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      Mindfulness-based Cognitive Therapy to Improve Sleep Quality in Older Adults with Insomnia Translated title: Terapia cognitiva basada en mindfulness para mejorar la calidad del sueño en adultos mayores con insomnio

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          ABSTRACT

          There is a high prevalence of insomnia in older adults, which has negative consequences for their well-being and quality of life. The recommendation for first-line treatments is to administer non-pharmacological interventions. The objective of this research was to verify the effectiveness of Mindfulness-Based Cognitive Therapy in older adults with subclinical and moderate insomnia, studying its impact on sleep quality. One hundred and six older adults participated and were assigned to the subclinical insomnia ( n = 50) or moderate insomnia ( n = 56) groups; subsequently, they were randomly assigned to the control and intervention groups. Subjects were evaluated at two times with the Insomnia Severity Index and the Pittsburgh Sleep Quality Index. Significant results were obtained on both scales, with a reduction in insomnia symptoms in the subclinical and moderate intervention groups. The administration of a treatment that combines mindfulness and cognitive therapy is effective for treating insomnia in older adults.

          RESUMEN

          Existe una alta prevalencia de insomnio en los adultos mayores, lo que tiene consecuencias negativas para su bienestar y calidad de vida. La recomendación para los tratamientos de primera línea es administrar intervenciones no farmacológicas. El objetivo de esta investigación fue verificar la efectividad de la terapia cognitiva basada en mindfulness en adultos mayores con insomnio subclínico y moderado, estudiando su impacto en la calidad del sueño. Participaron 106 adultos mayores que fueron asignados a los grupos de insomnio subclínico ( n = 50) o de insomnio moderado ( n = 56); posteriormente, fueron asignados aleatoriamente a los grupos de control y de intervención. Los sujetos fueron evaluados antes y después de la intervención con el índice de gravedad del insomnio y el índice de calidad del sueño de Pittsburgh. Se obtuvieron resultados significativos en ambas escalas, con una reducción de los síntomas de insomnio en los grupos de intervención subclínica y moderada. La administración de un tratamiento que combina mindfulness y terapia cognitiva es eficaz para tratar el insomnio en adultos mayores.

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          The Pittsburgh sleep quality index: A new instrument for psychiatric practice and research

          Despite the prevalence of sleep complaints among psychiatric patients, few questionnaires have been specifically designed to measure sleep quality in clinical populations. The Pittsburgh Sleep Quality Index (PSQI) is a self-rated questionnaire which assesses sleep quality and disturbances over a 1-month time interval. Nineteen individual items generate seven "component" scores: subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, use of sleeping medication, and daytime dysfunction. The sum of scores for these seven components yields one global score. Clinical and clinimetric properties of the PSQI were assessed over an 18-month period with "good" sleepers (healthy subjects, n = 52) and "poor" sleepers (depressed patients, n = 54; sleep-disorder patients, n = 62). Acceptable measures of internal homogeneity, consistency (test-retest reliability), and validity were obtained. A global PSQI score greater than 5 yielded a diagnostic sensitivity of 89.6% and specificity of 86.5% (kappa = 0.75, p less than 0.001) in distinguishing good and poor sleepers. The clinimetric and clinical properties of the PSQI suggest its utility both in psychiatric clinical practice and research activities.
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            European guideline for the diagnosis and treatment of insomnia

            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).
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              Meta-analysis of quantitative sleep parameters from childhood to old age in healthy individuals: developing normative sleep values across the human lifespan.

              The purposes of this study were to identify age-related changes in objectively recorded sleep patterns across the human life span in healthy individuals and to clarify whether sleep latency and percentages of stage 1, stage 2, and rapid eye movement (REM) sleep significantly change with age. Review of literature of articles published between 1960 and 2003 in peer-reviewed journals and meta-analysis. 65 studies representing 3,577 subjects aged 5 years to 102 years. The research reports included in this meta-analysis met the following criteria: (1) included nonclinical participants aged 5 years or older; (2) included measures of sleep characteristics by "all night" polysomnography or actigraphy on sleep latency, sleep efficiency, total sleep time, stage 1 sleep, stage 2 sleep, slow-wave sleep, REM sleep, REM latency, or minutes awake after sleep onset; (3) included numeric presentation of the data; and (4) were published between 1960 and 2003 in peer-reviewed journals. In children and adolescents, total sleep time decreased with age only in studies performed on school days. Percentage of slow-wave sleep was significantly negatively correlated with age. Percentages of stage 2 and REM sleep significantly changed with age. In adults, total sleep time, sleep efficiency, percentage of slow-wave sleep, percentage of REM sleep, and REM latency all significantly decreased with age, while sleep latency, percentage of stage 1 sleep, percentage of stage 2 sleep, and wake after sleep onset significantly increased with age. However, only sleep efficiency continued to significantly decrease after 60 years of age. The magnitudes of the effect sizes noted changed depending on whether or not studied participants were screened for mental disorders, organic diseases, use of drug or alcohol, obstructive sleep apnea syndrome, or other sleep disorders. In adults, it appeared that sleep latency, percentages of stage 1 and stage 2 significantly increased with age while percentage of REM sleep decreased. However, effect sizes for the different sleep parameters were greatly modified by the quality of subject screening, diminishing or even masking age associations with different sleep parameters. The number of studies that examined the evolution of sleep parameters with age are scant among school-aged children, adolescents, and middle-aged adults. There are also very few studies that examined the effect of race on polysomnographic sleep parameters.
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                Author and article information

                Journal
                Interv Psicosoc
                Interv Psicosoc
                inter
                Psychosocial Intervention
                Colegio Oficial de la Psicología de Madrid
                1132-0559
                2173-4712
                20 July 2022
                July 2022
                : 31
                : 3
                : 159-167
                Affiliations
                [a ] orgnameUniversity of Valencia Valencia Spain originalUniversity of Valencia, Spain;
                [b ] orgnameUniversidad Internacional de Valencia Valencia Spain originalUniversidad Internacional de Valencia, Spain
                Author notes
                Correspondence: melendez@ 123456uv.es (J. C. Melendez).

                Conflict of Interest: The authors of this article declare no conflict of interest.

                Article
                00003
                10.5093/pi2022a12
                10268553
                37361010
                c68c0f46-bfeb-4dd5-a7d5-b1b6c2cda0cc
                Copyright © 2022, Colegio Oficial de la Psicología de Madrid

                This is an Open Access article distributed under the terms of the Creative Commons Attribution-Noncommercial No Derivative License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium provided the original work is properly cited and the work is not changed in any way.

                History
                : 15 February 2022
                : 06 June 2022
                : 06 July 2022
                Page count
                Figures: 1, Tables: 5, Equations: 0, References: 75
                Categories
                Research-Article

                subclinical insomnia,moderate insomnia,aging,sleep quality,insomnio subclínico,insomnio moderado,envejecimiento,calidad del sueño

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