Sleep can be easily disrupted by variety of conditions. Most of medical illnesses could be a primary condition causing secondary insomnia. The common underlying mechanism of secondary insomnia is presumed to be stress effects on sleep. The assessment and treatment of secondary insomnia are often complicated. Establishing an causal inference between primary condition and insomnia is the key to assessment. However, it can be difficult even for experienced clinicians due to diagnostic ambiguity of secondary insomnia. Therefore, through medical evaluation and integrative understanding of primary condition is essential to manage secondary insomnia properly. Although treatment have been usually focused on the primary medical illnesses per se, nonpharmacologic interventions, such as sleep hygiene, might be effective in many cases.
Hygiene ; Sleep Initiation and Maintenance Disorders*

OBJECTIVES: The present study investigated current practices of insomnia treatment among Korean doctors in clinical settings. METHODS: A total of 100 doctors participated in the present study and filled out a series of survey questions regarding their treatment of insomnia patients. RESULTS: The results revealed that the primary type of insomnia treatment was pharmacological and that the most popular medication was zolpidem. The majority of doctors reported that they also utilized non-pharmacological treatments such as sleep hygiene education and cognitive-behavioral therapy. However, these treatments tended to result in low satisfaction. In addition, the doctors perceived that patients largely preferred pharmacological treatments to non-pharmacological ones and did not have sufficient knowledge of non-pharmacological treatments. CONCLUSION: Many doctors believed that non-pharmacological treatments for insomnia were important, but reported that they were difficult to implement in practice. The results of this study suggest that improved medical conditions for non-pharmacological treatments and education of physicians are necessary to appropriately treat insomnia.
Education ; Humans ; Hygiene ; Sleep Initiation and Maintenance Disorders*

Schizophrenia is a chronic, currently incurable, and devastating syndrome. Although sleep disturbances are not primary symptoms of schizophrenia, they are important aspects of schizophrenia. Difficulties initiating or maintaining sleep are frequently encountered in patients with schizophrenia. Many schizophrenics report low subjective sleep quality. Measured by polysomnography, increased sleep latency as well as reduced total sleep time, sleep efficiency, slow wave sleep, and rapid eye movement sleep latency (REM latency), are found in most patients with schizophrenia and appear to be an important aspect of the pathophysiology of this disorder. Some literatures suggest that worsening sleep quality precedes schizophrenic exacerbations. Co-morbid sleep disorders such as obstructive sleep apnea (OSA) and restless legs syndrome (RLS), and sleep-disrupting behaviors associated with schizophrenia may lead to sleep disturbances. Clinicians should screen the patient with sleep complaints for primary sleep disorders like OSA and RLS, and carefully evaluate sleep hygiene behaviors of all patients with schizophrenia who complain of sleep disturbances.
Antipsychotic Agents ; Humans ; Hygiene ; Polysomnography ; Restless Legs Syndrome ; Schizophrenia ; Sleep Apnea, Obstructive ; Sleep Wake Disorders ; Sleep, REM

Borderline personality disorder (BPD) is characterized by identity and interpersonal problem, affective dysregulation and pervasive severe impulsivity. Although sleep disturbances are not primary symptoms of BPD, they are important aspects of this disorder. However, clinicians and researchers did not give much attention to the sleep symptoms of BPD yet. Measured by nocturnal polysomnography, increased sleep latency as well as reduced total sleep time and sleep efficiency, and 'depression-like' REM abnormalities (i.e., reduced REM latency and increased REM density) are found in BPD patients. Co-morbid sleep disorders such as chronic insomnia, nightmare disorder or circadian rhythm sleep disorder associated with BPD have been reported. Clinicians should focus on the sleep complaints of BPD patients, and carefully manage such symptoms with sleep hygiene education, cognitive psychotherapy or light therapy.
Borderline Personality Disorder ; Circadian Rhythm ; Cognitive Therapy ; Dreams ; Humans ; Hygiene ; Phototherapy ; Polysomnography ; Sleep Wake Disorders ; Sleep Initiation and Maintenance Disorders

OBJECTIVES: It is very important to understand the personality characteristics of chronic insomniacs far diagnosis and treatment in clinical practice. The authors investigated the personality factors and the ways of coping to define the personality characteristics which underly the development of insomnia. METHODS: The authors used the diagnostic criteria of International Classification of Sleep Disorders to diagnose chronic insomnia, and performed 16 Personality Factors(PF) test and the Ways of Coping Checklist to both chronic insomniacs and normal controls. The diagnosis of chronic insomnia included psychophysiologic insomnia, poor sleep hygiene, and hypnotics dependent insomnia. The subjects were 21 chronic insomniacs and 26 normal controls. RESULTS: The chronic insomniacs showed significantly lower stableness(C factor ; 4.57 +/-1.89 VS 7.38+/-1.83), intelligence(B factor ; 3.76+/-2.23 VS 6.54+/-1.96), motivation distorsion(B factor ; 3.76+/-2.23 VS 6.54+/-1.96) factor scores, and higher guilt-proneness(O factor ; 6.67+/-2.11 VS 3.81+/-1.65), tension and anxiety(Q4, factor ; 7.57+/-2.29 VS 3.46+/-1.88) factor scores than controls in 16 PF. The chronic insomniacs had significantly higher emotional-focused coping(30.30+/-9.53 VS 24.52+/-5.71) and passive coping pattern scores(50.75+/-13.76 VS 43.26+/-8.73) than controls in the Ways of Coping Checklist. CONCLUSION: The authors suggest that chronic insomniacs are characterized by depressive mood and anxiety-proneness from low ego strength, high levels of anxiety and guilty feelings, and passive and emotion-concentrated coping pattern. This traits are supposed to be factors contributing the state of emotional arousal and resultant physiological activation that has developed and maintained the insomnia.
Anxiety ; Arousal ; Checklist ; Classification ; Diagnosis ; Ego ; Hygiene ; Hypnotics and Sedatives ; Motivation ; Sleep Wake Disorders ; Sleep Initiation and Maintenance Disorders

PURPOSE: This study was to examine the effects of sleep promoting program on sleep and the immune response in the elderly with insomnia. METHODS: The study was designed as a quasi-experimental, nonequivalent control group pre-post test design. Thirty two elders who suffered from insomnia (16 experimental and 16 control subjects) were selected among the elders who had been enrolled in two churches. The subjects in the experimental group participated in a sleep promoting program which was composed of sleep hygiene education and progressive muscle relaxation for 4 weeks. Data were analyzed using the SPSS/WIN. RESULTS: The experimental group showed higher sleep score than that of the control group (t = 7.86, p = .00). The experimental group showed higher sleep satisfaction score than that of the control group (t = 7.61, p = .00). The sleep promoting program was not effective in enhancing immune response. CONCLUSION: The sleep promoting program increased the sleep score, sleep-satisfaction score and B cell in immune response of elderly people suffering from insomnia. Therefore, sleep promoting program can be applied as an effective nursing intervention to promote sleep quality and sleep satisfaction.
Aged ; Evaluation Studies as Topic ; Humans ; Hygiene ; Muscle Relaxation ; Sleep Initiation and Maintenance Disorders ; Stress, Psychological

PURPOSE: Poor sleep hygiene can complicate any other syndrome producing insomnia complaint and must always be considered in any treatment. In clinical situation, it is important for Insomniacs to practice the sleep hygiene rule in treatment strategies. The authors investigated the recognition of sleep hygiene and the practice of it in general population, then provided the data available for physician to educate the sleep hygiene in treatment of insomnia. METHOD: The 330 subjects were at the age above 18 in Seoul, Korea. The questionnaire included the experience of insomnia and knowledge of caffeine, and 4 categories of sleep hygiene instruction, eg, homeostatic drive far sleep, circadian factors, drug effects, and arousal in sleep sleeper. The interview was done face to face by the investigators. RESULTS: In general, the knowledge about the drug effects on sleep was relatively poor. The degree of recognition of each item indicating organization of sleep and arousal in sleep setting was various. Poor sleeper showed no difference in recognition of sleep hygiene categories except drug effects on sleep compared to good sleeper, but they practiced sleep hygiene rules poorly in categories of homeostatic drive and arousal in sleep setting, though various by items. CONCLUSION: The findings, in which the degree of recognition of the items in 4 sleep hygiene categories was venous, indicated that sleep hygiene education should be done in details by each item. It seems like the poor sleeper practiced sleep hygiene poorly in categories of homeostatic drive and arousal in sleep setting compared to good sleeper. this finding suggested that the efforts, which reflected the behavioral patterns of insomniacs shown in clinical setting to get good sleep, frustrated the practice of sleep hygiene actively.
Arousal ; Caffeine ; Education ; Humans ; Hygiene* ; Korea ; Surveys and Questionnaires ; Research Personnel ; Seoul* ; Sleep Initiation and Maintenance Disorders

OBJECTIVES: To investigate the therapeutic effect of cranial electrotherapy stimulation (CES) with sleep hygiene in patients with chronic insomnia. METHODS: This study was designed as a prospective, double-blinded, and randomized controlled trial. Twenty-seven patients with chronic insomnia were recruited and randomly allocated to two groups; cranial microcurrent therapy (MC) group and sham group. All patients received sleep hygiene education. Pittsburgh Sleep Quality Index (PSQI) and Insomnia Severity Index (ISI) were measured at baseline (pre-treatment), and 2 weeks and 4 weeks of treatment. RESULTS: In MC group, the PSQI and ISI showed a tendency to decrease consistently until 4 weeks of treatment. In sham group, PSQI and ISI initially decreased during the first 2 weeks, but it increased after 2 weeks of treatment. CONCLUSIONS: This study showed that combination treatment of CES and sleep hygiene is more effective in treating chronic insomnia than sleep hygiene only as demonstrated by improvement and maintenance of sleep score for 1 month.
Education ; Electric Stimulation Therapy ; Humans ; Hygiene ; Prospective Studies ; Sleep Initiation and Maintenance Disorders

OBJECTIVES: Insomnia is one of the major concerns in the elderly population. Cognitive behavioral treatment for insomnia is the first line treatment option, but there are some limitations including time and cost burdens and the requirement for sufficient cognitive resources to obtain a proper treatment effect. The Brief intervention for insomnia (BII) is a treatment that focuses on behavioral aspects of insomnia in primary care practices. The purpose of this study was to evaluate the effects of BII in community-dwelling older adults. METHODS: A total of 47 older adults with insomnia were enrolled from community centers between May 2016 and January 2018. They participated in the BII program for three weeks. We gathered sleep-related participant information with using the Pittsburgh sleep quality index (PSQI), the Sleep hygiene index, and a sleep diary. Clinical efficacy was evaluated by comparing total sleep time (TST), sleep latency (SL), waking after sleep onset (WASO), and sleep efficiency (SE) before and after the treatment. RESULTS: There was significant improvement in sleep-related features after BII. Global score and sleep quality from the PSQI, freshness, and WASO from the sleep diary showed statistically significant improvement. CONCLUSION: We found BII showed positive clinical efficacy in community dwelling older adults, especially from the perspective of subjective sleep quality and WASO. This finding implies that BII can be effectively applied for the managment of elderly insomnia patients in a community setting.
Adult ; Aged ; Humans ; Hygiene ; Independent Living ; Primary Health Care ; Sleep Initiation and Maintenance Disorders ; Treatment Outcome

: We examined the nighttime sleep habits associated with insufficient sleep quantity and poor sleep quality among healthy preschool-aged Taiwanese children.: The study population of this cross-sectional survey was a stratified random sample of 3 to 6-year-old preschool children from 19 cities and counties in Taiwan. A caregiver-administered questionnaire was used to collect information on preschooler sleep quantity (sleep duration and sleep latency) and sleep quality (sleep disturbances and disruption) and potentially related sleep habits.: Of the 1253 children for whom analysable survey data were collected (children's mean age: 5.03 ± 1.27 years), more than half (53.07%) engaged in bedtime television (TV)-viewing, 88.95% required a sleep reminder, 43.85% exhibited bedtime resistance, 93.6% engaged in co-sleeping (bed-sharing or room-sharing), and only 33.72% slept in a well darkened bedroom. Bedtime TV-viewing, co-sleeping, bedroom light exposure, and bedtime resistance were the primary predictors, without a bedtime TV-viewing habit was the strongest predictor analysed; it explained 15.2% and 19.9% of the variance in adequate sleep quantity and improved sleep quality in preschool children.: Sleep loss and poor sleep quality in preschool children could be alleviated, at least partly, by curtailing bedtime TV-viewing, limiting light exposure during sleeping, and reducing bed-sharing habit.
Child ; Child Behavior ; Child, Preschool ; Cross-Sectional Studies ; Female ; Humans ; Lighting ; Male ; Sleep ; Sleep Deprivation ; Sleep Hygiene ; Surveys and Questionnaires ; Taiwan ; Television