Explore the vast range of titles available.

Adults are thought to show a sleep-stress spiral in which greater stress worsens sleep quality, which amplifies stress, which leads to worse sleep. This study examined whether adolescents show a similar spiral, and if so, whether coping self-efficacy—believing one can cope with stress—interrupts the spiral. Temporal dynamics of perceived stress, sleep quality, and coping self-efficacy were tracked in 381 9th graders (49% female, mean age 14.43, age range 14–16) using daily surveys across two school weeks (3184 observations). Though expected associations were evident between individuals, only a unidirectional path was found within individuals from sleep quality to perceived stress via coping self-efficacy. This challenges the conventional bidirectional understanding of sleep-stress relations and suggests coping self-efficacy as an intervention target.

For people with insomnia and often comorbid disorders such as depression, anxiety, and chronic pain, this book has methods from cognitive behavioral therapy for getting the sleep they need and improving their symptoms in the process.

Historically, insomnia has been viewed as a symptom of depressive illness that is expected to resolve with adequate treatment of the depressive disorder. This article reviews the evidence that increasingly challenges this simplistic view and summarizes research demonstrating the multifaceted interplay between insomnia and depression. It discusses the prevalence, clinical significance, and time course of insomnia, distinguishing between poor sleep and an insomnia disorder. The article also discusses abnormalities in sleep architecture in major depressive disorder and theories about the pathways connecting sleep and depression. It concludes with a discussion of issues related to treatment, including the effects of antidepressants on sleep and new evidence of the utility of adding an insomnia-specific therapy for improved management of depressed patients with comorbid insomnia.

سوف يساعدك هذا الكتاب في تهدئة عقلك مفرط النشاط عندما تحاول الخلود الى النوم ويقدم لك تمارين ونصائح يسيرة لمساعدتك على إنشاء النظام والبيئة اللذين يعززان حصولك على قسط جيد من النوم ووضع طبقة عازلة بين ضغوطك اليومية ووسادتك وتمرين عقلك المزعج على الهدوء عندما تأوي إلى الفراش، والكتاب نتاج عالمتين من عالمات النفس وهو يهدف لتهدئة العقل المفرط والنشاط، ويتضمن تمارين ونصائح تساعد على وضع طبقة عازلة بين الضغوط اليومية ووسادة النوم وتمرين العقل المزعج على التزام الهدوء.

Study Objectives: This paper describes CBT-I Coach, a patient-facing smartphone app designed to enhance cognitive behavioral therapy for insomnia (CBT-I). It presents findings of two surveys of U.S. Department of Veterans Affairs (VA) CBT-I trained clinicians regarding their perceptions of CBT-I Coach before it was released (n = 138) and use of it two years after it was released (n = 176). Methods: VA-trained CBT-I clinicians completed web-based surveys before and two years after CBT-I Coach was publicly released. Results: Prior to CBT-I Coach release, clinicians reported that it was moderately to very likely that the app could improve care and a majority (87.0%) intended to use it if it were available. Intention to use the app was predicted by smartphone ownership (β = 0.116, p < 0.05) and perceptions of relative advantage to existing CBT-I practices (β = 0.286, p < 0.01), compatibility with their own needs and values (β = 0.307, p < 0.01), and expectations about the complexity of the app (β = 0.245, p < 0.05). Two years after CBT-I Coach became available, 59.9% of participants reported using it with patients and had favorable impressions of its impact on homework adherence and outcomes. Conclusions: Findings suggest that before release, CBT-I Coach was perceived to have potential to enhance CBT-I and address common adherence issues and clinicians would use it. These results are reinforced by findings two years after it was released suggesting robust uptake and favorable perceptions of its value. Citation: Kuhn E, Weiss BJ, Taylor KL, Hoffman JE, Ramsey KM, Manber R, Gehrman P, Crowley JJ, Ruzek JI, Trockel M. CBT-I Coach: a description and clinician perceptions of a mobile app for cognitive behavioral therapy for insomnia. J Clin Sleep Med 2016;12(4):597–606.

Background Eligibility criteria are a critical component of a well-designed clinical trial, enhancing trial safety and internal validity. Yet, data suggest that exclusion rates based on these criteria often vary by participant race/ethnicity. Method This study compared the proportion of participants ( n  = 4235) from seven racial/ethnic groups, who were included versus excluded from participation in a randomized controlled trial (RCT) testing two digital sleep interventions for the prevention of perinatal depression. Eight 2 × 7 chi-squared tests were conducted to compare the proportion of each racial/ethnic group excluded due to each eligibility criterion. Logistic regressions were fitted to estimate the magnitude of the relationship between racial/ethnic group and exclusion based on each eligibility criterion. Results The proportion of excluded participants differed by race/ethnicity across all eight eligibility criteria. For example, Black participants were more likely to be excluded due to comorbid conditions such as sleep apnea X 2  (6,  N  = 4151) = 20.94,  p  = .002, and Asian participants were more likely to be excluded for reporting subclinical insomnia symptoms X 2  (6,  N  = 4151) = 85.99,  p  < .001. Logistic regressions showed that compared to White participants, Black participants had significantly higher odds (odds ratios ranging from 1.70 to 6.86) of study exclusion for three of the eight eligibility criteria. Conclusions Eligibility criteria excluded prospective study participants at different rates dependent on their race/ethnicity. Differences in trial exclusion can contribute to the under-enrollment of minoritized pregnant people in RCTs for behavioral health. Quantifying and reporting eligibility disparities enables investigators to more precisely evaluate the trade-offs of specific inclusion criteria against the generalizability of findings to diverse populations.

Introduction As dropout from treatment potentially diminishes its therapeutic effect and poses clinical concern, it is important to find out which characteristics of participants are suitable for online-based treatment. Therefore, we aimed to identify factors that predicted a dropout in the e-mail based cognitive behavioral therapy (REFRESH) developed by Stanford University for the purpose of psychological intervention for insomnia. Methods Participants who participated in the REFRESH program consisted of 158 university and graduate students aged 18 to 30 in Hong Kong and Korea who scored higher than 10 on the Insomnia Severity Index (ISI), and the intervention was delivered in 8 weekly sessions sent via weekly e-mails. Among them, 110 were women (70%) and the average age was 22 (±2.71) years old. All participants were asked to answer the following self-reporting questionnaires before and after the intervention: Insomnia Severity Index; ISI, Depression Anxiety Stress Scale 21; DASS-21, Sleep Hygiene Practice Scale; SHPS, Dysfunctional Beliefs and Attitude about Sleep 16; DBAS-16. Descriptive statistics and ROC decision tree analysis were conducted to address our aim. Results Of the 158 participants, 68 completed the program, and 90 participants (57%) dropped out. The best predictor of dropout was DASS score with an optimal cup-point of <34. Of the 107 participants who reported DASS <30, 70(65.4%) dropped out. In contrast, of the 50 participants who reported DASS ≥34, 12(38%) dropped out. The second-level predictor was expectations for sleep score with a cut-point of <18. Among participants with DASS <34 and expectations for sleep score <18, 57(73.1%) dropped out. Of the 29 participants who reported DASS <34 and expectations for sleep score ≥18, 13(44.8%) dropped out. Conclusion Mild levels of depression, anxiety and stress and expectations for sleep appear to be predictive of dropout in an e-mail based intervention. People with mild symptoms may experience less distress and impairment, which may result in lower motivation to receive treatment. This may lead to inability to complete treatment and higher rates of dropout. Support (if any):

Background Insomnia symptoms during the perinatal period are prevalent and may contribute to negative mental health and birthing outcomes. Cognitive Behavioural Therapy for Insomnia (CBT-I) is a non-pharmacological therapy efficacious in the treatment of insomnia. Previous studies have shown the effectiveness of digital CBT-I during the perinatal period. However, to date, our understanding of whether this treatment can be effectively implemented in community perinatal care is limited. Methods In this two-arm hybrid effectiveness-implementation type 1 randomised controlled trial (RCT), eligible pregnant individuals with self-reported insomnia symptoms (Insomnia Severity Index > 7) will be randomised to either the CBT-I intervention (Healthy Sleep Program) or active control (sleep hygiene education). The primary outcome is maternal insomnia symptom severity at (i) one pregnancy endpoint and (ii) averaged across three times post birth for the postpartum endpoint. An economic evaluation will assess cost-effectiveness. Barriers and enablers to sustained implementation will be explored using the Theoretical Domains Framework and the Practical Robust Implementation and Sustainability Model. Discussion This study will offer an understanding of the effectiveness, cost-effectiveness, and sustained implementation potential of a digital sleep health program in perinatal care. These outcomes will provide empirical evidence to inform broader implementation of a scalable sleep program to improve insomnia symptoms in perinatal populations. Trial registration Australian New Zealand Clinical Trials Registry ACTRN12622000940774. Registered on 1 July 2022.

Background Obstructive sleep apnea (OSA) and insomnia are commonly co-occurring conditions that amplify morbidity and complicates the management of affected patients. Unfortunately, previous research provides limited guidance as to what constitutes the best and most practical management approach for this comorbid patient group. Some preliminary studies show that when cognitive behavioral insomnia therapy (CBT-I) is combined with standard OSA therapies for these patients, outcomes are improved. However, the dearth of trained providers capable of delivering CBT-I has long served as a pragmatic barrier to the widespread use of this therapy in clinical practice. The emergence of sophisticated online CBT-I (OCBT-I) programs could improve access, showing promising reductions in insomnia severity. Given its putative scalability and apparent efficacy, some have argued OCBT-I should represent a 1st-stage intervention in a broader stepped care model that allocates more intensive and less assessable therapist-delivered CBT-I (TCBT-I) only to those who show an inadequate response to lower intensity OCBT-I. However, the efficacy of OCBT-I as a 1st-stage therapy within a broader stepped care management strategy for insomnia comorbid with OSA has yet to be tested with comorbid OSA/insomnia patients. Methods/design This dual-site randomized clinical trial will use a Sequential Multiple Assignment Randomized Trial (SMART) design to test a stepped care model relative to standard positive airway pressure (PAP) therapy and determine if (1) augmentation of PAP therapy with OCBT-I improves short-term outcomes of comorbid OSA/insomnia and (2) providing a higher intensity 2nd-stage CBT-I to patients who show sub-optimal short-term outcomes with OCBT-I+PAP improves short and longer-term outcomes. After completing baseline assessment, the comorbid OSA/insomnia patients enrolled will be randomized to a 1st-stage therapy that includes usual care PAP + OCBT-I or UC (usual care PAP + sleep hygiene education). Insomnia will be reassessed after 8 weeks. OCBT-I recipients who meet “remission” criteria (defined as an Insomnia Severity Index score < 10) will continue PAP but will not be offered any additional insomnia intervention and will complete study outcome measures again after an additional 8 weeks and at 3 and 6 month follow-ups. OCBT-I recipients classified as “unremitted” after 8 weeks of treatment will be re-randomized to a 2nd-stage treatment consisting of continued, extended access to OCBT-I or a switch to TCBT-I. Those receiving the 2nd-stage intervention as well as the UC group will be reassessed after another 8 weeks and at 3- and 6-month follow-up time points. The primary outcome will be insomnia remission. Secondary outcomes will include subjective and objective sleep data, including sleep time, sleep efficiency, fatigue ratings, PAP adherence, sleepiness ratings, sleep/wake functioning ratings, and objective daytime alertness. Discussion This study will provide new information about optimal interventions for patients with comorbid OSA and insomnia to inform future clinical decision-making processes. Trial registration ClinicalTrials.gov, NCT03109210 , registered on April 12, 2017, prospectively registered.