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Sleep Initiation and Maintenance Disorders: HELP
Articles by Kai Spiegelhalder
Based on 63 articles published since 2010
(Why 63 articles?)
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Between 2010 and 2020, K. Spiegelhalder wrote the following 63 articles about Sleep Initiation and Maintenance Disorders.
 
+ Citations + Abstracts
Pages: 1 · 2 · 3
1 Guideline European guideline for the diagnosis and treatment of insomnia. 2017

Riemann, Dieter / Baglioni, Chiara / Bassetti, Claudio / Bjorvatn, Bjørn / Dolenc Groselj, Leja / Ellis, Jason G / Espie, Colin A / Garcia-Borreguero, Diego / Gjerstad, Michaela / Gonçalves, Marta / Hertenstein, Elisabeth / Jansson-Fröjmark, Markus / Jennum, Poul J / Leger, Damien / Nissen, Christoph / Parrino, Liborio / Paunio, Tiina / Pevernagie, Dirk / Verbraecken, Johan / Weeß, Hans-Günter / Wichniak, Adam / Zavalko, Irina / Arnardottir, Erna S / Deleanu, Oana-Claudia / Strazisar, Barbara / Zoetmulder, Marielle / Spiegelhalder, Kai. ·Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany. · University Hospital for Neurology, Inselspital Bern, Bern, Switzerland. · Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway. · Institute of Clinical Neurophysiology, University Medical Center Ljubljana, Ljubljana, Slovenia. · Northumbria Sleep Research Laboratory, Northumbria University, Newcastle, UK. · Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neuroscience at the University of Oxford, Oxford, UK. · Sleep Research Institute Madrid, Madrid, Spain. · Stavanger University Hospital, Stavanger, Norway. · Centro de Medicina de Sono, Hospital Cuf, Porto, Portugal. · Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden. · Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark. · Centre du Sommeil et de la Vigilance et EA 7330 VIFASOM, Université Paris Descartes, Clinic Hotel-Dieu, Sorbonne Paris Cité, APHP, HUPC, Hotel Dieu de Paris, Paris, France. · University Hospital of Psychiatry, Bern, Switzerland. · Department of Medicine and Surgery, University of Parma, Parma, Italy. · National Institute for Health and Welfare Helsinki, Helsinki, Finland. · Sleep Medicine Centre, Kempenhaeghe Foundation, Heeze, The Netherlands. · Multidisciplinary Sleep Disorders Centre, Antwerp University Hospital and University of Antwerp, Edegem-Wilrijk, Belgium. · Sleep Center Pfalzklinikum, Klingenmünster, Germany. · Sleep Medicine Center and Third Department of Psychiatry, Institute of Psychiatry and Neurology, Warsaw, Poland. · Burnasyan Federal Medical Biophysical Center of the Federal Medical Biological Agency, Moscow, Russia. · Sleep Measurements, National University Hospital of Iceland, Reykjavik, Iceland. · Institute for Pneumology, Medical Faculty, University of Bucharest, Bucharest, Romania. · Centre for Sleep Disorders in Children and Adolescents, General Hospital Celje, Ljubljana, Slovenia. · Department of Neurology, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark. ·J Sleep Res · Pubmed #28875581.

ABSTRACT: This European guideline for the diagnosis and treatment of insomnia was developed by a task force of the European Sleep Research Society, with the aim of providing clinical recommendations for the management of adult patients with insomnia. The guideline is based on a systematic review of relevant meta-analyses published till June 2016. The target audience for this guideline includes all clinicians involved in the management of insomnia, and the target patient population includes adults with chronic insomnia disorder. The GRADE (Grading of Recommendations Assessment, Development and Evaluation) system was used to grade the evidence and guide recommendations. The diagnostic procedure for insomnia, and its co-morbidities, should include a clinical interview consisting of a sleep history (sleep habits, sleep environment, work schedules, circadian factors), the use of sleep questionnaires and sleep diaries, questions about somatic and mental health, a physical examination and additional measures if indicated (i.e. blood tests, electrocardiogram, electroencephalogram; strong recommendation, moderate- to high-quality evidence). Polysomnography can be used to evaluate other sleep disorders if suspected (i.e. periodic limb movement disorder, sleep-related breathing disorders), in treatment-resistant insomnia, for professional at-risk populations and when substantial sleep state misperception is suspected (strong recommendation, high-quality evidence). Cognitive behavioural therapy for insomnia is recommended as the first-line treatment for chronic insomnia in adults of any age (strong recommendation, high-quality evidence). A pharmacological intervention can be offered if cognitive behavioural therapy for insomnia is not sufficiently effective or not available. Benzodiazepines, benzodiazepine receptor agonists and some antidepressants are effective in the short-term treatment of insomnia (≤4 weeks; weak recommendation, moderate-quality evidence). Antihistamines, antipsychotics, melatonin and phytotherapeutics are not recommended for insomnia treatment (strong to weak recommendations, low- to very-low-quality evidence). Light therapy and exercise need to be further evaluated to judge their usefulness in the treatment of insomnia (weak recommendation, low-quality evidence). Complementary and alternative treatments (e.g. homeopathy, acupuncture) are not recommended for insomnia treatment (weak recommendation, very-low-quality evidence).

2 Editorial Editorial: Neuroimaging Findings in Sleep Disorders and Circadian Disruption. 2019

Dai, Xi-Jian / Rao, Hengyi / Spiegelhalder, Kai. ·Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, China. · Division of Sleep, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States. · Department of Psychiatry and Psychotherapy, Faculty of Medicine, Medical Center - University of Freiburg, Freiburg, Germany. ·Front Neurol · Pubmed #30984096.

ABSTRACT: -- No abstract --

3 Editorial Insomnia research--Time for "fine-tuning". 2015

Riemann, Dieter / Spiegelhalder, Kai. ·Department of Clinical Psychology and Psychophysiology, Center for Mental Disorders, Freiburg University Medical Center, Hauptstrasse 5, 79104 Freiburg, Germany. Electronic address: dieter.riemann@uniklinik-freiburg.de. · Department of Clinical Psychology and Psychophysiology, Center for Mental Disorders, Freiburg University Medical Center, Hauptstrasse 5, 79104 Freiburg, Germany. ·Sleep Med Rev · Pubmed #25794842.

ABSTRACT: -- No abstract --

4 Editorial The "anti-inflammatory" properties of CBT-I. 2014

Kyle, Simon D / Spiegelhalder, Kai. · ·Sleep · Pubmed #25142561.

ABSTRACT: -- No abstract --

5 Review Neuroimaging insights into the link between depression and Insomnia: A systematic review. 2019

Bagherzadeh-Azbari, Shadi / Khazaie, Habibolah / Zarei, Mojtaba / Spiegelhalder, Kai / Walter, Martin / Leerssen, Jeanne / Van Someren, Eus J W / Sepehry, Amir A / Tahmasian, Masoud. ·Institute of Medical Sciences and Technology, Shahid Beheshti University, Tehran, Iran; Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany. · Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran. · Institute of Medical Sciences and Technology, Shahid Beheshti University, Tehran, Iran. · Department of Psychiatry and Psychotherapy, Medical Centre - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany. · Department of Psychiatry, University of Tübingen, Tübingen, Germany; Clinical Affective Neuroimaging Laboratory, Leibniz Institute for Neurobiology, Otto-von-Guericke University, Magdeburg, Germany. · Department of Sleep and Cognition, Netherlands Institute for Neuroscience, an institute of the Royal Netherlands Academy of Arts and Sciences, 1105 BA, Amsterdam, Netherlands; Departments of Psychiatry and Integrative Neurophysiology, Center for Neurogenomics and Cognitive Research (CNCR), Amsterdam Neuroscience, Vrije Universtiteit Amsterdam, Amsterdam UMC, De Boelelaan 1085, 1081 HV Amsterdam, the Netherlands. · Clinical and Counselling Psychology Program, Adler University, Vancouver, BC, Canada. · Institute of Medical Sciences and Technology, Shahid Beheshti University, Tehran, Iran. Electronic address: m_tahmasian@sbu.ac.ir. ·J Affect Disord · Pubmed #31401541.

ABSTRACT: BACKGROUND: Insomnia is a common symptom of Major Depressive Disorder (MDD) and genome-wide association studies pointed to their strong genetic association. Although the prevalence of insomnia symptoms in MDD is noticeable and evidence supports their strong bidirectional association, the number of available neuroimaging findings on patients of MDD with insomnia symptoms is limited. However, such neuroimaging studies could verily improve our understanding of their shared pathophysiology and advance corresponding theories. METHODS: Based on the preferred reporting items for systematic reviews and meta-analysis (PRISMA) guideline, we have conducted a literature search using PubMed, EMBASE, and Scopus databases and systematically explored 640 studies using various neuroimaging modalities in MDD patients with different degrees of insomnia symptoms. RESULTS: Despite inconsistencies, current findings from eight studies suggested structural and functional disturbances in several brain regions including the amygdala, prefrontal cortex and anterior cingulate cortex and insula. The aberrant functional connectivity within and between the main hubs of the salience and default mode networks could potentially yield new insights into the link between MDD and insomnia, which needs further assessment. LIMITATIONS: The number of studies reviewed herein is limited. The applied methods for assessing structural and functional neural mechanisms of insomnia and depression were variable. CONCLUSION: Neuroimaging methods demonstrated the overlapping underlying neural mechanisms between MDD and insomnia. Future studies may facilitate better understanding of their pathophysiology to allow development of specific treatment.

6 Review Making sleep easier: pharmacological interventions for insomnia. 2018

Frase, Lukas / Nissen, Christoph / Riemann, Dieter / Spiegelhalder, Kai. ·a Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine , University of Freiburg , Freiburg im Breisgau , Germany. · b University Hospital of Psychiatry and Psychotherapy , University Psychiatric Services , Bern , Switzerland. ·Expert Opin Pharmacother · Pubmed #30175928.

ABSTRACT: INTRODUCTION: The disorder insomnia represents a relevant and frequent condition in clinical care. Cognitive behavioral therapy of insomnia (CBT-I) is regarded as first line treatment. Pharmacotherapy can be considered if CBT-I is not available or effective. Therefore, pharmacological approaches for disturbed sleep are still among the most widely prescribed pharmacological treatments in clinical care. AREAS COVERED: In this review, the authors highlight basic physiological pathways of sleep regulation to understand fundamental pharmacological principles of sleep medicine. Available guidelines and reviews are summarized and recommendations formulated regarding the use of benzodiazepines and hypnotic benzodiazepine receptor agonists, melatonin and melatonin receptor agonists, sedating antidepressants, antipsychotics and antihistamines, and orexin receptor antagonists in insomnia disorder. Variations in the treatment of insomnia disorder in subpopulations with increased prevalence of sleep disorders - childhood, pregnancy and old age - are specified. EXPERT OPINION: The well-established off-label use of hypnotic drugs should evocate a debate about a better alignment of clinical practice and scientific evidence and guidelines. Better understanding of sleep regulation could help in the development of completely new substance classes. Focusing subjective sleep disturbances, such as superficial sleep perception might help identify novel pathways.

7 Review A lack of consistent brain alterations in insomnia disorder: An activation likelihood estimation meta-analysis. 2018

Tahmasian, Masoud / Noori, Khadijeh / Samea, Fateme / Zarei, Mojtaba / Spiegelhalder, Kai / Eickhoff, Simon B / Van Someren, Eus / Khazaie, Habibolah / Eickhoff, Claudia R. ·Institute of Medical Science and Technology, Shahid Beheshti University, Tehran, Iran. · Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran. · Institute for Cognitive and Brain Sciences, Shahid Beheshti University, Tehran, Iran. · Department of Psychiatry and Psychotherapy, Medical Centre - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany. · Institute of Systems Neuroscience, Medical Faculty, Heinrich-Heine University Düsseldorf, Germany; Institute of Neuroscience and Medicine (INM-1; INM-7), Research Center Jülich, Jülich, Germany. · Department of Sleep and Cognition, Netherlands Institute for Neuroscience, Meibergdreef 47, 1105 Amsterdam BA, The Netherlands; Department of Psychiatry and Integrative Neurophysiology, Center for Neurogenomics and Cognitive Research (CNCR), Neuroscience Campus Amsterdam, VU University and Medical Center, De Boelelaan 1187, 1081 Amsterdam HV, The Netherlands. · Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran. Electronic address: hakhazaie@gmail.com. · Institute of Neuroscience and Medicine (INM-1; INM-7), Research Center Jülich, Jülich, Germany; Institute of Clinical Neuroscience and Medical Psychology, Heinrich Heine University Düsseldorf, Düsseldorf, Germany. ·Sleep Med Rev · Pubmed #30093361.

ABSTRACT: Insomnia disorder is a prevalent sleep disorder, which affects about 10% of general population. However, its neural mechanisms are poorly understood. Recently, several structural and functional neuroimaging studies have been conducted in patients with insomnia disorder, but these studies have yielded diverse findings. Here, we aimed to identify consistent patterns of abnormal brain alterations in insomnia disorder by performing a quantitative coordinate-based meta-analysis. Following the preferred reporting for systematic reviews and meta-analyses statement, we searched PubMed database and used reference tracking and finally retrieved 19 eligible studies (six task-based functional magnetic resonance imaging, eight resting-state functional magnetic resonance imaging, three voxel-based morphometry, and two positron emission tomography). We extracted peak coordinates from these studies and tested for convergence using the activation likelihood estimation method. Using this method, we found no significant convergent evidence for combination of structural atrophy and functional disturbances across previous studies (p = 0.914). Inconsistencies across these studies might be related to heterogonous clinical populations, the explorative nature of these studies in combination with small sample sizes, different experimental designs, and various preprocessing and statistical approaches. Future neuroimaging studies on insomnia disorder should include larger well-characterized samples, as well as standard imaging and analysis protocols.

8 Review The effectiveness of behavioural and cognitive behavioural therapies for insomnia on depressive and fatigue symptoms: A systematic review and network meta-analysis. 2018

Ballesio, Andrea / Aquino, Maria Raisa Jessica V / Feige, Bernd / Johann, Anna F / Kyle, Simon D / Spiegelhalder, Kai / Lombardo, Caterina / Rücker, Gerta / Riemann, Dieter / Baglioni, Chiara. ·Department of Psychology, Sapienza University of Rome, Italy. · School of Health Sciences, City, University of London, UK. · Department of Clinical Psychology and Psychophysiology/Sleep Medicine, Center for Mental Disorders, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany. · Sleep and Circadian Neuroscience Institute, University of Oxford, UK. · Institute for Medical Biometry and Statistics, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany. · Department of Clinical Psychology and Psychophysiology/Sleep Medicine, Center for Mental Disorders, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany. Electronic address: chiara.baglioni@uniklinik-freiburg.de. ·Sleep Med Rev · Pubmed #28619248.

ABSTRACT: This review aimed to assess the impact of behavioural therapy for insomnia administered alone (BT-I) or in combination with cognitive techniques (cognitive-behavioural therapy for insomnia, CBT-I) on depressive and fatigue symptoms using network meta-analysis. PubMed, Scopus and Web of Science were searched from 1986 to May 2015. Studies were included if they incorporated sleep restriction, a core technique of BT-I treatment, and an adult insomnia sample, a control group and a standardised measure of depressive and/or fatigue symptoms. Face-to-face, group, self-help and internet therapies were all considered. Forty-seven studies were included in the meta-analysis. Eleven classes of treatment or control conditions were identified in the network. Cohen's d at 95% confidence interval (CI) was calculated to assess the effect sizes of each treatment class as compared with placebo. Results showed significant effects for individual face-to-face CBT-I on depressive (d = 0.34, 95% CI: 0.06-0.63) but not on fatigue symptoms, with high heterogeneity between studies. The source of heterogeneity was not identified even after including sex, age, comorbidity and risk of bias in sensitivity analyses. Findings highlight the need to reduce variability between study methodologies and suggest potential effects of individual face-to-face CBT-I on daytime symptoms.

9 Review Functional reorganization in obstructive sleep apnoea and insomnia: A systematic review of the resting-state fMRI. 2017

Khazaie, Habibolah / Veronese, Mattia / Noori, Khadijeh / Emamian, Farnoosh / Zarei, Mojtaba / Ashkan, Keyoumars / Leschziner, Guy D / Eickhoff, Claudia R / Eickhoff, Simon B / Morrell, Mary J / Osorio, Ricardo S / Spiegelhalder, Kai / Tahmasian, Masoud / Rosenzweig, Ivana. ·Sleep Disorders Research Center, Kermanshah University of Medical Sciences (KUMS), Kermanshah, Iran. · Sleep and Brain Plasticity Centre, Department of Neuroimaging, IoPPN, King's College, London, UK. · Sleep Disorders Research Center, Kermanshah University of Medical Sciences (KUMS), Kermanshah, Iran; Department of Psychiatry, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran. · Institute of Medical Sciences and Technology, Shahid Beheshti University, Tehran, Iran; School of Cognitive Sciences, Institute for Research in Fundamental Sciences (IPM), Tehran, Iran. · Sleep and Brain Plasticity Centre, Department of Neuroimaging, IoPPN, King's College, London, UK; Department of Neurosurgery, King's College Hospital, London, UK. · Sleep and Brain Plasticity Centre, Department of Neuroimaging, IoPPN, King's College, London, UK; Sleep Disorders Centre, Guy's and St Thomas' Hospital, London, UK. · Institute of Neuroscience and Medicine (INM-1), Research Center Jülich, Jülich, Germany; Department of Psychiatry, Psychotherapy, and Psychosomatics, RWTH Aachen University, Aachen, Germany. · Institute of Neuroscience and Medicine (INM-1), Research Center Jülich, Jülich, Germany; Institute of Clinical Neuroscience & Medical Psychology, Heinrich Heine University Düsseldorf, Düsseldorf, Germany. · Academic Unit of Sleep and Breathing, National Heart and Lung Institute, Imperial College London, UK and NIHR Respiratory Disease Biomedical Research Unit at the Royal Brompton and Harefield NHS Foundation Trust,Sydney Street, London, SW3 6NP, UK. · Center for Brain Health, NYU School of Medicine, New York, NY, United States. · Department of Clinical Psychology and Psychophysiology/Sleep Medicine, Center for Mental Disorders, University of Freiburg Medical Center, Freiburg, Germany. · Sleep Disorders Research Center, Kermanshah University of Medical Sciences (KUMS), Kermanshah, Iran; Institute of Medical Sciences and Technology, Shahid Beheshti University, Tehran, Iran; School of Cognitive Sciences, Institute for Research in Fundamental Sciences (IPM), Tehran, Iran. Electronic address: masoudtahmasian@gmail.com. ·Neurosci Biobehav Rev · Pubmed #28344075.

ABSTRACT: Functional neuroimaging techniques have accelerated progress in the study of sleep disorders. Considering the striking prevalence of these disorders in the general population, however, as well as their strong bidirectional relationship with major neuropsychiatric disorders, including major depressive disorder, their numbers are still surprisingly low. This review examines the contribution of resting state functional MRI to current understanding of two major sleep disorders, insomnia disorder and obstructive sleep apnoea. An attempt is made to learn from parallels of previous resting state functional neuroimaging findings in major depressive disorder. Moreover, shared connectivity biomarkers are suggested for each of the sleep disorders. Taken together, despite some inconsistencies, the synthesis of findings to date highlights the importance of the salience network in hyperarousal and affective symptoms in insomnia. Conversely, dysfunctional connectivity of the posterior default mode network appears to underlie cognitive and depressive symptoms of obstructive sleep apnoea.

10 Review Insomnia disorder. 2015

Morin, Charles M / Drake, Christopher L / Harvey, Allison G / Krystal, Andrew D / Manber, Rachel / Riemann, Dieter / Spiegelhalder, Kai. ·Université Laval, École de psychologie, 2325 rue des Bibliothèques, Québec City, Québec G1V 0A6, Canada. · Henry Ford Hospital Sleep Disorders and Research Center, Detroit, Michigan, USA. · Department of Psychology, University of California, Berkeley, Berkeley, California, USA. · Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA. · Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California, USA. · Department of Clinical Psychology and Psychophysiology/Sleep Medicine, Center for Mental Disorders, University of Freiburg Medical Center, Freiburg, Germany. ·Nat Rev Dis Primers · Pubmed #27189779.

ABSTRACT: Insomnia disorder affects a large proportion of the population on a situational, recurrent or chronic basis and is among the most common complaints in medical practice. The disorder is predominantly characterized by dissatisfaction with sleep duration or quality and difficulties initiating or maintaining sleep, along with substantial distress and impairments of daytime functioning. It can present as the chief complaint or, more often, co-occurs with other medical or psychiatric disorders, such as pain and depression. Persistent insomnia has been linked with adverse long-term health outcomes, including diminished quality of life and physical and psychological morbidity. Despite its high prevalence and burden, the aetiology and pathophysiology of insomnia is poorly understood. In the past decade, important changes in classification and diagnostic paradigms have instigated a move from a purely symptom-based conceptualization to the recognition of insomnia as a disorder in its own right. These changes have been paralleled by key advances in therapy, with generic pharmacological and psychological interventions being increasingly replaced by approaches that have sleep-specific and insomnia-specific therapeutic targets. Psychological and pharmacological therapies effectively reduce the time it takes to fall asleep and the time spent awake after sleep onset, and produce a modest increase in total sleep time; these are outcomes that correlate with improvements in daytime functioning. Despite this progress, several challenges remain, including the need to improve our knowledge of the mechanisms that underlie insomnia and to develop more cost-effective, efficient and accessible therapies.

11 Review Sleep-related attentional bias in insomnia: A state-of-the-science review. 2015

Harris, Kamelia / Spiegelhalder, Kai / Espie, Colin A / MacMahon, Kenneth M A / Woods, Heather Cleland / Kyle, Simon D. ·School of Psychological Sciences, Faculty of Medical and Human Sciences, The University of Manchester, Brunswick Street, Manchester M13 9PL, United Kingdom. · Department of Psychiatry and Psychotherapy, University of Freiburg Medical Centre, Hauptstraße 5, Freiburg 79104, Germany. · Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Headley Way, Oxford OX3 9DU, United Kingdom. · Clinical Psychology, School of Health in Social Science, University of Edinburgh, Medical School, Teviot Row, Edinburgh EH8 9AG, United Kingdom. · School of Psychology, University of Glasgow, 58 Hillhead Street, Glasgow G12 8QB, United Kingdom. · Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Headley Way, Oxford OX3 9DU, United Kingdom. Electronic address: simon.kyle@ndcn.ox.ac.uk. ·Clin Psychol Rev · Pubmed #26284598.

ABSTRACT: Prominent models of insomnia posit that sleep-related attentional bias plays an important role in the development and maintenance of insomnia. Here we conduct the first systematic review of the sleep-related attentional bias construct, indexed through reaction time-based experimental tasks. Literature search identified 13 studies that met pre-defined inclusion/exclusion criteria. Included studies involved between-group comparisons (poor sleepers versus controls), as well as sleep manipulations and correlational investigations with healthy sleepers. For studies involving comparisons between poor sleepers and healthy controls, effect size estimates were computed for task-relevant dependent variables. Six of the nine studies comparing poor sleepers and controls revealed statistically significant group differences in support of a differential sleep-related attentional bias (medium-to-large effect sizes), with flicker, dot-probe and Posner tasks being most sensitive to group effects. Due to the paucity of studies and variability in design and measurement, no conclusions could be reached regarding manipulation or induction of attentional bias in good sleepers. Results from the relatively small number of studies support the presence of sleep-related attentional bias in insomnia; however, its role in the development and/or maintenance of insomnia remains to be elucidated. We set out a research agenda aimed at advancing the understanding of sleep-related attention bias.

12 Review The neurobiology, investigation, and treatment of chronic insomnia. 2015

Riemann, Dieter / Nissen, Christoph / Palagini, Laura / Otte, Andreas / Perlis, Michael L / Spiegelhalder, Kai. ·Department of Clinical Psychology and Psychophysiology/Sleep Medicine, Centre for Mental Disorders, Freiburg University Medical Centre, Freiburg, Germany. Electronic address: dieter.riemann@uniklinik-freiburg.de. · Department of Clinical Psychology and Psychophysiology/Sleep Medicine, Centre for Mental Disorders, Freiburg University Medical Centre, Freiburg, Germany. · Department of Clinical Experimental Medicine, Psychiatric Unit, University of Pisa, School of Medicine, Pisa, Italy. · Biomedical Engineering, Faculty of Electrical Engineering and Information Technology, Offenburg University, Offenburg, Germany. · Department of Psychiatry, Penn Behavioral Health, Perelman School of Medicine, Pennsylvania University, Philadelphia, PA, USA. ·Lancet Neurol · Pubmed #25895933.

ABSTRACT: Chronic insomnia is defined by difficulties in falling asleep, maintaining sleep, and early morning awakening, and is coupled with daytime consequences such as fatigue, attention deficits, and mood instability. These symptoms persist over a period of at least 3 months (Diagnostic and Statistical Manual 5 criteria). Chronic insomnia can be a symptom of many medical, neurological, and mental disorders. As a disorder, it incurs substantial health-care and occupational costs, and poses substantial risks for the development of cardiovascular and mental disorders, including cognitive deficits. Family and twin studies confirm that chronic insomnia can have a genetic component (heritability coefficients between 42% and 57%), whereas the investigation of autonomous and central nervous system parameters has identified hyperarousal as a final common pathway of the pathophysiology, implicating an imbalance of sleep-wake regulation consisting of either overactivity of the arousal systems, hypoactivity of the sleep-inducing systems, or both. Insomnia treatments include benzodiazepines, benzodiazepine-receptor agonists, and cognitive behavioural therapy. Treatments currently under investigation include transcranial magnetic or electrical brain stimulation, and novel methods to deliver psychological interventions.

13 Review Neuroimaging insights into insomnia. 2015

Spiegelhalder, Kai / Regen, Wolfram / Baglioni, Chiara / Nissen, Christoph / Riemann, Dieter / Kyle, Simon D. ·Department of Psychophysiology/Sleep Medicine, University Medical Center Freiburg, Hauptstraße 5, 79104, Freiburg, Germany, Kai.Spiegelhalder@uniklinik-freiburg.de. ·Curr Neurol Neurosci Rep · Pubmed #25687698.

ABSTRACT: Insomnia is one of the most prevalent health complaints afflicting approximately 10% of the population in Western industrialized countries at a clinical level. Despite the proposition that both biological and psychological factors play a role in the experience of insomnia, the field continues to puzzle over so-called "discrepancies" between objective and subjective measurements of sleep and daytime functioning. The promise of neuroimaging is to uncover physiological processes that may readily explain patient reports. However, while there has been an explosion in the number of studies investigating the neural correlates of insomnia with neuroimaging technologies, there appears to be little consistency in findings across studies. We suggest a number of methodological reasons which may, at least partially, explain variability in findings across neuroimaging studies in insomnia.

14 Review Neuroimaging studies in insomnia. 2013

Spiegelhalder, Kai / Regen, Wolfram / Baglioni, Chiara / Riemann, Dieter / Winkelman, John W. ·Department of Psychiatry and Psychotherapy, University of Freiburg Medical Center, Hauptstraße 5, 79104, Freiburg, Germany, Kai.Spiegelhalder@uniklinik-freiburg.de. ·Curr Psychiatry Rep · Pubmed #24057158.

ABSTRACT: Chronic insomnia is one of the most prevalent psychiatric disorders and has a significant impact on individual's health. However, the pathophysiology of the disorder is poorly understood. The current review focuses on neuroimaging findings in insomnia. In summary, the current data suggest the following: (1) insomnia is characterized by corticolimbic overactivity during sleep and wakefulness that interferes with sleep initiation and/or maintenance; (2) insomnia patients' daytime performance is associated with a hypoactivation of task-related areas; (3) neurochemically, insomnia patients are probably characterized by reduced cortical GABA levels; (4) insomnia may be associated with abnormal brain morphometry in the frontal cortex, hippocampus and/or anterior cingulate cortex. Future investigations should include larger sample sizes or longitudinal within-subject comparisons. Other possible methodological improvements are discussed.

15 Review The microstructure of sleep in primary insomnia: an overview and extension. 2013

Feige, Bernd / Baglioni, Chiara / Spiegelhalder, Kai / Hirscher, Verena / Nissen, Christoph / Riemann, Dieter. ·Department of Psychiatry and Psychotherapy, Freiburg University Medical Center, Hauptstraße 5, 79104 Freiburg, Germany. Electronic address: Bernd.Feige@gmx.net. ·Int J Psychophysiol · Pubmed #23583625.

ABSTRACT: The present review was undertaken to summarize studies elucidating sleep microstructural differences in chronic insomnia. The etiology of insomnia is still unknown, whereas the hyperarousal concept has gained much attention with respect to pathophysiology. According to this model, insomnia is characterized by significant hyperarousal on an autonomous and central nervous level. Objective findings derived from polysomnography frequently show much less severe differences to good sleepers than subjective sleep complaints assessed by self-rating questionnaires. However, using more fine-grained methods to characterize the electrophysiology of sleep in insomnia, rather distinct differences between the sleep of good sleepers and patients with insomnia have been noted. These methods include the spectral analysis of the sleep EEG, micro-arousal and CAP (cyclic alternating pattern) analysis as well as the assessment of event-related potentials (ERPs) during night-sleep. The application of these methods shows stronger correlations with the subjective experience of disturbed sleep than standard sleep EEG scoring. An overview of the relevant empirical evidence is presented, previous investigations are extended and a theoretical synthesis within the framework of the hyperarousal concept of insomnia is attempted.

16 Review REM sleep instability--a new pathway for insomnia? 2012

Riemann, D / Spiegelhalder, K / Nissen, C / Hirscher, V / Baglioni, C / Feige, B. ·Department of Psychiatry and Psychotherapy, Freiburg University Medical Center, Freiburg, Germany. dieter.riemann@uniklinik-freiburg.de ·Pharmacopsychiatry · Pubmed #22290199.

ABSTRACT: Chronic insomnia afflicts approximately 10% of the adult population and is associated with daytime impairments and an elevated risk for developing somatic and mental disorders. Current pathophysiological models propose a persistent hyperarousal on the cognitive, emotional and physiological levels. However, the marked discrepancy between minor objective alterations in standard parameters of sleep continuity and the profound subjective impairment in patients with insomnia is unresolved. We propose that "instability" of REM sleep contributes to the experience of disrupted and non-restorative sleep and to the explanation of this discrepancy. This concept is based on evidence showing increased micro- and macro-arousals during REM sleep in insomnia patients. As REM sleep represents the most highly aroused brain state during sleep it seems particularly prone to fragmentation in individuals with persistent hyperarousal. The continuity hypothesis of dream production suggests that pre-sleep concerns of patients with insomnia, i. e., worries about poor sleep and its consequences, dominate their dream content. Enhanced arousal during REM sleep may render these wake-like cognitions more accessible to conscious perception, memory storage and morning recall, resulting in the experience of disrupted and non-restorative sleep. Furthermore, chronic fragmentation of REM sleep might lead to dysfunction in a ventral emotional neural network, including limbic and paralimbic areas that are specifically activated during REM sleep. This dysfunction, along with attenuated functioning in a dorsal executive neural network, including frontal and prefrontal areas, might contribute to emotional and cognitive alterations and an elevated risk of developing depression.

17 Review Insomnia as a predictor of depression: a meta-analytic evaluation of longitudinal epidemiological studies. 2011

Baglioni, Chiara / Battagliese, Gemma / Feige, Bernd / Spiegelhalder, Kai / Nissen, Christoph / Voderholzer, Ulrich / Lombardo, Caterina / Riemann, Dieter. ·Department of Psychiatry & Psychotherapy, University of Freiburg Medical Center, Hauptstrasse 5, 79104 Freiburg, Germany. chiara.baglioni@uniklinik-freiburg.de ·J Affect Disord · Pubmed #21300408.

ABSTRACT: BACKGROUND: In many patients with depression, symptoms of insomnia herald the onset of the disorder and may persist into remission or recovery, even after adequate treatment. Several studies have raised the question whether insomniac symptoms may constitute an independent clinical predictor of depression. This meta-analysis is aimed at evaluating quantitatively if insomnia constitutes a predictor of depression. METHODS: PubMed, Medline, PsycInfo, and PsycArticles databases were searched from 1980 until 2010 to identify longitudinal epidemiological studies simultaneously investigating insomniac complaints and depressed psychopathology. Effects were summarized using the logarithms of the odds ratios for insomnia at baseline to predict depression at follow-up. Studies were pooled with both fixed- and random-effects meta-analytic models in order to evaluate the concordance. Heterogeneity test and sensitivity analysis were computed. RESULTS: Twenty-one studies met inclusion criteria. Considering all studies together, heterogeneity was found. The random-effects model showed an overall odds ratio for insomnia to predict depression of 2.60 (confidence interval [CI]: 1.98-3.42). When the analysis was adjusted for outliers, the studies were not longer heterogeneous. The fixed-effects model showed an overall odds ratio of 2.10 (CI: 1.86-2.38). LIMITATIONS: The main limit is that included studies did not always consider the role of other intervening variables. CONCLUSIONS: Non-depressed people with insomnia have a twofold risk to develop depression, compared to people with no sleep difficulties. Thus, early treatment programs for insomnia might reduce the risk for developing depression in the general population and be considered a helpful general preventive strategy in the area of mental health care.

18 Review Chronic insomnia: clinical and research challenges--an agenda. 2011

Riemann, D / Spiegelhalder, K / Espie, C / Pollmächer, T / Léger, D / Bassetti, C / van Someren, E. ·Department of Psychiatry and Psychotherapy of Freiburg University Medical Center, Freiburg, Germany. dieter.riemann@uniklinik-freiburg.de ·Pharmacopsychiatry · Pubmed #21161882.

ABSTRACT: Chronic insomnia afflicts up to 10% of the population in Western industrialized countries. It is characterized by delayed sleep onset, problems in maintaining sleep, early morning awakening or the feeling of non-restorative sleep coupled with significant daytime impairments on an emotional, social or professional level. It can occur as a co-morbid condition in any other medical or mental disorder, but also as a primary condition. Within the last decade new diagnostic and differential diagnostic approaches have been suggested that enhance diagnostic precision. Epidemiological data and data relating to the health care and cost situation of chronic insomnia suggest a huge burden for society. Chronic insomnia leads to a clear-cut increased risk for psychopathology (i. e., affective disorders) and probably also for cardiovascular and metabolic dysfunction. The pathophysiology of the condition is still poorly understood and will profit from integrating modern neuroscientific approaches (animal studies, molecular biology, neuroimaging, neurophysiology, etc.). Current treatment strategies are mainly based on cognitive behavioural interventions (CBT-I) and hypnotic treatment with benzodiazepine receptor agonists and sedating antidepressants. Although the effectiveness of these treatments has been clearly demonstrated, a substantial proportion of patients proves to be treatment-resistant or profits only poorly. The question of long-term pharmaceutical treatment of chronic insomnia, at least in Europe, is unresolved and urgently needs answers. Novel rational treatment avenues require clues on causes and mechanisms from integrated neuroscientific approaches. The important issues concerning insomnia treatment in the future especially in Europe will be reviewed and discussed critically.

19 Review Sleep and emotions: a focus on insomnia. 2010

Baglioni, Chiara / Spiegelhalder, Kai / Lombardo, Caterina / Riemann, Dieter. ·Department of Psychiatry & Psychotherapy, University of Freiburg Medical Center, Hauptstrasse 5, 79104 Freiburg, Germany. chiara.baglioni@uniklinik-freiburg.de ·Sleep Med Rev · Pubmed #20137989.

ABSTRACT: Insomnia disorder is defined as difficulties in initiating/maintaining sleep and/or non-restorative sleep accompanied by decreased daytime functioning, persisting for at least four weeks. For many patients suffering from depression and anxiety, insomnia is a pervasive problem. Many of the aetiological theories of insomnia postulate that heightened emotional reactivity contributes to the maintenance of symptoms. This review focuses on the role of emotional reactivity in insomnia, and how the relationship between insomnia and depression and anxiety may be mediated by emotional reactivity. Furthermore, studies investigating the valence of emotions in insomnia are reviewed. Overall, there is empirical evidence that dysfunctional emotional reactivity might mediate the interaction between cognitive and autonomic hyperarousal, thus contributing to the maintenance of insomnia. Moreover, dysfunctions in sleep-wake regulating neural circuitries seem to be able to reinforce emotional disturbances. It seems plausible that dysfunctional emotional reactivity modulates the relationship between insomnia and depression and anxiety. Considering the interaction between sleep and emotional valence, poor sleep quality seems to correlate with high negative and low positive emotions, both in clinical and subclinical samples. Good sleep seems to be associated with high positive emotions, but not necessarily with low negative emotions. This review underlines the need for future research on emotions in insomnia.

20 Clinical Trial Sleep Stage Transition Dynamics Reveal Specific Stage 2 Vulnerability in Insomnia. 2017

Wei, Yishul / Colombo, Michele A / Ramautar, Jennifer R / Blanken, Tessa F / van der Werf, Ysbrand D / Spiegelhalder, Kai / Feige, Bernd / Riemann, Dieter / Van Someren, Eus J W. ·Department of Sleep and Cognition, Netherlands Institute for Neuroscience (NIN), Royal Netherlands Academy of Arts and Sciences, Amsterdam, The Netherlands. · Bernstein Center Freiburg and Faculty of Biology, University of Freiburg, Freiburg, Germany. · Centre for Chronobiology, Psychiatric Hospital of the University of Basel (UPK), Basel, Switzerland. · Departments of Psychiatry and Integrative Neurophysiology, Center for Neurogenomics and Cognitive Research (CNCR), Amsterdam Neuroscience, VU University and Medical Center, Amsterdam, The Netherlands. · Department of Anatomy and Neurosciences, Amsterdam Neuroscience, VU University Medical Center, Amsterdam, The Netherlands. · Department of Psychiatry and Psychotherapy, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany. ·Sleep · Pubmed #28934523.

ABSTRACT: Study Objectives: Objective sleep impairments in insomnia disorder (ID) are insufficiently understood. The present study evaluated whether whole-night sleep stage dynamics derived from polysomnography (PSG) differ between people with ID and matched controls and whether sleep stage dynamic features discriminate them better than conventional sleep parameters. Methods: Eighty-eight participants aged 21-70 years, including 46 with ID and 42 age- and sex-matched controls without sleep complaints, were recruited through www.sleepregistry.nl and completed two nights of laboratory PSG. Data of 100 people with ID and 100 age- and sex-matched controls from a previously reported study were used to validate the generalizability of findings. The second night was used to obtain, in addition to conventional sleep parameters, probabilities of transitions between stages and bout duration distributions of each stage. Group differences were evaluated with nonparametric tests. Results: People with ID showed higher empirical probabilities to transition from stage N2 to the lighter sleep stage N1 or wakefulness and a faster decaying stage N2 bout survival function. The increased transition probability from stage N2 to stage N1 discriminated people with ID better than any of their deviations in conventional sleep parameters, including less total sleep time, less sleep efficiency, more stage N1, and more wake after sleep onset. Moreover, adding this transition probability significantly improved the discriminating power of a multiple logistic regression model based on conventional sleep parameters. Conclusions: Quantification of sleep stage dynamics revealed a particular vulnerability of stage N2 in insomnia. The feature characterizes insomnia better than-and independently of-any conventional sleep parameter.

21 Clinical Trial Quality of life improvements after acceptance and commitment therapy in nonresponders to cognitive behavioral therapy for primary insomnia. 2014

Hertenstein, Elisabeth / Thiel, Nicola / Lüking, Marianne / Külz, Anne Katrin / Schramm, Elisabeth / Baglioni, Chiara / Spiegelhalder, Kai / Riemann, Dieter / Nissen, Christoph. ·Department of Psychiatry and Psychotherapy, University of Freiburg Medical Center, Freiburg, Germany. ·Psychother Psychosom · Pubmed #25323449.

ABSTRACT: -- No abstract --

22 Clinical Trial The Glasgow Sleep Impact Index (GSII): a novel patient-centred measure for assessing sleep-related quality of life impairment in Insomnia Disorder. 2013

Kyle, Simon D / Crawford, Megan R / Morgan, Kevin / Spiegelhalder, Kai / Clark, Ailie A / Espie, Colin A. ·University of Glasgow Sleep Centre, Institute of Neuroscience & Psychology, University of Glasgow, Scotland, United Kingdom. simon.kyle@manchester.ac.uk ·Sleep Med · Pubmed #23347908.

ABSTRACT: OBJECTIVES: Daytime dysfunction and quality of life impairment are important and salient consequences of poor sleep in those with insomnia. Existing measurement approaches to functional impact tend to rely on non-specific generic tools, non-validated scales, or ad hoc single scale items. Here we report the development and validation of the Glasgow Sleep Impact Index (GSII), a novel self-report measure which asks patients to generate, and assess, three domains of impairment unique to their own individual context. These three patient-generated areas of impairment are ranked in order of concern (1-3; i.e. 1=the most concerning impairment), and then rated on a visual analogue scale with respect to impact in the past two weeks. Patients re-rate these specified areas of impairment, post-intervention, permitting both individual and group-level analyses. METHODS: One-hundred and eight patients (71% female; Mean age=45 yrs) meeting Research Diagnostic Criteria for Insomnia Disorder completed the GSII, resulting in the generation of 324 areas (ranks) of sleep-related daytime and quality of life impairment. Fifty-five patients also completed the GSII pre- and post-sleep restriction therapy. The following psychometric properties were assessed: content validity of generated domains; relationship between ranks of impairment; and sensitivity to change post-behavioural intervention. RESULTS: Content analysis of generated domains support recent DSM-5 proposals for specification of daytime consequences of insomnia; with the most commonly cited areas reflecting impairments in energy/motivation, work performance, cognitive functioning, emotional regulation, health/well-being, social functioning and relationship/family functioning. Preliminary results with 108 patients indicate the GSII to have excellent face and construct validity. The GSII was found to be sensitive to change, post-behavioural treatment (p<0.001; Cohen's d≥0.85 for all three ranks of impairment), and improvements were associated with reductions in insomnia severity in both correlational (range of r=0.28-0.56) and responder versus non-responder analyses (all p<0.05). CONCLUSIONS: The development of the GSII represents a novel attempt to capture and measure sleep-related quality of life impairment in a valid and meaningful way. Further psychometric and clinical evaluation is suggested.

23 Article The effects of digital cognitive behavioural therapy for insomnia on cognitive function: A randomised, controlled trial. 2020

Kyle, Simon D / Hurry, Madeleine E D / Emsley, Richard / Marsden, Antonia / Omlin, Ximena / Juss, Amender / Spiegelhalder, Kai / Bisdounis, Lampros / Luik, Annemarie I / Espie, Colin A / Sexton, Claire E. ·Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK. · Division of Neuroscience and Experimental Psychology, University of Manchester, Manchester, UK. · Kings College London, Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, London, UK. · Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, UK. · Nuffield department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK. · Department of Psychiatry and Psychotherapy, Faculty of Medicine, Medical Center - University of Freiburg, Freiburg, Germany. · Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, Netherlands. · Big Health Ltd., London, UK. · Oxford Centre for Human Brain Activity, Wellcome Centre for Integrative Neuroimaging, Department of Psychiatry, University of Oxford, Oxford, UK. · Global Brain Health Institute, Memory and Aging Center, Department of Neurology, University of California, San Francisco, USA. ·Sleep · Pubmed #32128593.

ABSTRACT: STUDY OBJECTIVES: We sought to examine the impact of digital cognitive behavioural therapy (dCBT) for insomnia on both self-reported cognitive impairment and objective cognitive performance. METHODS: The DISCO trial was an online, two-arm, single-blind, randomised clinical trial of dCBT versus wait-list control. Participants were aged 25 years and older, met DSM-5 diagnostic criteria for insomnia disorder and reported difficulties with concentration or memory. Assessments were carried out online at baseline, and 10 and 24 weeks post-randomisation. The primary outcome measure was self-reported cognitive impairment, assessed with the British Columbia Cognitive Complaints Inventory (BC-CCI). Secondary outcomes included tests of cognitive performance, insomnia symptoms, cognitive failures, fatigue, sleepiness, depression and anxiety. RESULTS: 410 participants with insomnia were recruited and assigned to dCBT (N = 205) or wait-list control (N = 205). At 10 weeks post-randomisation the estimated adjusted mean difference for the BC-CCI was -3.03 [95% CI: -3.60,-2.47; p<.0001, d = -0.86], indicating that participants in the dCBT group reported less cognitive impairment than the control group. These effects were maintained at 24 weeks (d = -0.96) and were mediated, in part, via reductions in insomnia severity and increased sleep efficiency. Treatment effects in favour of dCBT, at both 10 and 24 weeks, were found for insomnia severity, sleep efficiency, cognitive failures, fatigue, sleepiness, depression, and anxiety. We found no between-group differences on objective tests of cognitive performance. CONCLUSIONS: Our study shows that dCBT robustly decreases self-reported cognitive impairment at post-treatment and these effects are maintained at 6 months.

24 Article Efficacy of a Self-Help Web-Based Recovery Training in Improving Sleep in Workers: Randomized Controlled Trial in the General Working Population. 2020

Behrendt, Doerte / Ebert, David Daniel / Spiegelhalder, Kai / Lehr, Dirk. ·Department of Health Psychology and Applied Biological Psychology, Institute of Psychology, Leuphana University of Lueneburg, Lueneburg, Germany. · Faculty of Behavioural and Movement Sciences, Clinical, Neuro- & Developmental Psychology, Free University Amsterdam, Amsterdam, Germany. · Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany. ·J Med Internet Res · Pubmed #31909725.

ABSTRACT: BACKGROUND: Sleep complaints are among the most prevalent health concerns, especially among workers, which may lead to adverse effects on health and work. Internet-delivered cognitive behavioral therapy for insomnia (iCBT-I) offers the opportunity to deliver effective solutions on a large scale. The efficacy of iCBT-I for clinical samples has been demonstrated in recent meta-analyses, and there is evidence that iCBT-I is effective in the working population with severe sleep complaints. However, to date, there is limited evidence from randomized controlled trials that iCBT-I could also be an effective tool for universal prevention among the general working population regardless of symptom severity. Although increasing evidence suggests that negatively toned cognitive activity may be a key factor for the development and maintenance of insomnia, little is known about how iCBT-I improves sleep by reducing presleep cognitive activity. OBJECTIVE: This study aimed to examine the efficacy of a self-help internet-delivered recovery training, based on principles of iCBT-I tailored to the work-life domain, among the general working population. General and work-related cognitive activities were investigated as potential mediators of the intervention's effect. METHODS: A sample of 177 workers were randomized to receive either the iCBT-I (n=88) or controls (n=89). The intervention is a Web-based training consisting of six 1-week modules. As the training was self-help, participants received nothing but technical support via email. Web-based self-report assessments were scheduled at baseline, at 8 weeks, and at 6 months following randomization. The primary outcome was insomnia severity. Secondary outcomes included measures of mental health and work-related health and cognitive activity. In an exploratory analysis, general and work-related cognitive activities, measured as worry and work-related rumination, were investigated as mediators. RESULTS: Analysis of the linear mixed effects model showed that, relative to controls, participants who received iCBT-I reported significantly lower insomnia severity scores at postintervention (between-group mean difference -4.36; 95% CI -5.59 to - 3.03; Cohen d=0.97) and at 6-month follow-up (between-group difference: -3.64; 95% CI -4.89 to -2.39; Cohen d=0.86). The overall test of group-by-time interaction was significant (P<.001). Significant differences, with small-to-large effect sizes, were also detected for cognitive activity and for mental and work-related health, but not for absenteeism. Mediation analysis demonstrated that work-related rumination (indirect effect: a CONCLUSIONS: A self-help Web-based recovery training, grounded in the principles of iCBT-I, can be effective in the general working population, both short and long term. Work-related rumination may be a particularly crucial mediator of the intervention's effect, suggesting that tailoring interventions to the workplace, including components to reduce the work-related cognitive activity, might be important when designing recovery interventions for workers. TRIAL REGISTRATION: German Clinical Trials Register DRKS00007142; https://www.drks.de/DRKS00007142.

25 Article The European Academy for Cognitive Behavioural Therapy for Insomnia: An initiative of the European Insomnia Network to promote implementation and dissemination of treatment. 2020

Baglioni, Chiara / Altena, Ellemarije / Bjorvatn, Bjørn / Blom, Kerstin / Bothelius, Kristoffer / Devoto, Alessandra / Espie, Colin A / Frase, Lukas / Gavriloff, Dimitri / Tuuliki, Hion / Hoflehner, Andrea / Högl, Birgit / Holzinger, Brigitte / Järnefelt, Heli / Jernelöv, Susanna / Johann, Anna F / Lombardo, Caterina / Nissen, Christoph / Palagini, Laura / Peeters, Geert / Perlis, Michael L / Posner, Donn / Schlarb, Angelika / Spiegelhalder, Kai / Wichniak, Adam / Riemann, Dieter. ·Department of Psychiatry and Psychotherapy, Faculty of Medicine, Medical Center - University of Freiburg, University of Freiburg, Freiburg, Germany. · Department of Human Sciences, University of Rome 'G. Marconi' - Telematic, Rome, Italy. · UMR 5287, Institut de Neurosciences Intégratives et Cognitives d'Aquitaine, Neuroimagerie et Cognition Humaine, CNRS, Université de Bordeaux, Bordeaux, France. · Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway. · Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, and Stockholm Health Care Services, Stockholm County Council, Huddinge Hospital, Stockholm, Sweden. · Department of Psychology, Uppsala University, Uppsala, Sweden. · Centre for Sleep Medicine, Rome, Italy. · Nuffield Department of Clinical Neuroscience, Sleep and Circadian Neuroscience Institute, University of Oxford, Oxford, UK. · Nordic Sleep Centre, Tallinn, Estonia. · Tartu University Hospital, Tartu, Estonia. · Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria. · Institut für Bewusstseins- und Traumforschung, Wien, Austria. · Finnish Institute of Occupational Health, Helsinki, Finland. · Department of Psychology and Logopedics, University of Helsinki, Finland. · Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Sweden. · Medical Psychology and Medical Sociology, Faculty of Medicine, University of Freiburg, Freiburg, Germany. · Department of Psychology, "Sapienza" University of Rome, Rome, Italy. · University Hospital of Psychiatry and Psychotherapy, Bern, Switzerland. · Department of Neuroscience, University of Pisa, Pisa, Italy. · Sleep Medicine Centre Kempenhaeghe, Heeze, The Netherlands. · Department of Psychiatry, Upenn Behavioral Sleep Medicine Program, University of Pennsylvania, Philadelphia, PA, USA. · Stanford University School of Medicine, Stanford, CA, USA. · Department of Psychology, University of Bielefeld, Bielefeld, Germany. · Sleep Medicine Centre and Third Department of Psychiatry, Institute of Psychiatry and Neurology, Warsaw, Poland. ·J Sleep Res · Pubmed #31856367.

ABSTRACT: Insomnia, the most prevalent sleep disorder worldwide, confers marked risks for both physical and mental health. Furthermore, insomnia is associated with considerable direct and indirect healthcare costs. Recent guidelines in the US and Europe unequivocally conclude that cognitive behavioural therapy for insomnia (CBT-I) should be the first-line treatment for the disorder. Current treatment approaches are in stark contrast to these clear recommendations, not least across Europe, where, if any treatment at all is delivered, hypnotic medication still is the dominant therapeutic modality. To address this situation, a Task Force of the European Sleep Research Society and the European Insomnia Network met in May 2018. The Task Force proposed establishing a European CBT-I Academy that would enable a Europe-wide system of standardized CBT-I training and training centre accreditation. This article summarizes the deliberations of the Task Force concerning definition and ingredients of CBT-I, preconditions for health professionals to teach CBT-I, the way in which CBT-I should be taught, who should be taught CBT-I and to whom CBT-I should be administered. Furthermore, diverse aspects of CBT-I care and delivery were discussed and incorporated into a stepped-care model for insomnia.

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