Chronic Insomnia Disorder (ID) is characterized by hyperarousal, a key pathophysiological feature. While Cognitive-Behavioral Therapy for Insomnia (CBT-I) is the first-line treatment, its physiological effects on sleep-related hyperarousal remain underexplored. This study assessed the impact of CBT-I on cortical hyperarousal using quantitative EEG (qEEG) during non-REM (NREM) sleep, with the delta/beta ratio as the primary outcome. Secondary aims included evaluating changes in sleep stability and exploring phenotypic differences in treatment response. Ninety-eight ID patients across five centers completed a 6-8-week CBT-I program. Pre-and post-treatment assessments included polysomnography (PSG), sleep diaries, and Insomnia Severity Index (ISI). Cortical hyperarousal was indexed by the NREM delta/beta ratio; sleep stability (Sstab) was derived from a transition probability matrix. Patients were categorized as insomnia with short (ISSD) or normal sleep duration (INSD) based on PSG-derived total sleep time (median TST = 347.3 min). CBT-I significantly improved ISI and sleep parameters (sleep onset latency, wake after sleep onset, time in bed, sleep efficiency) in both self-reported and PSG, with smaller effects in the latter. qEEG analyses revealed a significant increase in the delta/beta ratio post-CBT-I (baseline:13.4 ± 4.9, end-of-treatment:14.6 ± 5.9; p = 0.002), indicating reduced cortical hyperarousal, with no center effects. Sstab improved significantly (p = 0.005), though it was not correlated with delta/beta changes. ISSD showed greater delta/beta improvements than INSD (p = 0.014), suggesting phenotypic differences. CBT-I reduces cortical hyperarousal in ID, as reflected by increased delta/beta ratio. The dissociation from sleep stability suggests distinct mechanisms. These findings support qEEG biomarkers as valuable tools for understanding the neurophysiological mechanisms of insomnia treatment and guiding precision medicine approaches.

Le trouble de sommeil lié au travail posté touche environ un quart des travailleuses et travailleurs en horaires atypiques et se manifeste par de l’insomnie et une somnolence excessive lorsque le travail chevauche la période normale de sommeil. Il résulte principalement d’une désynchronisation des processus de régulation du sommeil, affectant la santé physique et mentale, la vigilance, la productivité et la sécurité au travail. Plusieurs interventions cognitives et comportementales ont été développées pour traiter ce trouble, notamment la thérapie cognitivo-comportementale de l’insomnie (TCC-I), la planification de périodes de sommeil et de repas, ainsi que la mise en place de siestes. Les études disponibles suggèrent que la TCC-I adaptée peut réduire la sévérité des symptômes d’insomnie et améliorer la qualité du sommeil, mais son efficacité reste à confirmer, en raison de la variabilité des horaires de travail et des échantillons limités. Certaines adaptations récentes à la TCC-I, comme la distinction des périodes de sommeil diurne et nocturne, montrent des effets positifs sur le sommeil et la somnolence, et peuvent même accroître l’activité physique. La combinaison des approches comportementales et cognitives, ainsi que l’harmonisation des mesures et des variables étudiées, pourraient permettre de développer des interventions optimales pour cette population. L’amélioration du sommeil des travailleuses et travailleurs postés pourrait réduire les impacts individuels, organisationnels et sociaux associés au trouble de sommeil lié à la pratique de travail posté, tout en soutenant leur santé, bien-être et sécurité au travail.

The 24/7 accessibility to online poker (OP) and online first-person shooter (FPS) games increases the risk of developing problematic behaviors. Previous studies have shown mixed results regarding the impact of OP and FPS severity on sleep problems, and more specifically on insomnia symptoms. However, the intense emotions and arousal experienced during these games, such as tilt and pre-sleep arousal, have not been thoroughly investigated yet. The objectives were to test whether (1) tilt’s severity mediates the relationship between problem gambling and insomnia symptoms in OP players; (2) tilt’s severity mediates the relationship between internet gaming disorder (IGD) and insomnia symptoms in FPS players; (3) pre-sleep arousal’s severity mediates the relationship between tilt and insomnia symptoms in OP players and (4) in FPS players. Participants were included in the study if they were aged 18–26, lived in the province of Quebec and were regular players. Self-reported data on insomnia-related symptoms, tilt, and playing severity of 62 OP (93.5

BACKGROUND:While prior research has shown that early life events can impact sleep during adulthood. However, the specific aspects of sleep affected in those who experienced abuse as a child and potential environmental factors that may help ameliorate these difficulties is less understood. OBJECTIVES:The present cross-sectional study examined the relationship between abuse as a child and several key dimensions of poor sleep (sleep quality, insomnia symptoms and typical sleep duration). Additionally, perceived bedroom safety was examined as a potential moderator. PARTICIPANTS AND METHODS:A sample of 1,002 individuals completed measures of current sleep problems and perceived levels of safety in the bedroom. Additionally, participants indicated whether they had been exposed to physical or sexual abuse as a child. 204 participants reported being abused during childhood, defined as sexual or physical abuse. RESULTS:A series of linear regressions demonstrated - a) associations between a history of abuse as a child and adult poorer sleep quality, increased insomnia symptomology, and shorter sleep durations and b) these associations, in the main, were moderated by current perceived bedroom safety. Of those who had experienced abuse as a child, perceiving the bedroom as a safe environment was associated with a 52% reduction in perceived poor sleep quality, 19% reduction in insomnia symptoms and 37% increase in sleep duration compared to those who currently slept in an environment they perceived to be unsafe. CONCLUSIONS:While childhood abuse is associated with worse sleep health, these self-reported results indicate that the adult perception of safe bedroom mitigates that association.

The study investigated differences in objective markers of sleep depth and identified phenotypes of insomnia. Participants were screened with the Insomnia-Severity-Index and clinical interviews and assigned to control (n = 50) or insomnia (n = 69) groups. They completed three nights of in-laboratory overnight polysomnography. We measured the Odds Ratio Product (ORP), a continuous measure of sleep depth (0 = deep sleep, 2.5 = full wakefulness) and calculated: (a) ORP in stages Wake, NREM, REM, (b) percentage of TRT in deep sleep (ORP < 0.5) and full-wakefulness (ORP > 2.25), (c) number/hour of sleep of transient increases in ORP to wake levels (Wake Intrusion Index [WII]), (d) gamma power, (e) frequency of alpha intrusions, (f) speed of return to deep sleep after arousals (ORP-9). We used Latent Class Analysis to differentiate two insomnia groups with 'Objectively Normal' and 'Objectively Poor' metrics. The Objectively Poor group had higher ORPwake, ORPNREM, ORPREM, %TRT > 2.25, gamma power, alpha intrusion, WII and ORP-9 than good sleeper (GSC) and the Objectively Normal group, illustrating evidence of hyperarousal, while the Objectively Normal group was comparable to GSC. The Objectively Poor group had higher %awake and lower TST. Both insomnia groups reported worse sleep and underestimated TST relative to GSC, despite similar objective sleep metrics in the Objectively Normal group. Using novel objective sleep metrics, we identified a subgroup of insomnia with abnormalities consistent with hyperarousal and another with no difference from GSC. Future research should test if these groups benefit from different treatment pathways and thus improve outcomes and time to determine appropriate treatments.

Journal Article Accepted manuscript Insomnia gone in one week, without medication: too good to be true? Get access Célyne H Bastien, Célyne H Bastien Université Laval, Québec, Québec, Canada Corresponding author: Célyne H. Bastien, Ph.D., École de psychologie, Pavillon Félix-Antoine-Savard, 2325, rue des Bibliothèques, local 1012, Université Laval, Québec (Québec) G1V 0A6, 418 656-2131, poste 408344, Télécopieur : 418 656-3646, Celyne.bastien@psy.ulaval.ca Search for other works by this author on: Oxford Academic Google Scholar Ellemarije Altena Ellemarije Altena Université de Bordeaux, Bordeaux, Aquitaine, France Corresponding author: Ellemarije Altena, Ph.D., Institut de Neurosciences Cognitives et Intégratives d'Aquitaine, CNRS UMR 5287, Université de Bordeaux, Bat Bordeaux Biologie Santé, 2 Rue Dr. Hoffman Martinot, 33000 Bordeaux, France, +33(0)5 57 57 95 43, Ellemarije.Altena@u-bordeaux.fr Search for other works by this author on: Oxford Academic Google Scholar Sleep, zsae092, https://doi.org/10.1093/sleep/zsae092 Published: 10 April 2024 Article history Received: 22 March 2024 Published: 10 April 2024

Abstract Introduction Odds-Ratio-Product (ORP) is an objective, continuous index of sleep depth and wake propensity ranging from 0 (very deep sleep) to 2.5 (full wakefulness) and measured in consecutive 3-second epochs. We investigated differences in ORP metrics in 69 insomnia patients with objectively short and normal sleep duration, and 50 controls. Methods Participants were recruited from the community and were screened with the Insomnia Severity Index and clinical interviews and assigned to either control or insomnia groups. Participants completed three nights of in-laboratory overnight polysomnography and the Odds Ratio Product (ORP) was computed from central EEG signals. Using average total sleep time (TST) of nights 2 and 3, patients with insomnia were divided into those with short sleep duration (< 6 hours; ISSD; n=20) or normal sleep duration (INSD, n=49). Percent of TRT spent in different ORP deciles was calculated along with average ORP over wake time (ORPWAKE, higher values reflect greater alertness), and NREM sleep (ORPNREM, higher values reflect lighter sleep). We also measured the frequency of wake intrusions (transient increases (>2.0) in ORP per hour of NREM sleep). Results Patients with ISSD had higher ORPwake than controls (p=.017) when controlling for age, spent more time in full wakefulness (decile 10, ORP>2.25) than the other groups (p<.001), less time in deep sleep (ORP< 0.5) than INSD (p=.018), and had a higher wake intrusion index than patients with INSD (p=.015). Absolute misperception of sleep onset latency was associated with ORPNREM (p=.003), ORPTRT (p=.008), and wake intrusions (p=.012) in ISSD, and ORPTRT (p=.009) and wake intrusions (p=.025) in controls, such that a greater degree of misperception was associated with elevated ORP and greater disruption to sleep. Conclusion Patients with insomnia and short sleep duration had evidence of physiological hyperarousal in EEG measured by ORP compared to controls and patients with insomnia and normal sleep duration. Sleep fragmentation, measured with ORP, was also associated with misperception of sleep onset latency in patients with short sleep duration and controls. These results can assist with the characterization of insomnia phenotypes. Differences in physiological hyperarousal within phenotypes of insomnia could suggest more targeted treatment pathways. Support (if any)

SummaryThe present study evaluates the efficacy of behavioural therapy adapted for shift work disorder with a randomised control design in a healthcare population. Forty‐three night shift workers (m. age: 34 years; 77% women) experiencing shift work disorder were randomised to either the behavioural therapy for shift work disorder (BT‐SWD) or a waiting‐list control group offered after the waiting period. Participants completed questionnaires on insomnia, sleepiness and mental health pre‐ and post‐treatment, pre‐ and post‐waiting, and at follow‐up, and a sleep diary. As night shift workers alternate between sleeping during the day after their night shifts and transitioning to nighttime sleep on days off, insomnia severity and sleep variables were analysed for daytime and nighttime sleep. The BT‐SWD involved sleep restriction therapy, stimulus control and fixed sleep periods in the dark. Statistical analyses were performed under intent‐to‐treat and per‐protocol approaches. Repeated‐measures two‐way ANCOVA analysis, controlling for age, sex and pre‐treatment daytime total sleep time, was performed with Bonferroni corrections, and between‐group effect sizes computed. Fourteen participants dropped out after randomisation. Under the intent‐to‐treat analysis, BT‐SWD participants had a significant greater decrease in daytime insomnia severity and an increase in daytime total sleep time at post‐treatment than the control group, with large between‐group effect sizes (−1.25 and 0.89). These corresponding results were also significant with large effect sizes under the per‐protocol analysis. Sleepiness, anxiety and depression levels improved at post‐treatment and maintained at follow‐up when the BT‐SWD treated controls were added to the BT‐SWD group. The behavioural therapy for shift work disorder can be used to improve the sleep and mental health of healthcare night workers.

Insomnia and nightmares are both prevalent and debilitating sleep difficulties. The present systematic review aims to document the relationships between insomnia and nightmares in individuals without a concomitant psychopathology. The relationships between insomnia and dreams are also addressed. PsycINFO and Medline were searched for papers published in English or French from 1970 to March 2023. Sixty-seven articles were included for review. Most results support positive relationships between insomnia variables and nightmare variables in individuals with insomnia, individuals with nightmares, the general population, students, children and older adults, and military personnel and veterans. These positive relationships were also apparent in the context of the COVID-19 pandemic. Some psychological interventions, such as Imagery Rehearsal Therapy, might be effective in alleviating both nightmares and insomnia symptoms. Regarding the relationships between insomnia and dreams, compared with controls, the dreams of individuals with insomnia are characterized by more negative contents and affects. The results show that insomnia and nightmares are connected and may be mutually aggravating. A model is proposed to explain how insomnia might increase the likelihood of experiencing nightmares, and how nightmares can in turn lead to sleep loss and nonrestorative sleep.

Investigating the mechanisms of action of cognitive-behavioural therapy for insomnia (CBT-I), the first-line treatment for chronic insomnia disorder (ID), can contribute to the overall understanding of insomnia and its treatment. To date, no study has examined the relationship between K-complexes (KC) and CBT-I, despite the known homeostatic and protective function of this relevant sleep brainwave. This retrospective multicentre study aims to explore the relationship between electroencephalographic (EEG) indices and CBT-I, with a particular focus on evaluating an index of sleep homeostasis identified by KC. This research is designed to assess the predictive value of this index for treatment outcomes and to examine its variations before and after intervention. Ninety eight patients with ID underwent a 6-8 week in-person CBT-I programme, with pre-and post-treatment evaluation conducted using polysomnography (PSG) and the Insomnia Severity Index (ISI). The main outcome was determined by calculating the slope of the linear equation indexing the KC density (number of KC/minutes of N2) in each non-artifacted NREM stage 2 epoch throughout the night (KCSlope). Furthermore, the sample was categorised into Responders (ISIdecrease ≥8) and non-Responders (ISIdecrease <8). The results indicate that the KC Slope is effective not only to predict treatment response (one-way ANOVA, F = 7.831 p = 0.007; Responders = -2.954*10-5 ± 3.346*10-5, non-Responders = -5.583*10-5 ± 5.305*10-5; adjusted for PSG wake after sleep onset at the baseline), but also to detect a statistically significant improvement in sleep pressure following CBT-I (Wilcoxon signed-rank test W = 3074.000 p = 0.022; KCSlope pre-treatment = -4.054*10-5 ± 4.446*10-5, KCSlope post-treatment = -4.797*10-5 ± 5.710*10-5). These findings suggest that CBT-I increases sleep pressure in patients with chronic insomnia, highlighting a novel and relevant biomarker in this context.

Study Objectives Apolipoprotein E ɛ4 (APOE4) is the strongest genetic risk factor for Alzheimer’s disease (AD). In addition, APOE4 carriers may exhibit sleep disturbances, but conflicting results have been reported, such that there is no clear consensus regarding which aspects of sleep are impacted. Our objective was to compare objective sleep architecture between APOE4 carriers and non-carriers, and to investigate the modulating impact of age, sex, cognitive status, and obstructive sleep apnea (OSA). Methods A total of 198 dementia-free participants aged >55 years old (mean age: 68.7 ± 8.08 years old, 40.91% women, 41 APOE4 carriers) were recruited in this cross-sectional study. They underwent polysomnography, APOE4 genotyping, and a neuropsychological evaluation. ANCOVAs assessed the effect of APOE4 status on sleep architecture, controlling for age, sex, cognitive status, and the apnea–hypopnea index. Interaction terms were added between APOE4 status and covariates. Results Rapid eye movement (REM) sleep percentage (F = 9.95, p = .002, ηp2 = 0.049) and duration (F = 9.23, p = .003, ηp2 = 0.047) were lower in APOE4 carriers. The results were replicated in a subsample of 112 participants without moderate-to-severe OSA. There were no significant interactions between APOE4 status and age, sex, cognitive status, and OSA in the whole sample. Conclusions Our results show that APOE4 carriers exhibit lower REM sleep duration, including in cognitively unimpaired individuals, possibly resulting from early neurodegenerative processes in regions involved in REM sleep generation and maintenance.

The present study aims at identifying sleep patterns in insomnia in a clinical sample using three strategies to define poor nights. Sleep diaries and self-reported questionnaires were collected from 77 clinical patients with insomnia. The conditional probabilities of observing a poor night after 1, 2, or 3 consecutive poor nights were computed according to three strategies with same criteria for sleep onset latency, wake after sleep onset, and sleep efficiency, but varying criterion for total sleep time. Latent profile analyses were conducted to derive sleep patterns. Uni- and multivariate analyses were conducted to characterise the sleep patterns identified. A total of 1586 nights were analysed. The strategy used significantly influenced the average percentage of reported poor nights. Two to three sleep patterns were derived per strategy. Within each strategy, sleep patterns differed from each other on sleep variables and night-to-night variability. Results suggest the existence of sleep patterns in insomnia among individuals consulting in psychological clinics. Adding a total sleep time of 6-h cut-off as a criterion to define poor nights increases the accuracy of the strategy to define poor night and allows to identify sleep patterns of poor nights in insomnia.

Abstract Introduction Studies on first-night effect using conventional sleep metrics have been inconclusive. ORP is an objective index of sleep depth and wake propensity ranging from 0 (very deep sleep) to 2.5 (full wakefulness). ORP provides more in-depth information about sleep. We compared several ORP-derived metrics measured during three consecutive PSGs in patients with and without insomnia. Methods Participants (n=119) were screened with the Insomnia Severity Index and clinical interviews and assigned to either control (n=50) or insomnia (n=69) groups. Participants completed 3 nights of in-laboratory polysomnography. After each PSG, participants answered the question “How was your night in the lab compared to a night at home?” on a 1 (much better) to 5 (very mediocre) scale. The following variables were compared across the three nights with repeated-measures ANOVA. Questionnaire response (Q); average ORP during stages wake (ORPW), NREM (ORPNR) and REM (ORPREM) sleep; percent of recording time in deep sleep (ORP< 0.5) and in full wakefulness (ORP>2.25); average instantaneous difference between right and left ORP (R/L ORP difference), a measure of interhemispheric dissociation in sleep depth; frequency (hr-1) of transient increases (>2.0) in ORP during NREM sleep (WII); along with total sleep time (TST), % time awake (%wake), minutes in stages NREM3 (N3 time) and REM sleep (REM time); arousal index (AI). Results There were no differences between nights 2 and 3 in any variable. Q decreased beyond night-1, indicating improvement relative to home. The following significant changes were observed in night-2 in both insomnia and control groups (Tukey’s test): ORPNR and ORPREM decreased (deeper sleep); more time in deep sleep (ORP< 0.5) and less time in full-wakefulness (ORP>2.25); less WII. The following significant changes were observed in night-2 only in participants with insomnia: Lower ORPW, indicating less alertness during stage W, and less R/L ORP differences. TST marginally increased and N3 time and AI marginally decreased in insomnia while %wake decreased marginally in both groups. Conclusion This study demonstrated clear first-night effects in several EEG microstructure variables in both control and insomnia participants, while the latter also showed reduced alertness and improved R/L agreement in sleep depth beyond night-1. Support (if any)