a 10-year observation period.

Design, Setting, and Participants
A longitudinal case-control cohort study of late-life suicide among a multisite, population-based community sample of older adults participating in the Established Populations for Epidemiologic Studies of the Elderly. Of 14 456 community older adults sampled, 400 control subjects were matched (on age, sex, and study site) to 20 suicide decedents.

Main Outcomes and Measures
Primary measures included the Sleep Quality Index, the Center for Epidemiologic Studies–Depression Scale, and vital statistics.

Results
Hierarchical logistic regressions revealed that poor sleep quality at baseline was significantly associated with increased risk for suicide (odds ratio [OR], 1.39; 95% CI, 1.14-1.69; P < .001) by 10 follow-up years. In addition, 2 sleep items were individually associated with elevated risk for suicide at 10-year follow-up: difficulty falling asleep (OR, 2.24; 95% CI, 1.27-3.93; P < .01) and nonrestorative sleep (OR, 2.17; 95% CI, 1.28-3.67; P < .01). Controlling for depressive symptoms, baseline self-reported sleep quality was associated with increased risk for death by suicide (OR, 1.30; 95% CI, 1.04-1.63; P < .05)

Conclusions and Relevance
Our results indicate that poor subjective sleep quality is associated with increased risk for death by suicide 10 years later, even after adjustment for depressive symptoms. Disturbed sleep appears to confer considerable risk, independent of depressed mood, for the most severe suicidal behaviors and may warrant inclusion in suicide risk assessment frameworks to enhance detection of risk and intervention opportunity in late life.

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