The relationship between subjective happiness and sleep problems in Japanese adolescents

ObjectivesLow sleep quality in adolescents is an important public health concern, as it relates to both their current and future physical and mental health. Furthermore, subjective happiness is also often regarded as a major life goal. Although Japan is an economically powerful country, the reported levels of subjective happiness among Japanese adolescents is low. Thus, this study aims to examine the relationship between subjective happiness and sleep problems in Japanese adolescents.MethodsWe conducted a nationally representative cross-sectional study of adolescents enrolled in junior and senior high schools in Japan. We used a questionnaire to determine the prevalence of sleep problems (eg, insomnia, short sleep duration (SSD) and poor sleep quality) and to evaluate the participants' reported levels of subjective happiness. Multivariable logistic regression analyses were used to examine the associations between subjective happiness and sleep problems. Adjusted variables were basic demographic characteristics (eg, gender and school grade), lifestyle behaviors, and mental health status.ResultsData from 64,329 students were analyzed (age range 12–18 years, mean age 15.7 years, 53.9% male). The results indicated that reported levels of subjective happiness were strongly associated with the prevalence of sleep problems. Linear relationships can be observed between sleep problems and subjective happiness scores. The multivariable logistic regression analysis showed that dose–response association of subjective happiness score was observed with all three sleep problems.ConclusionsDue to these findings, we recommend that policy makers and school officials educate adolescents on the importance of both subjective happiness and good sleep hygiene.     

Associations between sleep disturbance and mental health status: A longitudinal study of Japanese junior high school students

Background: A limited number of longitudinal studies have addressed the association between sleep disturbance and mental health status among adolescents. To examine whether each of these is a risk factor for the onset of the other, we conducted a prospective longitudinal study of Japanese adolescents.Methods: In 2004, we performed a baseline study of students attending three private junior high schools in Tokyo, and in 2006, a follow-up study was performed on the same population. The mean age of the subjects was 13 years. The Pittsburgh Sleep Quality Index was used to evaluate sleep disturbance, and the 12-item General Health Questionnaire was used to evaluate mental health status.Results: The subjects were 698 students, of whom 516 were suitable for analysis. The incidence of newly developed poor mental health status during the 2 years leading to the follow-up study was 35.1%. New onset of poor mental health status was significantly associated with new onset of sleep disturbance and lasting sleep disturbance. The incidence of sleep disturbance during the 2 years leading to the follow-up study was 33.3%. New onset of sleep disturbance was significantly associated with new onset of poor mental health status and lasting poor mental health status.Conclusions: Sleep disturbance and poor mental health status increase each other’s onset risk.     

上海市中学生对心理卫生问题的知晓度调查

目的 了解并比较上海初中生与高中生对心理卫生问题的知晓情况。方法 采用儿童心理卫生知晓问卷和长处与困难问卷（SDQ）对737名中学生进行了研究。结果 初中生在同伴交往和社会行为方面问题多于高中生组。高中生在情绪、注意力上问题多于初中生。高中生对严重心理卫生问题的识别力高于初中生。初中生和高中生对服药和与人谈论来解决心理问题的方法都不认可,尤其是高中生。都认为家庭对心理卫生问题的影响很大,初中生更相信他们的父母能发现并帮助他们解决心理问题,而高中组中则相反。结论 上海初中生和高中生对心理卫生问题的知晓情况存在差别。     

Annual longitudinal survey at up to five time points reveals reciprocal effects of bedtime delay and depression/anxiety in adolescents

ObjectiveTo investigate the longitudinal relationship between sleep habits and mental health in adolescents.MethodsMultipoint observation data of up to five years were employed from a prospective cohort study of sleep habits and mental health status conducted from 2009 to 2013 in a unified junior and senior high school (grades 7–12) in Tokyo, Japan. A total of 1078 students answered a self-report questionnaire, including items on usual bed and wake-up times on school days, and the Japanese version of the 12-item General Health Questionnaire (GHQ-12).ResultsLatent growth model (LGM) analysis, which requires three or more time point data, showed that longitudinal changes in bedtime and GHQ-12 score (or score for depression/anxiety) were significantly and moderately correlated (correlation coefficient = 0.510, p < 0.05). Another result of interest was that, using an autoregressive cross-lagged (ARCL) model, bedtime and the depression/anxiety score had reciprocal effects the following year: ie, bedtime significantly affects the following year's depression/anxiety, and vice versa. In addition, the analysis provided estimates of mutually predicted changes: one-hour bedtime delay may worsen the GHQ-12 score by 0.2 points, and one-point worsening of the score may delay bedtime by 2.2 minutes.ConclusionsBy using up to five multiple time point data, the present study confirms the correlational and reciprocally longitudinal relationship between bedtime delay and mental health status in Japanese adolescents. The results indicate that preventing late bedtime may have a significant effect on improving mental health in adolescents.     

The association between sleep disturbance and second-hand smoke exposure: a large-scale,nationwide, cross-sectional study of adolescents in Japan

ObjectiveThis study investigated the association between secondhand-smoke (SHS) exposure and sleep disturbance symptoms.MethodsThis study was a cross-sectional survey of junior and senior high school students throughout Japan. A total of 85,931 adolescents responded, and 84,988 questionnaires were included in the analysis.ResultsAdolescents who had never smoked accounted for 88.0% of respondents; among that group 39.1% reported having been exposed to SHS over the previous week. The results of multiple logistic regression analyses indicated that the adjusted odds ratios for insomnia symptoms such as difficulty initiating sleep (DIS), difficulty maintaining sleep (DMS) and early morning awakening (EMA), as well as sleep disturbance symptoms such as subjectively insufficient sleep and short sleep duration (<6 h), tended to be higher both among never-smoking adolescents with SHS exposure and among smoking adolescents, as compared with never-smoking adolescents without SHS exposure. When adolescents with one or more of DIS, DMS, and EMA were defined as having insomnia, the adjusted odds ratio for insomnia was highest for adolescents who smoked, followed in descending order by those exposed to SHS both inside and outside the home, those exposed to SHS only inside the home, those exposed to SHS only outside the home, and never-smoking adolescents without SHS exposure (p < 0.001).ConclusionsThe present study has revealed that SHS exposure is associated with sleep disturbance. Thus, in addition to smoking cessation programs, it is also necessary to endorse measures to protect adolescents from SHS exposure in order to promote good sleep in this population.     

Subtypes of insomnia and the risk of chronic spinal pain: the HUNT study

ObjectiveTo examine the association between subtypes of insomnia and the risk of chronic spinal pain.MethodsThe study comprised 16,401 participants without chronic spinal pain at baseline who were followed for ∼11 years. People were categorized into ‘no insomnia symptoms’, ‘subthreshold insomnia’, and ‘insomnia’. Insomnia was defined according to the diagnostic classification system requiring both daytime and nighttime symptoms, and further categorized into subtypes based on nighttime symptoms (ie, sleep onset latency [SOL-insomnia], wake after sleep onset [WASO-insomnia], early morning awakening [EMA-insomnia], or combinations of these). Subthreshold insomnia comprised those with only daytime impairment or one or more nighttime symptoms. Chronic spinal pain was defined as pain in either ‘neck’, ‘low back’, or ‘upper back’, or a combination of these.ResultsIn multivariable regression analysis using people without insomnia as reference, people with subthreshold insomnia or insomnia had relative risks (RRs) of chronic spinal pain of 1.29 (95% confidence interval [CI] 1.21–1.38) and 1.50 (95% CI 1.34–1.68), respectively. The RRs for people with one nighttime symptom were 1.30 (95% CI 0.83–2.05) for WASO-insomnia, 1.32 (95% CI 1.06–1.65) for EMA-insomnia, and 1.70 (95% CI 1.32–2.18) for SOL-insomnia, respectively. Combinations of nighttime insomnia symptoms gave RRs from 1.45 (95% CI 1.08–1.94) for WASO + EMA-insomnia to 1.72 (95% CI 1.36–2.19) for all nighttime symptoms (SOL + WASO + EMA-insomnia).ConclusionsThese findings suggest that the risk of chronic spinal pain is highest among persons with insomnia subtypes characterized by sleep onset latency or among those having insomnia symptoms in all parts of the sleep period.     

How does the COVID-19 affect mental health and sleep among Chinese adolescents: a longitudinal follow-up study

ObjectiveThe Corona Virus Disease-19 (COVID-19) pandemic has evolved into the largest public health event in the world. Earlier COVID-19 studies have reported that the pandemic caused widespread impacts on mental health and sleep in the general population. However, it remains largely unknown how the prevalence of mental health problems and sleep disturbance developed and interacted in adolescents at different times in the epidemic.Methods831 teenagers (aged 14–19) underwent a longitudinal follow-up study to evaluate the prevalence of mental health problems and sleep disturbance among adolescents before, during, and after the COVID-19 breakout in China and to explore the interaction between mental health and sleep across the three measurements. The chronotype, anxiety and depression level, sleep quality, and insomnia were investigated during each measurement.ResultsThe adolescents had delayed sleep onset and sleep offset time, longer sleep duration during the quarantine than before and after the epidemic, whereas their chronotype tended to morning type during the epidemic. Yet, the highest prevalence of anxiety, depression, poor sleeper, and insomnia symptoms were observed before but not during the COVID-19 breakout. The females and adolescents who were eveningness type showed significantly higher anxiety and depression levels, poorer sleep quality, and severe insomnia status than the males and the intermediate and morning types. Sleep disturbance was positively associated with mental problems among three measurements. Pre-measured depression level significantly predicted sleep disturbance level at follow-ups.ConclusionThese findings suggested that adolescents' high prevalence of mental health and sleep problems occurred before the COVID breakout and decreased during and after the epidemic. Gender and chronotype were significant risk factors associated with affective and sleep disturbances. Depression positively predicted later sleep problems, but not vice versa.     

Sleep problems among Chinese adolescents and young adults during the coronavirus-2019 pandemic

ObjectiveTo assess the prevalence and sociodemographic correlates of insomnia symptoms among Chinese adolescents and young adults affected by the outbreak of coronavirus disease-2019 (COVID-19).MethodsThis cross-sectional study included Chinese adolescents and young adults 12–29 years of age during part of the COVID-19 epidemic period. An online survey was used to collect demographic data, and to assess recognition of COVID-19, insomnia, depression, and anxiety symptoms using the Pittsburgh Sleep Quality Index (PSQI), the Patient Health Questionnaire (PHQ-9), and the Generalized Anxiety Disorder (GAD-7) questionnaires, respectively. The Social Support Rate Scale was used to assess social support.ResultsAmong 11,835 adolescents and young adults included in the study, the prevalence of insomnia symptoms during part of the COVID-19 epidemic period was 23.2%. Binomial logistic regression analysis revealed that female sex and residing in the city were greater risk factors for insomnia symptoms. Depression or anxiety were risk factors for insomnia symptoms; however, social support, both subjective and objective, was protective factors against insomnia symptoms. Furthermore, anxiety and depression symptoms were mediators of social support and insomnia symptoms.ConclusionsResults of this study revealed a high prevalence of sleep problems among adolescents and young adults during the COVID-19 epidemic, especially senior high school and college students, which were negatively associated with students’ projections of trends in COVID-19. The adverse impact of COVID-19 was a risk factor for insomnia symptoms; as such, the government must devote more attention to sleep disorders in this patient population while combating COVID-19.     

Association between eveningness preference,socio-behavioral factors,and insomnia symptoms in Korean adolescents

Objective/BackgroundStudies focusing on insomnia in adolescents are relatively scarce compared to those on excessive daytime sleepiness. We aimed to investigate the prevalence of insomnia symptoms and associated factors in Korean high school students.Patients/methodsA total of 8565 students (girls: 4104) were investigated nationwide, across 15 South Korean districts using an online self-report questionnaire. Insomnia symptoms were evaluated using the Global Sleep Assessment Questionnaire. The participants’ mean age was 16.77 ± 0.85 years.ResultsThe prevalence of insomnia symptoms was 39.43% (n = 3377). Logistic regression was used to estimate the odds ratio (OR) of insomnia symptoms associated with sleep characteristics and social behaviors after adjusting for the relevant covariates. Evening preference (OR, 2.51, 95% CI, 2.20–2.86), perception of insufficient sleep (OR, 3.55, 95% CI, 3.11–4.06), snoring usually/always (OR, 1.25; 95% CI, 1.00–1.55), witnessed sleep apnea usually/always (OR, 1.70; 95% CI, 1.17–2.46), increased internet addiction (OR, 1.02; 95% CI, 1.02–1.03), bad sleep environment (OR, 1.77; 95% CI, 1.50–2.10), ≥3 private extra classes (OR, 1.23; 95% CI, 1.01–1.49), often coffee consumption (OR, 1.31; 95% CI, 1.10–1.56), and often nocturnal eating (OR, 1.24; 95% CI, 1.06–1.45) were associated with insomnia symptoms. Evening preference (OR, 3.48; 95% CI, 2.52–4.82) was also associated with insomnia symptoms in the perceived sufficient sleep subgroup.ConclusionInsomnia symptoms were common in Korean high school students. Evening preference was the major factor associated with insomnia symptoms. Various socio-behavioral factors were also associated with insomnia symptoms.     

Clarification of the factor structure of the 12-item General Health Questionnaire among Japanese adolescents and associated sleep status

If the factors affecting the mental health status of adolescents and their association with sleep status could be clarified, this information would be helpful for formulating lifestyle and healthcare guidance for the promotion of healthy growth and the prevention of mental problems in these individuals. The purpose of this study was to clarify (1) the factor structure of the 12-item General Health Questionnaire (GHQ-12), and (2) the associations between the factors extracted from this questionnaire and lifestyle, in particular sleep status, by using a representative sample population of Japanese adolescents. One hundred three thousand sixty hundred fifty self-administered questionnaires were collected from students enrolled in junior high and high schools in Japan. Of these questionnaires, 99,668 were analyzed. Sleep duration, subjective sleep assessment, bedtime, and insomnia symptoms of these students over the past month were studied to investigate sleep status. The factor analyses yielded two factors: depression/anxiety and loss of positive emotion. Sleep duration of less than 7 h was found to be associated with both depression/anxiety and loss of positive emotion, whereas sleep duration of 8 h or more was associated only with loss of positive emotion. Subjective sleep assessment and insomnia symptoms were associated with both depression/anxiety and loss of positive emotion. It was demonstrated that two underlying factors of mental health status were associated with differences in sleep status. In order to improve the mental health status of adolescents, it is important to provide guidance about sleep and lifestyle habits according to the mental health status of the individual.     

An epidemiologic study of sleep problems among adolescents in North Taiwan

Background and purposeTo investigate the prevalence of sleep problems and their association with daytime sleepiness among Taiwanese adolescents by use of a validated questionnaire.Patients and methodsThis is a cross-sectional, community based study with self-reported sleep questionnaires. Completed questionnaires from 1939 adolescent subjects from schools in Lin-Kou district (Taipei, Taiwan) (96.7% responded); 1906 valid questionnaires (62.3% girls) were analyzed. The randomly selected classes included elementary grade 6 (age range: 12–13 years), junior high school (age range: 14–16 years) and senior high school students (age range: 17–18 years).ResultThe mean sleep duration on weekdays was 7.35 ± 1.23 h and on weekends 9.38 ± 1.62 h. Weeknight sleep decreased significantly with increasing school grade (6.87 ± 1.14 h for high school seniors). There was a trend towards increased daytime sleepiness for students in higher school grade levels. Daytime sleepiness directly correlated with shorter total sleep time (TST) on weekdays, longer TST on weekends, snoring, insomnia and nightmares. Coffee intake, smoking, periodic leg movement/restless legs syndrome, body mass index (BMI), mouth breathing and breathing problems were indirect factors that induced daytime sleepiness. Pearson correlation showed no significant correlation between the TST during the weekday and BMI (?0.047, p = 0.079) or body weight (BW) (?0.048, p = 0.072). But it showed significant negative correlation (?0.103, p = 0.0001) for increasing total sleep time on the weekend and decreasing BMI.ConclusionsDaytime sleepiness correlated with the shorter TST on weekdays, longer TST on weekends, snoring, insomnia and nightmares. There is no significant correlation between the weekday TST and BMI or BW. Meals and food intake of children are still traditional and have not changed as much in Taiwan as in some other western countries, and compared to a similar survey performed 12 years ago in Taiwan among junior high school students, sleep duration was not significantly different but reduced due to school demands.     

The Impact of the COVID-19 Pandemic on the Mental Health of First-Year Undergraduate Students Studying at a Major Canadian University: A Successive Cohort Study

ObjectiveTo examine the impact of the COVID-19 pandemic on first year undergraduate student mental health.MethodsAs part of the Queen’s University U-Flourish Student Well-Being and Academic Success study, three successive cohorts of students entering undergraduate studies in 2018 (pre-pandemic), 2019 (transitional), and 2020 (during pandemic) completed electronic surveys at entry and completion of first year. Validated self-report measures were used to assess mental health status including symptom levels of anxiety, depression, and insomnia, self-harm and frequency of substance use. Propensity matching and multivariable log-binomial regression were used in comparisons of mental health indicators across the cohorts.ResultsClinically significant symptoms of depression, anxiety, insomnia, and self-harm were reported more frequently in the 2020–2021 cohort, coincident with remote learning and pandemic restrictions. In female students, screen positive rates for anxiety and depression, and suicidal ideation increased from about one-third to just under one-half in association with the pandemic (χ², p < .01), while increases in mental health concerns were less pronounced among males. Among females, increases in clinically significant symptoms over first year appeared greatest during the pandemic year, while striking decreases in alcohol consumption in both females and males were reported in that same year. Studying under pandemic conditions had a negative impact on student well-being, social relationships and school connectedness, quality of learning experience, leisure activities, and optimism about future prospects.ConclusionsMental health concerns including anxiety, depression and sleep problems increased in first year students during the pandemic, especially among females, while alcohol use declined. These findings highlight the negative mental health impact associated with studying under pandemic restrictions involving remote learning and social distancing.     

Enquête quantitative sur le sommeil d’adolescents tout-venant français : insomnie,anxiété-dépression et rythmes circadiens

IntroductionInsomnia is a sleep disorder that particularly affects teenagers. Its psychic and physical consequences are major and make it a public health priority. The main purpose of the study was to provide contemporary data on adolescent sleep and to explore the intrications between insomnia and mood disorders while investigating the chronotype responsibility.MethodA battery of questionnaires was offered to 1,036 French teenagers, enrolled in secondary school, aged between 12 and 20 years old and living in urban areas for middle school students and in rural areas for high school students. It was mainly composed of the Insomnia Severity Index (ISI), the Hospital Anxiety and Depression Scale (HADS) and the - Morningness-Eveningness Questionnaire (MEQ). The authorities responsible for ethics and professional conduct have issued a favorable opinion.ResultsThis study demonstrated that anxiety, depression, gender and age were factors linked to insomnia, reaffirming a female predisposition and asserting a high school entry effect (especially at 15 years old). The results also indicated that a tendency to vesperality increased the risk and the level of insomnia, thus evoking the responsibility of circadian typologies in this sleep disorder.ConclusionThis study underlines the importance of prevention and screening for insomnia when entering high school, as well as the need, in sleep disorder clinics and in psychotherapy, to deal with individual circadian rhythms, their consequences and organizational choices in the sleep/wakefulness articulation.     

The associations between sleep situations and mental health among Chinese adolescents: A longitudinal study

ObjectiveFew studies are conducted to explore the longitudinal relationships between sleep situations and mental health among adolecents. This study aimed to explore the sleep situations (ie, sleep habits and sleep problems) among Chinese adolescents and the longitudinal associations between sleep situations and mental disorder symptoms (ie, depressive and anxiety symptoms).MethodsThis longitudinal study included 1957 high school students from ten schools in Guangzhou in January 2019, with 1836 students contributing valid data at a one-year follow-up (retention rate: 93.9%). Data of depressive and anxiety symptoms, sleep habits, and sleep problems were collected using a self-reported questionnaire.ResultsThe current study found that over half of the adolescents did not reach the recommended 8-h sleep-time on weekdays (63.3%). Short sleep duration, especially on weekdays, was significantly associated with subsequent depressive (AOR = 0.86, 95%CI: 0.80–0.92) and anxiety symptoms (AOR = 0.86, 95%CI: 0.77–0.96). In addition, longer weekday-weekend catch-up sleep and more sleep problems were risk factors of depressive and anxiety symptoms.ConclusionsThe health effects of insufficient sleep and suboptimal sleep quality on adolescents should not be neglected. Our longitudinal research showed that adolescents would demonstrate severer depressive and anxiety symptoms if lacking of a healthy sleeping practice. A regular sleep schedule and close attention to adolescents’ mental disorders are highly recommended.     

江门市新会区高中生独生子女心理健康状况的抽样调查

目的调查江门市新会区高中生独生子女的心理健康状况。方法采用症状自评量表对江门市新会区三所高中的103名独生子女和464名非独生子女进行心理卫生评定。结果约20．39％的高中独生子女存在明显的心理问题，其阳性检出率同非独生子女（15．3％）无明显差异。单亲家庭独生子女阳性检出率高于核心家庭及大家庭（P〈0．05）。独生子女Scl-90中8个因子得分高于非独生子女，其中尤以强迫、偏执、精神病性因子分差异显著（P〈0．05），女生在强迫、人际关系敏感、抑郁、恐怖、敌对及精神病性得分显著高于男生（P〈0．05）。结论高中生独生子女心理健康状况总体上与非独生子女相近，单亲家庭及女生心理问题较多。     

少数民族聚集地区卫校学生心理卫生状况调查

目的　了解少数民族聚集地区卫校学生的心理健康状况。方法　采用心理卫生自评量表 (SCL -90 )对 170名少数民族卫生学校学生进行了调查。结果　少数民族聚集地区卫校学生的SCL - 90总均分及各因子分均显著高于国内 (青年组 )常模 (P <0 .0 0 1)。高年级躯体化、人际关系、抑郁、偏执因子分高于低年级 (P <0 .0 5 )。结论　少数民族学生的心理健康问题相对突出 ,应予以重视及相应干预     

Relationships between insomnia,long working hours,and long commuting time among public school teachers in Japan: a nationwide cross-sectional diary study

ObjectivesThe present study aimed to clarify the prevalence and risk factors of insomnia among public school teachers in Japan by examining the relationships between working hours, commuting time, and insomnia. Time spent on work activities among teachers with insomnia was also investigated.MethodsThis study was a secondary analysis of data obtained in a 2016 survey of working conditions among public elementary/junior high school teachers in Japan. A total of 11,390 teachers (women: 47.4%, average age: 42.2 ± 11.3 years) were selected for analysis. The relationships between working hours, commuting time, and insomnia were evaluated using a binomial logistic regression model. The primary outcome was insomnia, defined by a score of ≥6 on the Athens Insomnia Scale. Explanatory factors were working hours/week, commuting time/day, six subscales of occupational stress, age group, presence of children, type of job, type of the school, and the urbanicity of the school.ResultsIn total, 41.7% of men and 44.0% of women were classified into the insomnia group. The insomnia group spent more time preparing for lectures, and a significant association was observed between insomnia and long working hours and commuting time. Results of multivariate logistic regression analysis showed that long working hours, long commuting time, and urbanicity of the school were statistically significantly associated with insomnia.ConclusionsInsomnia is common among public school teachers in Japan. Our findings suggest the importance of reducing the time spent on working to prevent insomnia.     

Identifying the best sleep measure to screen clinical insomnia in a psychiatric population

BackgroundInsomnia symptoms are highly prevalent among patients with psychiatric disorders, and this mandates the need to identify the best self-administered sleep measure to screen for clinical insomnia among them.MethodsA total of 400 psychiatric outpatients completed the Pittsburgh Sleep Quality Index, Insomnia Severity Index (ISI), Epworth Sleepiness Scale, Flinders Fatigue Scale, Functional Outcomes of Sleep Questionnaire, and Dysfunctional Beliefs and Attitudes about Sleep Scale in a cross-sectional study. The sensitivity, specificity, positive, and negative predictive values of these six sleep scales were assessed and compared in relation to both ICD-10 and DSM-5 insomnia disorder status established using the interviewer-administered Brief Insomnia Questionnaire.ResultsReceiver operator characteristic curves with the area under the curve (AUC) revealed the ISI to be the most accurate measure to discriminate cases and non-cases on both ICD-10 (AUC = 0.88, 95% CI = 0.84–0.92) and DSM-5 (AUC = 0.82, 95% CI = 0.78–0.86) criteria with “good” accuracy. The cut-off scores of ≥14 and ≥ 11 for the ISI provided optimal sensitivity and specificity for the detection of ICD-10 and DSM-5 insomnia, respectively.DiscussionWith the new calling from DSM-5 to treat sleep symptoms in the presence of a co-existing mental condition, early detection of psychiatric patients with clinically significantly insomnia using a simple but accurate self-report sleep measure becomes important. Our study suggests that the ISI could be used as a potential screening tool for comorbid insomnia disorder in patients with mental disorders.     

Diagnostic and Statistical Manual criteria for insomnia related impairment in daytime functioning: polysomnographic correlates in older adults

ObjectiveDiagnosis of insomnia disorder by the Diagnostic and Statistical Manual (DSM)-IV, and as proposed by the DSM-V, includes criteria for impairment in occupational- or social functioning due to sleep complaints. This study evaluated the clinical and polysomnographic correlates of impairment in daytime functioning in older adults with insomnia.MethodsIn older adults with DSM-IV chronic insomnia (n = 68), clinical and demographic information, and measures of health functioning, medical co-morbidity, and polysomnographic sleep were obtained. Four questions that evaluated difficulties or distress in occupational- or social functioning related to sleep complaints were used to code DSM threshold criteria for impairment in daytime functioning. Stepwise regression was used to identify predictors of impairment in daytime functioning.ResultsImpairment in daytime functioning was significantly associated with younger age (p < 0.05), and the amount of wake time after sleep onset as assessed by polysomnography (p < 0.001), controlling for health functioning and minority racial status.ConclusionsAmount of wake time after sleep onset uniquely contributes to criteria symptoms of impairment in daytime functioning among older adults with insomnia. Treatments that target sleep maintenance have the potential to improve social and occupational functioning in older adults with sleep complaints.     

Nationwide epidemiological study of insomnia in Japan

BackgroundThis study was a nationwide epidemiological study of insomnia in Japan. It was conducted because very few studies on this topic have previously been performed for the general Japanese population.MethodsAn interview survey on symptoms of insomnia (difficulty initiating sleep, difficulty maintaining sleep with difficulty resuming sleep, and early morning awakening with difficulty resuming sleep) and daytime dysfunction was conducted on the general nationwide population in the winter (February) and summer (August) of 2008. Data from 2614 participants who provided valid responses (age range 20–95 years, valid response rate 54.2%) were analyzed.ResultsThe prevalence of difficulty initiating sleep, difficulty maintaining sleep with difficulty resuming sleep, and early morning awakening with difficulty resuming sleep was 8.3%, 5.8%, and 5.8%, respectively, in men, and 11.0%, 8.1%, and 7.4%, respectively, in women. The prevalence of insomnia was 12.2% in men and 14.6% in women, and the prevalence of insomnia with daytime dysfunction was 3.2% in men and 4.2% in women. The results of logistic regression analyses indicated that the factors aggravating insomnia for men were unemployment and having mental health issues, and for women they were being aged ≥70 years, completing fewer years of schooling, and having mental health issues. Seasonality and regionality in association with insomnia were also examined, but no significant associations were found.ConclusionIn the present survey, insomnia was defined by using criteria that were closer to the clinical diagnostic criteria (eg, coexistence of both difficulty resuming sleep and daytime dysfunction was considered). Therefore, it is believed that the results of this study were representative of the clinical actuality of insomnia in Japan.