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Biomedical subjects

Kenneth L Lichstein

Publications and source records attributed to Kenneth L Lichstein.

13 recordsLinked to original sources
PubMed2006

The influence of age, gender, ethnicity, and insomnia on Epworth sleepiness scores: a normative US population.

BACKGROUND AND PURPOSE: This study explored the distribution of Epworth Sleepiness Scale (ESS) scores in a randomly sampled, community population and provided percentile scores that will assist in decision-making in both research and clinical settings. PATIENTS AND METHODS: Participants included 703 individuals between the ages of 20 and 98, with 116 people with insomnia (PWI) and 587 people not having insomnia (PNI). Analyses produced main effects for sleep status and ethnicity. RESULTS: PWI had higher ESS scores than PNI and African-Americans had higher ESS scores than Caucasians, although effect sizes were small. Gender, age group, and season did not impact ESS scores. Receiver operating characteristic (ROC) curve analysis proved the ESS to discriminate poorly between PWI and PNI. CONCLUSIONS: This study found higher percentages of 'sleepy' individuals than previous studies. PWI did have slightly elevated scores on the ESS, but this elevation was not necessarily predictive of an insomnia diagnosis. Results support a continuum of sleepiness/alertness among PWI.

Adult↗
PubMed2006

The sleep of African Americans: a comparative review.

Researchers have not thoroughly assessed the sleep of African Americans (AAs) despite the recent increased attention to ethnic research. This article reviews the sleep and epidemiological literatures to assess AA sleep. Although the limited data were sometimes inconsistent, they suggest that AAs sleep worse than Caucasian Americans. AAs take longer to fall asleep, report poorer sleep quality, have more light and less deep sleep, and nap more often and longer. AAs have a higher prevalence of sleep-disordered breathing and exhibit more risk factors for poor sleep. These differences are concentrated in young- and middle-age adults. There are no sleep disorders treatment data for AAs. These data support further research into ethnic differences in both normal and disturbed sleep.

Adult↗
PubMed2006

Actigraphy validation with insomnia.

STUDY OBJECTIVE: Actigraphy, a method of inferring sleep from the presence or absence of wrist movement, has been well validated against polysomnography in trials with people without insomnia. However, the small amount of literature on validation with insomniacs has revealed an actigraphy bias toward overscoring sleep. The current validation trial with insomniacs used the largest number of subjects to date in such research and attracted participants with diverse demographic characteristics. DESIGN: People with insomnia slept 1 night in the laboratory while simultaneously being monitored by polysomnography, actigraphy (high-sensitivity algorithm of the Mini Mitter AW64 Actiwatch), and morning sleep diary. SETTING: Sleep disorders center. PARTICIPANTS: Participants were 57 volunteers from the community, 26 men and 31 women, ranging in age from 21 to 87 years. All participants satisfied conservative criteria for insomnia. The sample included subjects with primary insomnia, subjects with comorbid insomnia, and hypnotic users with current insomnia complaints. INTERVENTIONS: N/A. MEASUREMENTS AND RESULTS: Actigraphy was successfully validated on 4 measures of sleep pattern--number of awakenings, wake time after sleep onset, total sleep time, and sleep efficiency percentage--based on nonsignificant mean differences and significant correlation between actigraphy and polysomnography. Sleep-onset latency with actigraphy was not significantly different from polysomnography but was weakly correlated with polysomnography. Hypnotic use contributed to actigraphic overscoring of sleep. CONCLUSIONS: Actigraphy proved to be a satisfactory objective measure of sleep on 4 of 5 sleep parameters, but these results are specific to this particular instrument using this particular algorithm and should not be construed as a blanket endorsement of actigraphy for measuring insomnia.

Adult↗
PubMed2005

Treatment of insomnia in older adults.

Insomnia outcome studies from the last 15 years show consistent success for behavioral treatment with older adults. The present review of evaluation and treatment covers the effects of aging on ability to sleep, the insomnia classification system, the treatment efficacy database, and critical outcome research methodology. Clinical trial methodology with older adults includes familiar challenges; for example, the need for placebo controls, and frequent failures to document the adequacy of treatment implementation. Recommendations for improving methodology are offered. A new review of treatment for primary insomnia in older adults shows strong improvement and consistent results for popular behavioral treatments. Older adult clinical trials show proven efficacy of behavioral treatment for primary insomnia, efficacy for secondary insomnia, and efficacy for insomnia associated with hypnotic dependency.

Aged↗
PubMed2005

Socioeconomic status and insomnia.

This investigation compared the likelihood of insomnia and insomnia-related health consequences among individuals of different socioeconomic status. A random-digit dialing procedure was used to recruit at least 50 men and 50 women in each age decade from 20 to 80+ years old. Participants completed 2 weeks of sleep diaries as well as questionnaires related to fatigue, sleepiness, and psychological distress. Socioeconomic status was measured by education status assessed at 3 different levels: individual, household, and community. Results indicated that individuals of lower individual and household education were significantly more likely to experience insomnia even after researchers accounted for ethnicity, gender, and age. Additionally, individuals with fewer years of education, particularly those who had dropped out of high school, experienced greater subjective impairment because of their insomnia.

Adult↗
PubMed2005

Epidemiology of insomnia, depression, and anxiety.

STUDY OBJECTIVES: This study used empirically validated insomnia diagnostic criteria to compare depression and anxiety in people with insomnia and people not having insomnia. We also explored which specific sleep variables were significantly related to depression and anxiety. Finally, we compared depression and anxiety in (1) different insomnia types, (2) Caucasians and African Americans, and (3) genders. All analyses controlled for health variables, demographics, organic sleep disorders, and symptoms of organic sleep disorders. DESIGN: Cross-sectional and retrospective. PARTICIPANTS: Community-based sample (N=772) of at least 50 men and 50 women in each 10-year age bracket from 20 to more than 89 years old. MEASUREMENTS: Self-report measures of health, sleep, depression, and anxiety. RESULTS: People with insomnia had greater depression and anxiety levels than people not having insomnia and were 9.82 and 17.35 times as likely to have clinically significant depression and anxiety, respectively. Increased insomnia frequency was related to increased depression and anxiety, and increased number of awakenings was also related to increased depression. These were the only 2 sleep variables significantly related to depression and anxiety. People with combined insomnia (ie, both onset and maintenance insomnia) had greater depression than did people with onset, maintenance, or mixed insomnia. There were no differences between other insomnia types. African Americans were 3.43 and 4.8 times more likely to have clinically significant depression and anxiety than Caucasians, respectively. Women had higher levels of depression than men. CONCLUSION: These results reaffirm the close relationship of insomnia, depression, and anxiety, after rigorously controlling for other potential explanations for the relationship.

Adolescent↗
PubMed2005

Insomnia and complicated grief symptoms in bereaved college students.

In this study, we extended previous research by concentrating on sleep- and grief-related symptoms in a cohort of bereaved college students, in view of the potential for each of these problems to exacerbate the other. A sample of 815 college students completed the Inventory of Complicated Grief (H. G. Prigerson & S. C. Jacobs, 2001), along with an assessment of diagnostic criteria for insomnia and associated sleep behaviors. As predicted, the rate of insomnia was significantly higher (22%) in the bereaved sample than in a nonbereaved comparison group (17%), a difference that was particularly pronounced in terms of middle insomnia. Also as hypothesized, bereaved insomniacs reported higher complicated grief scores than bereaved noninsomniacs, and several specific sleep variables (including sleep-onset insomnia related to nighttime rumination about the loss and sleep-maintenance insomnia associated with dreaming of the deceased) were significantly related to complicated grief symptomatology.

Adolescent↗
PubMed2004

The relation between smoking and sleep: the influence of smoking level, health, and psychological variables.

The relation between smoking and sleep was examined in a randomly selected sample of 769 individuals (379 men and 390 women, ages 20 to 98). Participants completed 2 weeks of sleep diaries, provided a global report on their sleep, indicated the number of cigarettes smoked per day, and supplied information on health, depressive symptoms, anxiety, and caffeine and alcohol use. After controlling for demographic, health, psychological, and behavioral variables, light smoking (< 15 cigarettes per day), but not heavier smoking, was associated with self-reported chronic insomnia and reduced sleep diary total sleep time and time in bed. Smokers did not differ significantly from nonsmokers on diary measures of sleep-onset latency, number of awakenings during the night, wake time after sleep onset, or sleep efficiency.

Adult↗
PubMed2003

Changes in depressive symptoms after continuous positive airway pressure treatment for obstructive sleep apnea.

It is generally believed that obstructive sleep apnea (OSA) causes depression in some patients, yet it is unknown whether this depression is an actual clinical phenomenon or purely a result of overlapping somatic/physical symptoms shared by both disorders. The present study investigated changes in both somatic and affective/cognitive symptoms of depression associated with the introduction of continuous positive airway pressure (CPAP) treatment for OSA. Participants were 39 outpatients (35 males, 4 females) with no current or past mental health problems, diagnosed with OSA in a hospital sleep disorders clinic. The Beck Depression Inventory (BDI) was administered prior to treatment and again 3 months after CPAP. Total BDI scores improved after CPAP, independent of objectively monitored CPAP compliance rates. Both somatic and affective/ cognitive symptoms of depression improved in a similar manner after treatment. Our findings suggest that depressive symptoms experienced by OSA patients are not solely the result of physical OSA symptoms but include a mood component as well. We introduce a hypothetical model to conceptualize the relationship between OSA and depression.

Adolescent↗
PubMed2003

Is there a need for another sleep journal?

OBJECTIVES: A new sleep journal, Behavioral Sleep Medicine (BSM), will publish its first issue shortly. This journal is interested in the application of behavioral/cognitive science to the study of normal and disordered sleep. I review the historical background leading to the creation of this journal and then focus on the justification for starting this journal. METHODS: The justification is mainly based on the availability and distribution of behavioral sleep medicine (bsm) research. We conducted a content analysis of sleep and nonsleep journals. RESULTS: We found that 17% of articles published in mainstream sleep journals relate to bsm. Most (75%) of the bsm literature is distributed among a large number of nonsleep journals, detracting from the visibility of bsm. CONCLUSION: BSM is needed to provide a focal point for this large but dispersed literature. Those who prize the field of bsm covet the aspiration that the journal will serve as a beacon stimulating clinical interest and scientific progress in this area.

Humans↗
PubMed2003

'Young old' and 'old old' poor sleepers with and without insomnia complaints.

OBJECTIVE: Sleep, psychological adjustment, health and insomnia complaints were examined in 277 community-dwelling seniors in order to identify characteristics that distinguish poor sleepers with complaints (likely to seek treatment) and those without complaints (unlikely to seek treatment). METHODS: Two weeks of sleep diaries and other sleep-related measures were collected. Young old (65-74 years) and old old (75+) participants were categorized as: good sleepers, poor sleepers with complaints (complainers), and poor sleepers without complaints (noncomplainers). RESULTS: In both age groups, complainers had poorer sleep than noncomplainers. Complainers also reported more depressive symptoms and had poorer health than noncomplainers. The old old slept longer each night, but took longer to fall asleep, napped more, and were more likely to complain of insomnia than the young old; otherwise, the young old/old old distinction did not explain sleep differences among the three types of sleepers. CONCLUSIONS: Implications for treating late-life insomnia include greater inclusion of the old old in treatment outcome research and more focus on the development of integrated intervention and prevention strategies that target health, depressive symptoms, and sleep.

Adaptation, Psychological↗
PubMed2003

Insomnia as a health risk factor.

This article reviewed insomnia epidemiological research, identifying areas where insomnia was a risk factor and isolating areas deserving of further investigation. Insomnia was consistently predictive of depression, anxiety disorders, other psychological disorders, alcohol abuse or dependence, drug abuse or dependence, and suicide, indicating insomnia is a risk factor for these difficulties. Additionally, insomnia was related to decreased immune functioning. The data were inconclusive regarding insomnia as a risk factor for cardiovascular disease and mortality, but sleep medication use was predictive of mortality. These results must be tempered with the knowledge that significant weaknesses existed in the studies reviewed. The main weaknesses were inadequate definition of insomnia and inadequate control for alternative explanations. Despite these limitations, this review suggests that insomnia is a risk factor for poor mental and physical health.

Cardiovascular Diseases↗