Behavioral sleep medicine
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Behavioral sleep medicine · Jan 2007
A self-management approach to improving continuous positive airway pressure adherence and outcomes.
Obstructive sleep apnea (OSA) is a condition with serious medical and psychosocial consequences. Low patient adherence to nasal continuous positive airway pressure (CPAP) limits the effectiveness of treatment. Intervention studies based on intensive support protocols have shown modest improvement in CPAP adherence; however, this approach would require significant resources and effort for integration into the existing U. ⋯ The purpose of this article is to describe the self-management approach to chronic illness, justify the self-management approach as applied to sleep apnea patients prescribed CPAP, and to report initial pilot data on feasibility and efficacy of the Sleep Apnea Self-Management Program. CPAP adherence measured at the end of the 4-session program averaged 5.5 +/- 2.3 hr per night. The Sleep Apnea Self-Management Program (SASMP) has the potential to be an effective and practical way to improve CPAP adherence and is designed for integration into current OSA clinical processes.
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Behavioral sleep medicine · Jan 2006
Insomnia as a risk factor for onset of depression in the elderly.
There are at least 9 studies that provide evidence that insomnia is a significant risk factor for recurrent and new onset major depressive disorder (MDD), two of which suggest that this association also exists specifically for the elderly. In this study, archival data from a community sample of healthy elderly participants were used to assess the extent to which insomnia predicts future illness in this age cohort. Out of the 147 participants with no prior history of mental illness, 66 participants were classified as having no insomnia, 47 had indeterminate insomnia, and 34 had persistent insomnia. ⋯ Two had no insomnia, 4 had indeterminate insomnia, and 6 had persistent insomnia. Persistent insomnia with onset of depression occurred only in female participants and was significantly associated with middle insomnia. These data suggest that elderly participants with persistent insomnia are at greater risk for the development of new onset depression.
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Behavioral sleep medicine · Jan 2005
Associations between sleep and cortisol responses to stress in children and adolescents: a pilot study.
A growing body of animal and human research suggests reciprocal associations between sleep and activity of the hypothalamic pituitary adrenocortical (HPA) axis. However, few studies have examined associations between sleep and stress-induced cortisol responses in children and adolescents. This pilot study examined associations among 3 sleep parameters (sleep-wake behavior problems, daytime sleepiness, sleep quantity) and cortisol responses to stress in 31 participants ages 10 to 17 (15 males, 16 females). ⋯ Significant associations between participant reported sleep-wake behavior problems and cortisol reactivity were found, with greater sleep-wake behavior problems associated with decreased cortisol responses. No associations emerged between sleep quantity and cortisol responses to stress; daytime sleepiness showed a trend toward an effect on cortisol reactivity. Although preliminary, results suggest there may be important influences of sleep quality but not quantity on HPA regulation and responses to daytime stressors in children and adolescents, and further study is warranted.