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Hypnosis for insomnia: an exaggerated myth or an underrated intervention?
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Abstracts / Sleep Medicine 14S (2013) e165–e238
tine in order to measure the endogenous circadian rhythms. Participants resided in a dimly lit (<15 lux), time-free environment in semi-supine position. They followed ‘‘1-h days’’ which involved 20-min sleep opportunities alternating with 40-min of enforced wakefulness. Core body temperature and salivary melatonin were recorded hourly and best fit temperature curves and dim light melatonin onsets were determined to derive circadian period length measures from the 80-h of data. Results: Although core temperature period lengths showed a trend in DSPD to be longer than controls, this trend was not statistically significant in this study. However, the melatonin period length was on average 23.4 min longer (p = .010) in the DSPD group (M = 24.64 h, SD = 0.35) than the healthy control sleepers (M = 24.25 h, SD = 0.21). Conclusion: Together these findings suggest that abnormally long biological circadian rhythms contribute to delayed sleeping patterns of individuals with DSPD. These outcomes may explain patients’ persistent tendency to delay and relapse post-treatment. Therefore, continuing treatment with morning bright light stimulation and early evening low dose melatonin administration are recommended to treat DSPD and prevent relapse. Acknowledgement: Australian Research Council grant # DP120101401. http://dx.doi.org/10.1016/j.sleep.2013.11.411
Hypnosis for insomnia: an exaggerated myth or an underrated intervention? T. Lam Social Welfare Department, Approved Consultant/American Society of Clinical Hypnosis, Fellow/Royal Statistical Society, China
Introduction: Hypnosis is one of the oldest forms of complementary and alternative medicine as well as a psychological intervention. Derived from its Greek origin, the term was once mythically associated with sleep. Because hypnosis is commonly more related to relaxation and imagery under suggestion, the approach may be helpful to improve insomnia by reducing hyperarousal. This presentation discusses its components, effectiveness and potential for treating insomnia. Materials and methods: Review of literature on the nature, characteristics and components and measurements of hypnosis and critical appraisal of 6 randomized controlled trials (RCTs) from 1970s to 2000s identified from keywords search in databases on the components, treatment regime of hypnosis as well as study design, methodology and limitations. Results: Despite lacking a unique definition, some characteristics of hypnosis such as lack of voluntary initiation and a fading of generalized reality orientation are recognized. Hypnotic responses are often assessed by behavioural scales or self-reported inventories. Another practice to operationalize hypnosis is the use of hypnotizability scales to measure the extent a subject responds to standardized suggestions presented after a standardized hypnotic induction procedure. The appraisal of the studies found that methodological quality of the included studies was low. Limitations include imprecise enrollment criteria and diagnostic procedure, unclear randomization and allocation concealment methods, inadequate outcome assessment and descriptions of withdrawal and dropouts, and lack of adverse event monitoring. None of the reviewed RCTs have assessed the hypnotic responses or the success of blinding of participants, though some argue that blinding is not possible in hypnosis. Despite low quality, most RCTs reported that a significant improvement in sleep parameters could
be achieved in 4 weekly sessions or less and no adverse events were reported. Conclusion: Although the overall results suggested that hypnosis treatment was safe and efficacious for treating insomnia, due to the methodological limitations, the generalizabilty of the positive findings remained questionable. Future studies with larger sample size, better study design and methodological quality are needed to ascertain the efficacy of hypnosis for insomnia. Acknowledgements: This presentation is part of my research project for PhD candidature at the Department of Psychiatry, University of Hong Kong. http://dx.doi.org/10.1016/j.sleep.2013.11.412
Sleep diaries for shift workers M. Lamy 1, E. Bastille-Denis 2, A. Vallières 2 1 Centre d’étude des troubles du sommeil, Université Laval, Canada 2 Laval University, Canada
Introduction: Sleep diaries have long been the preferred method for collecting data on self-reported sleep over time in insomnia research. Only a few studies were dedicated to daily self-reports of sleep difficulties associated with shift work. The aim of this study is to qualitatively document the use of sleep diaries in the context of shift work and to present a diary template that reflects the reality of shift work. Materials and methods: The sample included 46 shift workers (86.9% women; mean age = 35.4 years old) taking part in a study on bio-psychosocial factors involved in the evolution of shift work sleep disorder. Among them the first 10 were given a sleep diary used in previous insomnia studies. This sleep diary consisted of 7day report presented on a single page with a column for each day of the week. This format is similar to the one proposed recently as a consensus sleep diary by a committee of experts. The other 36 participants received a diary with a 24-h scale on each page. Both sleep diaries included 6 questions on sleep and wake time, and a question on medication, alcohol and caffeine use. Both formats used a sleepiness rating scale (Likert scale from ‘‘1’’ to ‘‘7’’) to be completed after each sleeping period. Results: 55.5% of the total sample (26 out of 46 participants) reported at least 3 sleep periods per day when working at night, 41.3% reported 2 sleep periods per day and only 1 participant reported 1 sleep period per day. The first 10 participants were unable to comply with the 7 columns for each day of the week diary. All of them reported that this version did not reflect the reality of their sleep schedules. A few added an extra column in order to report transitions before and after night shift. Most of them did not report napping periods as they consider that they had more than one sleep period per day rather than a nap. Most of them wanted to comment on their sleep difficulties occurring at different time point. The 36 participants using the second sleep diary format did not report any of these difficulties. Conclusion: Qualitative reports suggest that within the context of shift work, sleep diaries need to be adjusted in order to capture the sleep patterns over 24 h. Moreover, this tool will help clinicians to better investigate difficulties with sleep in the shift work population and to develop a treatment plan that better suits the reality of shift work sleep disorder. Acknowledgement: Supported by the Canadian Institutes of Health Research (#197171). http://dx.doi.org/10.1016/j.sleep.2013.11.413
Abstracts / Sleep Medicine 14S (2013) e165–e238
tine in order to measure the endogenous circadian rhythms. Participants resided in a dimly lit (<15 lux), time-free environment in semi-supine position. They followed ‘‘1-h days’’ which involved 20-min sleep opportunities alternating with 40-min of enforced wakefulness. Core body temperature and salivary melatonin were recorded hourly and best fit temperature curves and dim light melatonin onsets were determined to derive circadian period length measures from the 80-h of data. Results: Although core temperature period lengths showed a trend in DSPD to be longer than controls, this trend was not statistically significant in this study. However, the melatonin period length was on average 23.4 min longer (p = .010) in the DSPD group (M = 24.64 h, SD = 0.35) than the healthy control sleepers (M = 24.25 h, SD = 0.21). Conclusion: Together these findings suggest that abnormally long biological circadian rhythms contribute to delayed sleeping patterns of individuals with DSPD. These outcomes may explain patients’ persistent tendency to delay and relapse post-treatment. Therefore, continuing treatment with morning bright light stimulation and early evening low dose melatonin administration are recommended to treat DSPD and prevent relapse. Acknowledgement: Australian Research Council grant # DP120101401. http://dx.doi.org/10.1016/j.sleep.2013.11.411
Hypnosis for insomnia: an exaggerated myth or an underrated intervention? T. Lam Social Welfare Department, Approved Consultant/American Society of Clinical Hypnosis, Fellow/Royal Statistical Society, China
Introduction: Hypnosis is one of the oldest forms of complementary and alternative medicine as well as a psychological intervention. Derived from its Greek origin, the term was once mythically associated with sleep. Because hypnosis is commonly more related to relaxation and imagery under suggestion, the approach may be helpful to improve insomnia by reducing hyperarousal. This presentation discusses its components, effectiveness and potential for treating insomnia. Materials and methods: Review of literature on the nature, characteristics and components and measurements of hypnosis and critical appraisal of 6 randomized controlled trials (RCTs) from 1970s to 2000s identified from keywords search in databases on the components, treatment regime of hypnosis as well as study design, methodology and limitations. Results: Despite lacking a unique definition, some characteristics of hypnosis such as lack of voluntary initiation and a fading of generalized reality orientation are recognized. Hypnotic responses are often assessed by behavioural scales or self-reported inventories. Another practice to operationalize hypnosis is the use of hypnotizability scales to measure the extent a subject responds to standardized suggestions presented after a standardized hypnotic induction procedure. The appraisal of the studies found that methodological quality of the included studies was low. Limitations include imprecise enrollment criteria and diagnostic procedure, unclear randomization and allocation concealment methods, inadequate outcome assessment and descriptions of withdrawal and dropouts, and lack of adverse event monitoring. None of the reviewed RCTs have assessed the hypnotic responses or the success of blinding of participants, though some argue that blinding is not possible in hypnosis. Despite low quality, most RCTs reported that a significant improvement in sleep parameters could
be achieved in 4 weekly sessions or less and no adverse events were reported. Conclusion: Although the overall results suggested that hypnosis treatment was safe and efficacious for treating insomnia, due to the methodological limitations, the generalizabilty of the positive findings remained questionable. Future studies with larger sample size, better study design and methodological quality are needed to ascertain the efficacy of hypnosis for insomnia. Acknowledgements: This presentation is part of my research project for PhD candidature at the Department of Psychiatry, University of Hong Kong. http://dx.doi.org/10.1016/j.sleep.2013.11.412
Sleep diaries for shift workers M. Lamy 1, E. Bastille-Denis 2, A. Vallières 2 1 Centre d’étude des troubles du sommeil, Université Laval, Canada 2 Laval University, Canada
Introduction: Sleep diaries have long been the preferred method for collecting data on self-reported sleep over time in insomnia research. Only a few studies were dedicated to daily self-reports of sleep difficulties associated with shift work. The aim of this study is to qualitatively document the use of sleep diaries in the context of shift work and to present a diary template that reflects the reality of shift work. Materials and methods: The sample included 46 shift workers (86.9% women; mean age = 35.4 years old) taking part in a study on bio-psychosocial factors involved in the evolution of shift work sleep disorder. Among them the first 10 were given a sleep diary used in previous insomnia studies. This sleep diary consisted of 7day report presented on a single page with a column for each day of the week. This format is similar to the one proposed recently as a consensus sleep diary by a committee of experts. The other 36 participants received a diary with a 24-h scale on each page. Both sleep diaries included 6 questions on sleep and wake time, and a question on medication, alcohol and caffeine use. Both formats used a sleepiness rating scale (Likert scale from ‘‘1’’ to ‘‘7’’) to be completed after each sleeping period. Results: 55.5% of the total sample (26 out of 46 participants) reported at least 3 sleep periods per day when working at night, 41.3% reported 2 sleep periods per day and only 1 participant reported 1 sleep period per day. The first 10 participants were unable to comply with the 7 columns for each day of the week diary. All of them reported that this version did not reflect the reality of their sleep schedules. A few added an extra column in order to report transitions before and after night shift. Most of them did not report napping periods as they consider that they had more than one sleep period per day rather than a nap. Most of them wanted to comment on their sleep difficulties occurring at different time point. The 36 participants using the second sleep diary format did not report any of these difficulties. Conclusion: Qualitative reports suggest that within the context of shift work, sleep diaries need to be adjusted in order to capture the sleep patterns over 24 h. Moreover, this tool will help clinicians to better investigate difficulties with sleep in the shift work population and to develop a treatment plan that better suits the reality of shift work sleep disorder. Acknowledgement: Supported by the Canadian Institutes of Health Research (#197171). http://dx.doi.org/10.1016/j.sleep.2013.11.413