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Does online insomnia treatment reduce depressive symptoms? A randomized controlled trial in individuals with both insomnia and depressive symptoms
Insomnia is effectively treated with online Cognitive Behavioral Therapy for Insomnia (CBT-I). Previous research has suggested the effects might not be limited to sleep and insomnia severity, but also apply to depressive symptoms. Results, however, are mixed.
In this randomized controlled trial we investigated the effects of guided online CBT-I on depression and insomnia in people suffering from symptoms of both. Participants (n = 104) with clinical insomnia and at least subclinical depression levels were randomized to (1) guided online CBT-I and sleep diary monitoring (i-Sleep) or (2) control group (sleep diary monitoring only). The primary outcome was the severity of depressive symptoms (Patient Health Questionnaire-9 without sleep item; PHQ-WS). Secondary outcomes were insomnia severity, sleep diary parameters, fatigue, daytime consequences of insomnia, anxiety, and perseverative thinking.
At post-test, participants in the i-Sleep condition reported significantly less depressive symptoms (PHQ-WS) compared with participants in the sleep-diary condition (d = 0.76). Large significant effects were also observed for insomnia severity (d = 2.36), most sleep diary parameters, daytime consequences of insomnia, anxiety, and perseverative thinking. Effects were maintained at 3 and 6 month follow-up. We did not find significant post-test effects on fatigue or total sleep time.
Findings indicate that guided online CBT-I is not only effective for insomnia complaints but also for depressive symptoms. The effects are large and comparable with those of depression therapy.
NTR6049 (Netherlands Trial Register).
Journal Article
How to tune and modify automotive engine management systems
\"Understanding fuel injection and engine management systems is the key to extracting higher performance from today's automobiles in a safe, reliable, and driveable fashion. Turbochargers, superchargers, nitrous oxide, high compression ratios, radical camshafts: all are known to make horsepower, but without proper understanding and control of fuel injection and other electronic engine management systems, these popular power-adders will never live up to their potential and, at worst, can cause expensive engine damage. Drawing on a wealth of knowledge and experience and a background of more than 1,000 magazine articles on the subject, engine-control expert Jeff Hartman explains everything from the basics of fuel injection to the building of complex project cars. Hartman covers the latest developments in fuel-injection and engine management technology applied by both foreign and domestic manufacturers, including popular aftermarket systems. No other book in the market covers the subject of engine management systems from as many angles and as comprehensively as this book. Through his continuous magazine writing, author Jeff Hartman is always up-to-date with the newest fuel-injection and engine management products and systems. \"-- Provided by publisher.
Book
Preventing postpartum insomnia: findings from a three-arm randomized-controlled trial of cognitive behavioral therapy for insomnia, a responsive bassinet, and sleep hygiene
Abstract
Study Objectives
Insomnia symptoms are common during the perinatal period and are linked to adverse outcomes. This single-blind three-arm randomized-controlled trial examined whether two interventions targeting different mechanisms prevent postpartum insomnia.
Methods
Participants were nulliparous females 26–32 weeks gestation with Insomnia Severity Index (ISI) scores ≥ 8, recruited in Australia and randomized 1:1:1 to: (1) a responsive bassinet (RB) designed to support infant sleep and reduce maternal sleep disruption until 6 months postpartum, (2) therapist-assisted cognitive behavioral therapy for insomnia (CBT-I) delivered during pregnancy and postpartum, or (3) a sleep hygiene booklet (control; CTRL). Outcomes were assessed at baseline (T1), 35–36 weeks gestation (T2), and 2, 6, and 12 months postpartum (T3–T5). The primary outcome was ISI scores averaged T3–T5. Primary analyses were regressions controlling for baseline outcomes.
Results
One hundred and twenty-seven participants (age M ± SD = 32.62 ± 3.49) were randomized (RB = 44, CBT-I = 42, CTRL = 41). Both interventions were feasible and well-accepted, with few related adverse events reported. Compared to CTRL, the average ISI across T3–T5 was lower for CBT-I (p = .014, effect size [ES] = 0.56, medium) but not RB (p = .270, ES = 0.25, small). Exploratory findings on maternal insomnia diagnosis, sleep disturbance, sleep-related impairment, beliefs and attitudes about sleep, depression, anxiety, as well as infant sleep outcomes were also presented.
Conclusions
CBT-I but not RB reduced prenatal insomnia (very large effect) and prevented postpartum insomnia (medium effect). Further research is needed to examine the effects of both CBT-I and RB on other outcomes such as sleep-related well-being, postpartum depression, and maternal postpartum sleep duration.
Clinical Trial Registration
The Study for Mother-Infant Sleep (The SMILE Project): reducing postpartum insomnia using an infant sleep intervention and a maternal sleep intervention in first-time mothers. https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=377927, Australian New Zealand Clinical Trials Registry: ACTRN12619001166167.
Graphical Abstract
Graphical Abstract
Journal Article
Amelioration of Acute Sequelae of Blast Induced Mild Traumatic Brain Injury by N-Acetyl Cysteine: A Double-Blind, Placebo Controlled Study
Mild traumatic brain injury (mTBI) secondary to blast exposure is the most common battlefield injury in Southwest Asia. There has been little prospective work in the combat setting to test the efficacy of new countermeasures. The goal of this study was to compare the efficacy of N-acetyl cysteine (NAC) versus placebo on the symptoms associated with blast exposure mTBI in a combat setting.
This study was a randomized double blind, placebo-controlled study that was conducted on active duty service members at a forward deployed field hospital in Iraq. All symptomatic U.S. service members who were exposed to significant ordnance blast and who met the criteria for mTBI were offered participation in the study and 81 individuals agreed to participate. Individuals underwent a baseline evaluation and then were randomly assigned to receive either N-acetyl cysteine (NAC) or placebo for seven days. Each subject was re-evaluated at 3 and 7 days. Outcome measures were the presence of the following sequelae of mTBI: dizziness, hearing loss, headache, memory loss, sleep disturbances, and neurocognitive dysfunction. The resolution of these symptoms seven days after the blast exposure was the main outcome measure in this study. Logistic regression on the outcome of 'no day 7 symptoms' indicated that NAC treatment was significantly better than placebo (OR = 3.6, p = 0.006). Secondary analysis revealed subjects receiving NAC within 24 hours of blast had an 86% chance of symptom resolution with no reported side effects versus 42% for those seen early who received placebo.
This study, conducted in an active theatre of war, demonstrates that NAC, a safe pharmaceutical countermeasure, has beneficial effects on the severity and resolution of sequelae of blast induced mTBI. This is the first demonstration of an effective short term countermeasure for mTBI. Further work on long term outcomes and the potential use of NAC in civilian mTBI is warranted.
ClinicalTrials.gov NCT00822263.
Journal Article
A randomized controlled trial on the effects of blue-blocking glasses compared to partial blue-blockers on sleep outcomes in the third trimester of pregnancy
Sleep disturbances are common in pregnancy. Blocking blue light has been shown to improve sleep and may be a suitable intervention for sleep problems during pregnancy. The present study investigated the effects of blue light blocking in the evening and during nocturnal awakenings among pregnant women on primary sleep outcomes in terms of total sleep time, sleep efficiency and mid-point of sleep.
In a double-blind randomized controlled trial, 60 healthy nulliparous pregnant women in the beginning of the third trimester were included. They were randomized, using a random number generator, either to a blue-blocking glass intervention (n = 30) or to a control glass condition constituting partial blue-blocking effect (n = 30). Baseline data were recorded for one week and outcomes were recorded in the last of two intervention/control weeks. Sleep was measured by actigraphy, sleep diaries, the Bergen Insomnia Scale, the Karolinska Sleepiness Scale and the Pre-Sleep Arousal Scale.
The results on the primary outcomes showed no significant mean difference between the groups at posttreatment, neither when assessed with sleep diary; total sleep time (difference = .78[min], 95%CI = -19.7, 21.3), midpoint of sleep (difference = -8.9[min], 95%CI = -23.7, 5.9), sleep efficiency (difference = -.06[%], 95%CI = -1.9, 1.8) and daytime functioning (difference = -.05[score points], 95%CI = -.33, .22), nor by actigraphy; total sleep time (difference = 13.0[min], 95%CI = -9.5, 35.5), midpoint of sleep (difference = 2.1[min], 95%CI = -11.6, 15.8) and sleep efficiency (difference = 1.7[%], 95%CI = -.4, 3.7). On the secondary outcomes, the Bergen Insomnia Scale, the Karolinska Sleepiness Scale and the Pre-Sleep Arousal Scale the blue-blocking glasses no statistically significant difference between the groups were found. Transient side-effects were reported in both groups (n = 3).
The use of blue-blocking glasses compared to partially blue-blocking glasses in a group of healthy pregnant participants did not show statistically significant effects on sleep outcomes. Research on the effects of blue-blocking glasses for pregnant women with sleep-problems or circadian disturbances is warranted.
The trial is registered at ClinicalTrials.gov (NCT03114072).
Journal Article
Optimal maintenance control of machine tools for energy efficient manufacturing
Performance of machine tool tends to deteriorate in the production process. This deterioration increases the processing energy consumption and leads to more defectives and corresponding energy waste. Maintenance can be taken to restore the performance of machine tool and improve the energy efficiency, which has a significant impact on the total energy consumption and productivity. This paper proposes an approach to improve the energy efficiency of the production process through scheduling the maintenance actions of the machine tool, taking into account productivity, product quality, and energy consumption. The deteriorating machine tool is modeled as a discrete-time, discrete-state Markov process. Partially observable Markov decision process (POMDP) framework is applied to develop the maintenance decision-making model, where the joint observation of processing energy consumption and quality of manufactured workpiece is used to infer the status of the machine tool. An optimal maintenance policy maximizing the total expected reward about energy efficiency over a finite horizon is obtained, which consists of a sequence of decision rules corresponding to the optimal action for each belief vector. The characteristics of the optimal policy are illustrated through a numerical example and the effects of parameters on the policy are analyzed.
Journal Article
Effect of Six-Month Diet Intervention on Sleep among Overweight and Obese Men with Chronic Insomnia Symptoms: A Randomized Controlled Trial
Growing evidence suggests that diet alteration affects sleep, but this has not yet been studied in adults with insomnia symptoms. We aimed to determine the effect of a six-month diet intervention on sleep among overweight and obese (Body mass index, BMI ≥ 25 kg/m2) men with chronic insomnia symptoms. Forty-nine men aged 30–65 years with chronic insomnia symptoms were randomized into diet (n = 28) or control (n = 21) groups. The diet group underwent a six-month individualized diet intervention with three face-to-face counseling sessions and online supervision 1–3 times per week; 300–500 kcal/day less energy intake and optimized nutrient composition were recommended. Controls were instructed to maintain their habitual lifestyle. Sleep parameters were determined by piezoelectric bed sensors, a sleep diary, and a Basic Nordic sleep questionnaire. Compared to the controls, the diet group had shorter objective sleep onset latency after intervention. Within the diet group, prolonged objective total sleep time, improved objective sleep efficiency, lower depression score, less subjective nocturnal awakenings, and nocturia were found after intervention. In conclusion, modest energy restriction and optimized nutrient composition shorten sleep onset latency in overweight and obese men with insomnia symptoms.
Journal Article
Development of IoT-enabled solutions for renewable energy generation and net-metering control for efficient smart home
Integrating renewable sources with conventional power grids is not just a necessity but a crucial step toward implementing sustainable energy solutions. However, the effective management and control of such systems, which are highly integrated during maintenance and fault, has been a persistent challenge. This paper presents a ground-breaking development—an Internet of Things (IoT)-enabled system designed to revolutionize the control and monitoring of renewable energy generation and net metering operations. The proposed system caters to three prime objectives: to develop a method for enabling utility companies to control power supply related to renewable energy generation in the case of maintenance or faults using IoT, to allow owners of renewable energy generation to track and control net-metering operations, and to develop an Android application for global monitoring and controlling of net metering parameters. It uses advanced IoT devices for real-time data acquisition, processing, and communication with renewable energy sources. The Android application provides users with an effective remote monitoring and control interface. Experiments show that the system can significantly improve operational efficiency and reliability with effective energy management. This IoT-enabled solution is scalable and cost-effective, enhancing the integration and management of distributed renewable energy sources in the power grid.
Journal Article
Managing for biodiversity: impact and action thresholds for invasive plants in natural ecosystems
Some studies examining the impacts of invasive plant species in native plant communities have demonstrated non-linear damage functions, whereby community components, such as species richness, are seemingly unaffected by the presence of an invader until it has attained relatively high levels of abundance, whereupon there is a marked decrease with further increases in abundance. Given chronic limitations in the resources available for managing invasive species, it has been argued that the most damaging invaders would be controlled most efficiently by maintaining their abundances below such threshold levels. Because many impact studies do not involve sampling over a wide range of invader abundances it is not possible to estimate the prevalence of threshold relationships. Furthermore, studies that have employed appropriate sampling methods have shown that different life forms exhibit different threshold responses, indicating that maintenance management for biodiversity values should be designed to protect the most sensitive species or groups of species. Since control costs increase with invader abundance, economic and ecological considerations are aligned when invaders are sustainably maintained at relatively low abundances. Adopting such an approach should also minimise negative impacts where damage functions are linear.
Journal Article