Moderators of Cognitive Behavioral Treatment for Insomnia on Depression and Anxiety Outcomes

Effect of Qi-based mindfulness therapy for mild-to-moderate depression

BACKGROUND

Depression is a disorder characterized by significant and persistent depressed mood, cognitive impairment, impaired voluntary activity, working memory, and somatic symptoms.

AIM

To determine the efficacy of Qi-based mindfulness therapy (QMT) in treating anxiety, depression, and sleep disturbances in individuals with mild-to-moderate depression.

METHODS

A self-controlled before–after trial was conducted. The study invited online participants for recruitment between May and July 2023. Participants (n = 18) aged 18-65 years with mild-to-moderate depression, who were receiving QMT training for 4 weeks, were included. The primary efficacy indicators were the 17 Hamilton Depression Rating Scale and Hamilton Anxiety Scale scores. The secondary outcome indicators included the Zung Self-rating Depression Scale, the self-rating Anxiety Scale, and the Insomnia Severity Index. Pre- and post-intervention assessments were conducted. The patients’ symptoms related to depression, anxiety, and insomnia were reassessed 4 weeks after the post-intervention evaluation.

RESULTS

Patients who underwent the QMT intervention for 4 weeks exhibited a statistically significant reduction in scores on the 17 Hamilton Depression Rating Scale, Hamilton Anxiety Scale, the Zung Self-Rating Depression Scale, the Self-Rating Anxiety Scale, and the Insomnia Severity Index relative to their pre-intervention scores (all P < 0.05).

CONCLUSION

QMT training for 4 weeks is an effective nonpharmacological treatment for symptoms of depression, anxiety, and insomnia among patients with mild-to-moderate depression.

Digital cognitive behavioral therapy as a novel treatment for insomnia

BACKGROUND

As a substitute for traditional drug therapy, digital cognitive-behavioral therapy positively impacts the regulation of brain function, which can improve insomnia. However, there is currently a paucity of studies on digital cognitive behavioral therapy as a treatment for insomnia.

AIM

To assess digital cognitive behavioral therapy for insomnia regarding its positive impact on brain function.

METHODS

Participants were randomly assigned to either a go/no-go group or a dot-probe group. The primary outcome was quality of sleep as assessed by the actigraphy sleep monitoring bracelet, Pittsburgh sleep quality index (PSQI), insomnia severity index (ISI), and depression anxiety and stress scale (DASS-21).

RESULTS

Eighty patients were included in the analysis (go/no-go group: n = 40; dot-probe group: n = 40). We combined the total scale scores of the two groups before and after the intervention in the analysis of covariance. Our study explored whether insomnia symptoms in both groups can be improved by using digital cognitive behavioral therapy instead of trying to compare the two trials; therefore, only one P value is listed. In both groups, we found a short-term time effect on insomnia symptom severity (PSQI: P < 0.001, η² = 0.336; ISI: P < 0.001, η² = 0.667; DASS-depression: P < 0.001, η² = 0.582; DASS-anxiety: P < 0.001, η² = 0.337; DASS-stress: P < 0.001, η² = 0.443) and some effect on sleep efficiency (but it was not significant, P = 0.585, η² = 0.004).

CONCLUSION

Go/no-go task training of inhibitory function had a short-term positive effect on sleep efficiency, whereas dot-probe task training had a positive short-term effect on emotion regulation.

Antepartum insomnia symptoms and its association with postpartum depression symptoms in women with and without psychiatric vulnerability: A prospective cohort study

BACKGROUND

Postpartum depression is common and may be linked to antepartum insomnia, a potentially modifiable risk factor. We examine the association between insomnia- and postpartum depression symptoms, considering whether psychiatric vulnerability moderates this link.

METHOD

Participants completed the Insomnia Severity Index during trimester two and three and the Hospital Anxiety and Depression questionnaire postpartum. Linear regression analyses were used to investigate the associations between antepartum insomnia- and postpartum depression symptoms. We used stratified regression models and a test for multiplicative interaction to understand if psychiatric vulnerability moderates this association.

RESULTS

A total of 217 women participated (median age 37, IQR 5). Women with clinically significant insomnia symptoms in trimester two and three reported higher postpartum depression symptoms (p = .008 and p = .002 respectively). Linear regression analyses showed effect sizes that were almost equal for both trimesters (two: β = 0.19, 95 % CI -0.20., 0.40, p = .069 and three: β = 0.23, 95 % CI 0.09., 0.36, p ≤ .001), but only statistically significant for trimester three. When antepartum depression was taken into account, neither the second nor third trimester was significantly associated with postpartum depressive symptoms. Psychiatric vulnerability did not moderate the relationship (p = .163).

CONCLUSION

Insomnia symptoms in the second and third trimesters are not associated with postpartum depression when antepartum depression is taken into account in both women with and without psychiatric vulnerability. Hence it is important to screen for both insomnia and depression during pregnancy to prevent postpartum depression in all pregnant women.

The applicability and effectiveness of the cognitive behavioral therapy for insomnia (Smart CBT-I plus) online program in patients with insomnia disorder combined with anxiety and depression: a randomized controlled trial protocol

Background

Insomnia is often accompanied by depression and anxiety, which can seriously affect people's quality of life. Cognitive behavioral therapy for insomnia (CBT-I) is the first-line treatment, but the existing CBT-I ignores the intervention for anxiety-depressive symptoms, and has poor efficacy due to the lack of artificial support, poor compliance, the inability to spread widely and high dropping rate. A balance is needed between the convenience and efficiency of web-based technology and patient needs. Again in this context, an online WeChat applet (Smart CBT-I plus) will be developed with CBT-I technology as the core, integrating cognitive behavioral intervention modules for depression and anxiety.

Objectives

This study will validate the effectiveness and applicability of Smart CBT-I plus by examining whether the Smart CBT-I plus study group will significantly reduce the distress of people suffering from insomnia with anxiety and/or depression symptoms compared to the psychoeducational group.

Methods

In this parallel-group, randomized controlled trial, 180 patients seeking help for insomnia combined with anxiety and/or depression will be recruited, and they will be randomized with 60 patients being assigned to the psychoeducation group (control group), and 120 patients being assigned to the Smart CBT-I plus group (study group). Measurements will be taken at baseline, post-intervention, 6 and 12 month follow-up, at the same time, semi-structured qualitative interviews about the experience of using Smart CBT-I plus will be conducted with randomly selected patients from the study group.

Results

The results will involve insomnia, depression and anxiety to explore its effectiveness, in-treatment dropout rates and subjective patient feedback to explore the applicability of Smart CBT-I plus.

Future recommendations

Self-help platforms need to be more individually designed to reach a wider audience. Research aimed at a wider audience, such as the general public, will make the research more universal and the platform more meaningful.

Advances in the research of comorbid insomnia and depression: mechanisms, impacts, and interventions

Insomnia and depression, both significantly impacting public health, are common psychosomatic illnesses that frequently co-occur in the same individual. Not only do these two conditions commonly co-occur, but they also exhibit a bidirectional link, where the existence of one may heighten the risk for the other. Latest research offers compelling evidence of significant overlap in biological, psychological, and sociological aspects in the comorbidity of insomnia and depression. Building on this, we aim to examine the pathophysiology of insomnia and depression, along with their comorbid mechanisms, encompassing biological routes (like genetics, HPA axis, immune-inflammatory activation, neuroendocrine regulation, microbiome alterations, and neural circuits integrating sleep and emotion regulation), as well as psychosocial routes. Consequently, proposing a self-perpetuating and mutually reinforcing "snowball effect" model of comorbid insomnia and depression, and examining corresponding preventative intervention strategies to rectify associated imbalances. Finally, this article encapsulates the challenges in this field of study and the directions for future research. Finally, the paper points out the limitations of current research (cross-sectional data being dominant, and the mechanism of multi-omics dynamics being unknown) and the future direction (longitudinal cohort combined with computational modeling to resolve temporal interactions), which will provide a theoretical basis for precision interventions.

Depression and anxiety in patients with atopic dermatitis: Recognizing and addressing mental health burden

The psychosocial burden of atopic dermatitis (AD) is extensive, stemming from intense itch, sleep disturbance, unpredictable flares, lifestyle restrictions and missed activities, social stigma, and treatment burden. Overall, adults with AD are at a 2- to 3-fold greater risk for depression and anxiety compared with individuals without AD and children at a 1.5-fold greater risk, with greatest risk for those with more severe disease. A number of mechanisms seem to affect the relationship between AD and mental health, including poorly controlled disease, sleep disturbance, stress-induced itch, inflammation, and coping patterns. In some cases, the mental health burden of AD may also negatively affect AD management and course, creating a reinforcing cycle of psychosocial burden. Although depression and anxiety are known comorbidities of AD, the mental health burden of AD often goes unaddressed, which may further a sense of isolation for patients and families. Given the strong association between symptom severity and increased mental health burden, optimizing AD treatment and reducing itch are critical. Health care professionals can support patients with AD and their caregivers by encouraging open conversations about mental health, addressing common areas of condition-related stress, screening for depression and anxiety, and facilitating referrals to mental health professionals for further assessment and evidence-based care. Existing research supports use of cognitive-behavioral interventions to help manage the physical and mental health burden of AD. Further research is needed to evaluate psychological interventions for pediatric patients with AD and for patients with clinical diagnoses of depression and anxiety to better guide shared decision-making around support for these patients.

Digital Cognitive Behavioral Therapy-Based Treatment for Insomnia, Nightmares, and Posttraumatic Stress Disorder Symptoms in Survivors of Wildfires: Pilot Randomized Feasibility Trial

BACKGROUND

Symptoms of insomnia, nightmares, and trauma are highly prevalent. However, there are significant barriers to accessing evidence-based treatments for these conditions, leading to poor mental health outcomes.

OBJECTIVE

This pilot trial evaluated the feasibility of a 4-week, digital self-paced intervention combining cognitive behavioral therapy for insomnia and exposure, relaxation, and rescripting therapy for nightmares in survivors of wildfires from Australia, Canada, and the United States.

METHODS

Study participants were recruited between May 2023 and December 2023 through social media platforms, workshops, conferences, and radio interviews. Participants had to meet at least one of the following criteria: a score of ≥8 on the Insomnia Severity Index, a score of ≥3 on the Nightmare Disorder Index, or a score of ≥31 on the PTSD Checklist for DSM-5. In total, 30 survivors of wildfires were allocated to either the treatment group (n=16, 53%) or the waitlist control group (n=14, 47%) in a sequential manner. Participants' ages ranged from 18 to 79 years, with a mean age of 52.50 (SD 16.26) years. The cohort consisted of 63% (19/30) female and 37% (11/30) male participants. Participants also completed self-report secondary outcome measures, including the Generalized Anxiety Disorder-7, the Patient Health Questionnaire-9, and the Pittsburgh Sleep Quality Index, via the HealthZone digital platform. Assessments were conducted at baseline, the posttreatment time point, and the 3-month follow-up, with the waitlist group undergoing an additional assessment at the pretreatment time point, after 4 weeks of waiting and before crossing over to treatment. This study used intention-to-treat analysis as a primary analysis and per-protocol analysis as a secondary analysis.

RESULTS

Mixed-effects linear regression models and difference-in-differences analyses were used to assess the intervention's effects. The intention-to-treat analysis revealed significant improvements over time (main effect of time), with a 1.64-point reduction (P=.001) on the Nightmare Disorder Index and 10.64-point reduction (P=.009) on the PTSD Checklist for DSM-5 at the postintervention time point. No significant changes were observed in insomnia symptoms. On the secondary measures, there was an interaction effect of condition × time, with a 2.22-point reduction (P<.001) on the Pittsburgh Sleep Quality Index, and a main effect of time, with a 6.48-point reduction (P<.001) on the Patient Health Questionnaire-9. No changes were detected on the Generalized Anxiety Disorder-7. The per-protocol analysis yielded comparable results for both the primary and secondary measures.

CONCLUSIONS

The findings of this pilot trial demonstrated a reduction in nightmares and trauma symptoms. Future research studies should aim at evaluating the intervention in a more definitive trial with a larger sample size.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12623000415606; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=385054.

Stress, Anxiety and Depressive Symptoms, Burnout and Insomnia Among Greek Nurses One Year After the End of the Pandemic: A Moderated Chain Mediation Model

Background/Objectives: Several studies have reported alarming rates of mental health issues and sleep problems among nurses even in the post-pandemic era. The objective was to investigate the prevalence of stress, anxiety and depressive symptoms, burnout and insomnia among nurses in Greece one year after the end of the pandemic and to construct a mediation model evaluating the impact of stress on insomnia, the chain mediating roles of depressive symptoms and burnout, as well as the moderating role of anxiety symptoms in the model. Methods: This cross-sectional study was conducted online in July 2024 and included 380 hospital nurses who completed the Depression Anxiety Stress Scale (DASS-21), the Copenhagen Burnout Inventory (CBI) and the Athens Insomnia Scale (AIS). Results: The prevalence rates of stress, anxiety and depressive symptoms, burnout and insomnia were 33.9% with 95% confidence interval (CI): [0.292, 0.390], 33.3% (95% CI: [0.284, 0.381]), 35% (95% CI: [0.302, 0.400]), 46.8% (95% CI: [0.399, 0.502]) and 56.1% (95% CI: [0.509, 0.611]), respectively. Multiple regression analysis indicated that the Depression subscale of the DASS-21 explained 40.6% of the variance in the AIS, while an additional 7.6% was explained by the CBI and another 1.3% rate by the Stress subscale of the DASS-21. Mediation analysis revealed that stress affected insomnia both directly and indirectly through the chain mediating roles of depressive symptoms and burnout. Anxiety symptoms moderated the chain mediation path by enhancing the negative impact of stress on depressive symptoms. Conclusions: The proposed moderated chain mediation model introduces certain factors influencing insomnia and explains how changes in any one of these factors effectuate changes in the other factors, offering insights for individualized interventions.

Efficacy of electroacupuncture in the treatment of insomnia in cancer patients: A meta-analysis

BACKGROUND

The purpose of this meta-analysis of current studies was to assess the efficacy of electroacupuncture for cancer-related insomnia.

METHODS

A comprehensive search was conducted encompassing randomized controlled trials examining the efficacy of electroacupuncture in treating cancer-related insomnia across CNKI, VIP, Wang Fang, PubMed, Embase, Cochrane library, and Web of Science, with a search deadline of December 26, 2023. The Cochrane manual's risk-of-bias evaluation was used for quality assessment, while Stata 15.0 was used for the data analysis.

RESULTS

Eight randomized controlled studies involving 537 individuals were finally included. Meta-analysis results suggested that electroacupuncture improved total sleep time [SMD = 0.68, 95% CI (0.31, 1.06)], sleep efficiency [SMD = 1.26, 95% CI (0.02, 2.50)], and reduced Pittsburgh sleep quality index [SMD = -0.44, 95% CI (-0.63, -0.25)], insomnia severity index [SMD = -1.23, 95% CI (-1.88, -0.58)], and sleep onset latency [SMD = -0.76, 95% CI (-1.36, -0.15)] in cancer patients.

CONCLUSION

Based on the current study, we found that electroacupuncture may have a better effect on insomnia in cancer patients.

Why is vestibular migraine associated with many comorbidities?

Vestibular migraine (VM) is a usual trigger of episodic vertigo. Patients with VM often experience spinning, shaking, or unsteady sensations, which are usually also accompanied by photophobia, phonophobia, motor intolerance, and more. VM is often associated with a number of comorbidities. Recurrent episodes of VM can affect the patient's emotions, sleep, and cognitive functioning to varying degrees. Patients with VM may be accompanied by adverse moods such as anxiety, fear, and depression, which can gradually develop into anxiety disorders or depressive disorders. Sleep disorders are also a common concomitant symptom of VM, which significantly lower patients' quality of life. The influence of anxiety disorders and sleep disorders may reduce cognitive functions of VM, such as visuospatial ability, attention, and memory decline. Clinically, it is also common to see VM comorbid with other vestibular disorders, making the diagnosis more difficult. VM episodes are relieved but lingering, in which case VM may coexist with persistent postural-perceptual dizziness (PPPD). Anxiety may be an important bridge between recurrent VM and PPPD. The clinical manifestations of VM and Meniere's disease (MD) overlap considerably, and those who meet the diagnostic criteria for both can be said to have VM/MD comorbidity. VM can also present with positional vertigo, and some patients with VM present with typical benign paroxysmal positional vertigo (BPPV) nystagmus on positional testing. In this paper, we synthesize and analyze the pathomechanisms of VM comorbidity by reviewing the literature. The results show that it may be related to the extensive connectivity of the vestibular system with different brain regions and the close connection of the trigeminovascular system with the periphery of the vestibule. Therefore, it is necessary to pay attention to the diagnosis of comorbidities in VM, synthesize its pathogenesis, and give comprehensive treatment to patients.

CBT-I for prevention and early intervention in mental disturbances: A systematic review and meta-analysis

Insomnia is well-known to be both a risk factor and a prodrome for psychiatric disorders, including mood, anxiety and psychotic disorders, as well as for suicide risk. In this framework, targeting insomnia may constitute a preventive strategy or an early intervention against the development or the recurrence of psychiatric disorders. Cognitive behavioral therapy for insomnia (CBT-I) is considered the first line treatment for chronic insomnia, even when comorbid with psychiatric disorders. Accordingly, the present work aimed at systematically reviewing available data on the effects of CBT-I for prevention or early intervention of psychiatric disorders.

METHOD

The available data on the effect of CBT-I on insomnia and mental health prevention/early intervention were systematically reviewed. We conducted a systematic search on PubMed, Scopus, Psychinfo electronic databases for English literature, published until March 2024, according to PRISMA Guidelines.

RESULTS

From the literature systematic search, 83 articles were eligible, and, at end, 11 studies were retained. Seven randomized controlled-trials examined the effects of CBT-I for the prevention of depressive symptoms, 1 for anxiety disorder, 1 for psychotic disorders, and 4 for suicidal risk. Results of meta-analyses on depressive symptoms showed that CBT-I for insomnia was effective in reducing depressive (z = -6.8466, p < 0.0001; RE Model = -0.5168 (95 % CI: 0.6648 to -0.3689); k = 6), and insomnia symptoms as well (z = -3.7126, p = 0.0002; RE Model = -0.8074 (95 % CI: 1.2336 to -0.3811); k = 5). Studies indicated some heterogeneities among them that may limit interpretations, with the impossibility of meta-analyzing suicidal, anxiety, and psychotic symptoms.

CONCLUSIONS

Currently data support the hypothesis that targeting insomnia with CBT-I may represent an early effective intervention in mental disorders, especially mood disorders.

Sleep disorder risk, perceived control over sleep, and mental health symptoms in paramedicine students

Paramedics commonly experience both poor sleep and mental health symptoms. Clarifying whether sleep or mental health symptoms are a challenge prior to commencement of employment is important, as early prevention and intervention initiatives during training could support these workers. Paramedicine students (n=53) were included, with sleep disorder screening (obstructive sleep apnea, insomnia and restless legs syndrome), and mental health outcomes (depressive symptoms: Patient Health Questionnaire-9, and anxiety symptoms: General Anxiety Disorder-7). Data were analysed using robust regression models, adjusted for age, sex, and shift work status. Meeting criteria for a sleep disorder (n=21) was associated with higher scores for anxiety (8.2 [95% CI: 5.9-10.5] v 4.6, [3.4-5.8]) and depressive symptoms (11.1 [8.6-13.6] v 4.4 [3.1-5.7)] compared to those who did not meet the criteria for a sleep disorder (n=32). Depressive symptoms were lower in those with perceived control over sleep (5.2 [3.2-7.2] v 9.8 [7.7-11.8]). There was no interaction between sleep disorder risk and perceived control over sleep on mental health symptoms. Investigation and management of factors contributing to low perceived control over sleep, together with early screening and management of sleep disorders, are likely to be important priorities to support paramedic student wellbeing prior to commencing shift work.

Efficacy and safety of non-pharmacological interventions for cancer-related insomnia: a study protocol for a systematic review and network meta-analysis

INTRODUCTION

Cancer-related insomnia (CRI), a significant concurrent symptom of cancer, profoundly impacts patients. Non-pharmacological interventions include cognitive behavioural therapy, mindfulness-based stress reduction programmes, bright light, acupuncture, exercise and music therapies and tai chi. These approaches, unlike pharmacological treatments, exhibit minimal adverse effects, without drug-drug interactions. They are a promising treatment strategy for CRI patients. However, a comprehensive comparative study evaluating the efficacy and safety of all non-pharmacological interventions for CRI is lacking. Accordingly, we aim to conduct a relatively comprehensive systematic review and network meta-analysis.

METHODS AND ANALYSIS

We will conduct an extensive search across various databases, including Pubmed, Web of Science, Cochrane Library, Embase, Google Scholar, China National Knowledge Infrastructure (CNKI), China Biomedical Literature Database (CBM), Wanfang and Vip databases (VIP). The search will focus on non-pharmacological therapeutic interventions related to CRI in randomised controlled trials published from the inception of these databases until 15 May 2024. The primary outcomes of this study will encompass the Pittsburgh Sleep Quality Index (PSQI) and the Insomnia Severity Index (ISI), while the secondary outcomes will evaluate sleep parameters, fatigue levels, anxiety-depressive mood, quality of life and any potential adverse effects. Paired meta-analyses and network meta-analyses will be conducted utilising ADDIS V.1.16.8, Stata V.14.2 and V.R4.1.2. Bias risk will be independently assessed using the Cochrane Risk of Bias tool (ROB V.2.0), and the evidence quality will be evaluated according to Grading of Recommendations Assessment, Development, and Evaluation (GRADE) standards.

ETHICS AND DISSEMINATION

There are no ethical issues as this study did not conduct any experiments, surveys, or human trials. We will ensure that the findings are shared through pertinent channels.

PROSPERO REGISTRATION NUMBER

CRD42023427752.

Trait-based Anxiety Symptoms are Associated with Higher Incidence of Nightmare Frequency in the Wisconsin Sleep Cohort

OBJECTIVES

Nightmares affect up to 12% of the population and are often comorbid with psychiatric disorders like anxiety and depression. Limited research has examined their influence on nightmare frequency. This study investigates the relationship between depression and trait-anxiety symptoms on incident nightmare frequency at follow-up.

METHOD

Cross-sectional and longitudinal analyses were conducted on 758 Wisconsin Sleep Cohort participants. Trait anxiety and depression symptom severity were measured using the State Trait Anxiety Inventory and Zung Depression Scale. Ordinal regression determined nightmare frequency cutoffs based on anxiety and depression severity. Cross-sectional associations were assessed with Spearman and Kruskal-Wallis tests. Longitudinal associations were analyzed using adjusted binomial regression of binary nightmare frequency (low: <4/month, high: >5/month) against clinical cutoffs of trait anxiety and depression.

RESULTS

Adjusted models indicated a small correlation between baseline nightmare frequency and trait anxiety (β = 0.01, p = .010) and depression symptoms (β = 0.01, p = .005). High baseline trait-anxiety symptoms were associated with frequent nightmares at follow-up (OR = 3.75, CI95% [1.306,10.793], p < .014), but depression symptoms were not (OR = 1.35, CI95%[0.399, 4.587], p = .627).

CONCLUSIONS

Our findings suggest that high trait-anxiety symptoms are associated with increased incident nightmare frequency, when adjusted for depression. However, high depression symptoms were not associated with an increase in nightmare frequency when adjusted for trait-anxiety.

Sleep Quality and Urinary Incontinence in Prostate Cancer Patients: A Data Analytics Approach with the ASCAPE Dataset

BACKGROUND

The ASCAPE project aims to improve the health-related quality of life of cancer patients using artificial intelligence (AI)-driven solutions. The current study employs a comprehensive dataset to evaluate sleep and urinary incontinence, thus enabling the development of personalized interventions.

METHODS

This study focuses on prostate cancer patients eligible for curative treatment with surgery. Forty-two participants were enrolled following their diagnosis and were followed up at baseline and 3, 6, 9, and 12 months after surgical treatment. The data collection process involved a combination of standardized questionnaires and wearable devices, providing a holistic view of patients' QoL and health outcomes. The dataset is systematically organized and stored in a centralized database, with advanced statistical and AI techniques being employed to reveal correlations, patterns, and predictive markers that can ultimately lead to implementing personalized intervention strategies, ultimately enhancing patient QoL outcomes.

RESULTS

The correlation analysis between sleep quality and urinary symptoms post-surgery revealed a moderate positive correlation between baseline insomnia and baseline urinary symptoms (r = 0.407, p = 0.011), a positive correlation between baseline insomnia and urinary symptoms at 3 months (r = 0.321, p = 0.049), and significant correlations between insomnia at 12 months and urinary symptoms at 3 months (r = 0.396, p = 0.014) and at 6 months (r = 0.384, p = 0.017). Furthermore, modeling the relationship between baseline insomnia and baseline urinary symptoms showed that baseline insomnia is significantly associated with baseline urinary symptoms (coef = 0.222, p = 0.036).

CONCLUSIONS

The investigation of sleep quality and urinary incontinence via data analysis through the ASCAPE project suggests that better sleep quality could improve urinary disorders.

Independent and combined effect of serum copper and folate on depression: cross-sectional data from the NHANES 2011-2016

Background and objective

Depression is a widespread mental health condition that can impact both mental and physical well-being. Prior research has shown that high levels of copper in the blood and low levels of folate are linked to depression. This study aimed to explore whether serum folate levels, independently or in combination with serum copper levels, associated with the risk of depression.

Methods

Data from participants aged 18-80 years in the National Health and Nutrition Examination Survey (NHANES) from 2011 to 2016 were analyzed to examine the role of trace elements. Depression was assessed using the nine-item Patient Health Questionnaire (PHQ-9). Logistic regression analyses were employed to evaluate the main effect of serum copper and folate levels on depression. Three indices, including the relative excess risk of interaction (RERI), attributable proportion of interaction (API), and synergy index (SI), were used to analyze the interaction effect.

Results

Among the 4,847 participants selected for this study, 429 (8.9%) had PHQ-9 scores above 10, which we defined as having depressive symptoms. After adjusting for all confounding factors, higher serum copper levels [≥15.5 vs. <15.5 μmol/L, odds ratio (OR): 1.54; 95% confidence intervals (CI): 1.18-2.11] and folate deficiency (folate ≥53.7 vs. <53.7 μmol/L, OR: 1.44; 95% CI: 1.21-2.10) were associated with an increased risk of depression. Patients with both higher serum copper levels and folate deficiency (OR: 2.11; 95% CI: 1.43-3.14) had the highest risk of depression than other levels. High copper levels and low folate levels are associated with the occurrence of depression symptoms, and there may be a synergistic effect between them (SI: 1.65; 95% CI: 1.49-4.76), with this interaction accounting for 19% of depression cases (API: 0.19; 95% CI: 0.01-0.54).

Conclusion

There may be a synergistic interaction between high copper levels and low folate levels associated with increasing risk of depression. Further population-based interventional studies are needed to confirm whether folic acid supplementation is effective in preventing depression in individuals with high blood copper levels.

Individualized Homeopathic Treatment for Persistent Insomnia and Generalized Anxiety Disorder: A Case Report

Insomnia is a widespread disease that tends to be associated with other problems, like anxiety. The most frequent anxiety disorder is generalized anxiety disorder (GAD), which is characterized by excessive worrying about everyday situations. Medications for insomnia and anxiety can have adverse reactions and the latter may be ineffective in up to 30% of patients. Here we present a case report of a 27-year-old male patient who suffered from persistent insomnia with comorbid GAD and schizophreniform disorder. Initially, he was taking alprazolam, paroxetine, and risperidone, which had a less-than-satisfactory effect. He was treated with individualized homeopathy, which produced a remarkable improvement within four months. This was evidenced by a decrease in difficulty falling asleep and daytime sleepiness; in addition, anxiety and its accompanying symptoms, such as irritability and diaphoresis, were reduced. This improvement persists for up to one year after the commencement of treatment and despite discontinuation of all medications. This clinical report provides preliminary evidence that persistent insomnia and comorbid GAD can be treated successfully with individualized homeopathy. However, further randomized controlled studies are needed to evaluate its efficacy, effectiveness, and safety more conclusively.

Factors influencing the effectiveness of digital cognitive behavioural therapy for chronic insomnia in clinical practice

Digital cognitive behavioural therapy for chronic insomnia (D-CBT-I) has been shown to be as efficacious as traditional CBT-I. However, not all patients achieve insomnia remission after treatment. We explored the factors influencing the effectiveness of D-CBT-I in a clinical practice. A total of 414 Asian chronic insomniacs were studied during a 6 week D-CBT-I intervention. All patients were assessed at baseline and posttreatment and were determined to be remitters or non-remitters, responders or non-responders by posttreatment criteria; Insomnia Severity Index (ISI <8) or ISI reduction ≥8, to examine whether remission and response status were associated with patient baseline characteristics. The average baseline ISI score in all subjects was 16.29 points. At posttreatment, 192 (46.4%) patients achieved ISI remission and 218 (52.7%) patients demonstrated an ISI response. An increased baseline early morning awakening time and ISI score were independently associated with a lower odds for remission (OR, 0.995 and 0.991, respectively). Increased baseline Patients Health Questionnaire-9 score was independently associated with higher odds for response (OR, 1.114). Our results suggest that D-CBT-I can be recommended as the first-line treatment for chronic insomnia, particularly in insomniacs with milder insomnia symptoms and more severe depressive symptoms. Meanwhile, the effectiveness of D-CBT-I was adversely affected by longer early morning awakening time and higher insomnia severity at pretreatment, which may be improved by more intense intervention and greater therapeutic support or by traditional CBT-I.

Treating Depression to Improve Survival in Coronary Heart Disease: What Have We Learned?

Major depressive disorder is a well-established risk factor for cardiac events in patients with coronary heart disease, but clinical trials have produced little evidence that treating depression reliably improves cardiac event-free survival in these patients. In this review, we offer evidence that certain symptoms that commonly remain after otherwise successful treatment of depression-insomnia, fatigue, and anhedonia-independently predict cardiac events. This may help to explain the failure of previous depression treatment trials to improve cardiac event-free survival even when other symptoms of depression improve. We thus propose that adverse cardiovascular effects that have long been attributed to syndromal depression may be instead caused by persistent fatigue, insomnia, and anhedonia, regardless of whether other symptoms of depression are present. We also identify interventions for these symptoms and call for more research to evaluate their effectiveness in depressed patients with coronary heart disease.

Latent profile analysis of depression in US adults with obstructive sleep apnea hypopnea syndrome

Objective

This study used latent profile analysis to explore the level of depression among US adults with obstructive sleep apnea hypopnea syndrome (OSAHS) symptoms and to identify different latent categories of depression to gain insight into the characteristic differences between these categories.

Methods

The data of this study were obtained from the National Health and Nutrition Examination Survey (NHANES) database, and the subjects with OSAHS symptoms were aged 18 years and older. The latent profile analysis (LPA) method was used to fit the latent depression categories in subjects with OSAHS symptoms. The chi-square test, rank sum test, and binary logistic regression were used to analyze the influencing factors of depression subgroups in subjects with OSAHS symptoms.

Results

Three latent profiles were identified: low-level (83.7%), moderate-level (14.5%) and high-level (1.8%) depression. The scores of 9 items in the high-level depression group were higher than those in the other two groups. Among them, item 4 "feeling tired or lack of energy" had the highest score in all categories.

Conclusion

Depression in subjects with OSAHS symptoms can be divided into low-level, moderate-level and high-level depression. There are significant differences among different levels of depression in gender, marital status, PIR, BMI, smoking, general health condition, sleep duration and OSAHS symptom severity.

Relationship of Sleep Disorder with Neurodegenerative and Psychiatric Diseases: An Updated Review

Sleep disorders affect many people worldwide and can accompany neurodegenerative and psychiatric diseases. Sleep may be altered before the clinical manifestations of some of these diseases appear. Moreover, some sleep disorders affect the physiological organization and function of the brain by influencing gene expression, accelerating the accumulation of abnormal proteins, interfering with the clearance of abnormal proteins, or altering the levels of related hormones and neurotransmitters, which can cause or may be associated with the development of neurodegenerative and psychiatric diseases. However, the detailed mechanisms of these effects are unclear. This review mainly focuses on the relationship between and mechanisms of action of sleep in Alzheimer's disease, depression, and anxiety, as well as the relationships between sleep and Parkinson's disease, Huntington's disease, and amyotrophic lateral sclerosis. This summary of current research hotspots may provide researchers with better clues and ideas to develop treatment solutions for neurodegenerative and psychiatric diseases associated with sleep disorders.

Circadian rhythms and mood disorders: Time to see the light

The importance of time is ever prevalent in our world, and disruptions to the normal light/dark and sleep/wake cycle have now become the norm rather than the exception for a large part of it. All mood disorders, including seasonal affective disorder (SAD), major depressive disorder (MDD), and bipolar disorder (BD), are strongly associated with abnormal sleep and circadian rhythms in a variety of physiological processes. Environmental disruptions to normal sleep/wake patterns, light/dark changes, and seasonal changes can precipitate episodes. Moreover, treatments that target the circadian system have proven to be therapeutic in certain cases. This review will summarize much of our current knowledge of how these disorders associate with specific circadian phenotypes, as well as the neuronal mechanisms that link the circadian clock with mood regulation. We also discuss what has been learned from therapies that target circadian rhythms and how we may use current knowledge to develop more individually designed treatments.

Effect of Sleep Quality on Anxiety and Depression Symptoms among College Students in China's Xizang Region: The Mediating Effect of Cognitive Emotion Regulation

BACKGROUND

While the exact mechanisms are not fully understood, there are significant links between sleep quality, anxiety, depressive symptoms, and cognitive emotion regulation. This research examines how sleep quality affects anxiety and depressive symptoms, as well as the potential of cognitive emotion regulation strategies (CERS) to moderate the impact of sleep quality on these symptoms.

METHODS

The Chinese version of the Pittsburgh Sleep Quality Index (CPSQI), the Cognitive Emotion Regulation Questionnaire (CERQ), the Patient Health Questionnaire-9 (PHQ-9), and the Generalized Anxiety Disorder Scale-7 (GAD-7) were all completed online by students from two colleges in China's Xizang region.

RESULTS

The study included 4325 subjects. The prevalence of poor sleep quality, anxiety symptoms, and depression symptoms was 45.69%, 36.81%, and 51.86%, respectively. We observed significant direct effects on poor sleep and severity of anxiety/depression: c'1 = 0.586 (0. 544-0.628), and c'2 = 0.728 (0.683-0.773). Adaptive CERS only had a mediating effect on the relationship between sleep quality and depression symptoms, with a1b3 = -0.005 (-0.011--0.001). The link between poor sleep quality and the intensity of anxiety and depression was significantly affected by the indirect effects of maladaptive CERS: effect a2b2 = 0.126 (0.106-0.147), and effect a2b4 = 0.145 (0.123-0.167).

CONCLUSIONS

Individuals who experience poor sleep quality are more likely to have increased levels of anxiety and depression. However, enhancing sleep quality led to a decrease in anxiety and depression levels. Adaptive CERS did not predict anxiety, but they did predict depression. Multiple maladaptive CERS could increase levels of anxiety and depression. To prevent mental stress, it is crucial to examine sleep problems among college students, understand their cognitive strategies, promote the adoption of adaptive CERS, and reduce the reliance on maladaptive CERS.

The relationship between COVID-19, depressive disorder, and anxiety: a bidirectional Mendelian randomization study

Background

Previous clinical studies have found that negative mental states such as depression and anxiety are closely related to COVID-19 infection. We used Mendelian randomization (MR) to explore the relationship between depression, anxiety, and COVID-19 infection.

Methods

Our data were based on publicly available GWAS databases. The COVID-19 samples were obtained from the COVID-19 Host Genetics Initiative (HGI). The depression samples were obtained from the Psychiatric Genomics Consortium (PGC). The anxiety samples were derived from the Finngen database. We used inverse-variance weighting (IVW) as the primary analysis method, with weighted median, MR Egger, and multivariate MRI adjustment.

Results

There was no causal effect of different COVID-19 infection statuses on depression and anxiety as determined by MR analysis. In addition, in the reverse MR analysis, we found a significant causal effect of anxiety on severe symptoms after COVID-19 infection. The results of the MR Egger regression, weighted median, and weighted mode methods were consistent with the IVW method. Based on sensitivity analyses, horizontal pleiotropy was unlikely to influence the final results.

Conclusion

Our findings indicate that anxiety is a risk factor for severe symptoms following COVID-19 infection. However, the mechanism of interaction between the two needs further investigation.

Temporal Network of Depressive Symptoms across College Students with Distinct Depressive Trajectories during the COVID-19 Pandemic

Background

There are marked differences in how individuals respond and adapt to depressive symptoms over time during the strain of public health emergencies; however, few studies have examined the interrelations between depressive symptoms in distinct depressive trajectories from the COVID-19 outbreak period to the COVID-19 control period. Therefore, this study conducted cross-lagged panel networks to investigate the temporal relationships between depressive symptoms across distinct depressive trajectories from the COVID-19 outbreak period (T1) to the COVID-19 control period (T2).

Methods

A total of 35,516 young participants from the College Students' Behavior and Health Cohort during the COVID-19 pandemic were included in the current study. Depressive symptoms were self-reported using the nine-item Patient Health Questionnaire. Unique longitudinal relationships between symptoms during the COVID-19 pandemic were estimated using a cross-lagged panel network.

Results

Longitudinal relationships across distinct depressive trajectories were unique during the COVID-19 pandemic. Specifically, suicidal ideation at T1 in the chronic- and delayed-dysfunction groups was most predictive of other symptoms at T2, whereas "sleep" at T1 in the recovery group and "lack of energy" at T1 in the resistance group may be strongly related to the remission of other depressive symptoms at T2.

Conclusions

These exploratory findings demonstrate the directionality of relationships underlying individual symptoms in the youth and highlight suicidal ideation, sleep, and energy as potential influencers of other depressive symptoms across distinct depressive trajectories. Targeting those symptoms during the outbreak period of COVID 19 would theoretically have been beneficial in preventing and/or reducing the likelihood of spontaneous depression during the subsequent control period.

Predictors of health-related quality of life in outpatients with coronary heart disease

Introduction

Health-related quality of life (HRQoL) is an important treatment target in patients with coronary heart disease (CHD) and is associated with poor outcomes. Therefore, it is of clinical importance to identify the key determinants of HRQoL among these patients. There is, however, limited knowledge of how a comprehensive set of psychosocial factors influence HRQoL. We aimed to determine the relative associations of clinical and psychosocial factors with mental and physical components of HRQoL in a sample of CHD outpatients.

Methods

This cross-sectional study included 1,042 patients 2-36 (mean 16) months after a CHD event recruited from two general Norwegian hospitals with a combined catchment area making up 7% of the Norwegian population, representative with regards to demographic and clinical factors. We collected data on HRQoL, demographics, comorbidities, coronary risk factors, and psychosocial factors. HRQoL was assessed using the Short Form 12 (SF12), which comprises a Mental Component Scale (MCS), and the Physical Component Scale (PCS). Crude and multi-adjusted linear regression analyses were used to investigate the association between covariates and MCS and PCS.

Results

Mean age was 61 [standard deviation (SD) 10] years, 20% were females, 18% had type D personality, 20% significant depression symptoms, 14% significant symptoms of anxiety whereas 45% reported insomnia. The presence of type D personality (β: -0.19), significant symptoms of depression (β: -0.15), and the presence of insomnia (β: -0.13) were negatively associated with MCS, but not PCS in multi-adjusted analyses. The presence of chronic kidney disease (β: -0.11) was associated with reduced MCS, whereas the presence of chronic obstructive pulmonary disease (β: -0.08) and low physical activity (β: -0.14) were negatively associated with PCS. Younger age was associated with lower MCS, whereas older age was associated with lower PCS.

Discussion

We conclude that Type D personality, depressive symptoms, insomnia, and chronic kidney disease were the strongest determinants of the mental component of HRQoL. Assessing and managing these psychological factors among CHD outpatients may improve their mental HRQoL.

Baseline symptoms of depression and anxiety negatively impact the effectiveness of CBTi in treating acute insomnia among young adults

Background

Cognitive-behavioural therapy for insomnia (CBTi) is the first-line treatment for those with this sleep disorder. However, depressive and anxiety symptoms often co-occur with acute insomnia, which may affect the effectiveness of CBTi treatment.

Aims

This study aimed to determine the impact of depressive and anxiety symptoms on the efficacy of CBTi in treating acute insomnia.

Methods

A single-arm clinical trial was conducted among individuals who have acute insomnia. Participants underwent self-guided CBTi for 1-week. Their insomnia, depressive symptoms and anxiety symptoms were evaluated using the Insomnia Severity Index and the Hospital Anxiety and Depression Scale at baseline, post-treatment and 3-month follow-up. Repeated measures analysis of variance was used to assess the effectiveness of CBTi in treating insomnia, depressive symptoms and anxiety symptoms. A multivariate Cox regression model was used to determine the impact of depressive and anxiety symptoms on insomnia.

Results

The study found significant reductions in insomnia, depressive symptoms and anxiety symptoms at both post-treatment and 3-month follow-up (F=17.45, p<0.001; F=36.37, p=0.001; and F=81.51, p<0.001, respectively). The duration of CBTi treatment had a positive impact on insomnia recovery (hazard ratio (HR)=0.94, p=0.018). However, baseline depressive symptoms (HR=1.83, p=0.004) and baseline anxiety symptoms (HR=1.99, p=0.001) had significant negative effects on insomnia recovery.

Conclusions

The study showed that a 1-week self-guided CBTi treatment is effective in treating acute insomnia and comorbid depressive and anxiety symptoms. However, baseline depressive and anxiety symptoms negatively impact treatment effectiveness. Therefore, clinicians should assess for depressive and anxiety symptoms before treating acute insomnia with monotherapy CBTi.

The Relationship between Nomophobia, Insomnia, Chronotype, Phone in Proximity, Screen Time, and Sleep Duration in Adults: A Mobile Phone App-Assisted Cross-Sectional Study

Earlier studies that have investigated the association between nomophobia and insomnia revealed that a strong relationship exists between both variables. This study aimed to explore possible associations between these variables and their impact on physical and mental health outcomes using a cross-sectional study design and mobile phone apps to collect data. Using a survey approach, data were collected from 444 participants (52% female, mean age 34 ± 12) using the Nomophobia Questionnaire (NMP-Q), the Insomnia Severity Index (ISI), the Morningness-Eveningness Questionnaire (MEQ) and three Android mobile phone apps. The Plees Tracker, screen time, and pedometer apps aided in collecting data on sleep duration, time spent on screen per day, and how close the phone was to the person. A statistically significant association was noted between nomophobia and insomnia, nomophobia and the eveningness chronotype, and nomophobia and screen time. The eveningness chronotype was also associated with an increased screen time use. The results show that NMP-Q, ISI, and screen time increase according to the chronotype. No statistically significant differences were noted in daily steps or sleep duration according to chronotype. The findings suggest that interventions targeting nomophobia may be beneficial in addressing insomnia among adults, particularly those with an evening chronotype. Future studies should consider exploring the causal relationship between them.

A Transdiagnostic group therapy for sleep and anxiety among adults with substance use disorders: Protocol and pilot investigation

Introduction

Treatment of substance use disorders (SUDs) is challenging with high rates of treatment dropout and relapse, particularly among individuals with comorbid psychiatric conditions. Anxiety and insomnia are prevalent among those with SUD and exacerbate poor treatment outcomes. Interventions that concurrently target anxiety and insomnia during the early stages of SUD treatment are lacking. To this end, we investigated the feasibility and preliminary effectiveness in a single-arm pilot trial of an empirically informed group transdiagnostic intervention, Transdiagnostic SUD Therapy, to concurrently reduce anxiety and improve sleep among adults receiving treatment for SUD. Specifically, we hypothesized that participants would evidence declines in anxiety and insomnia and improvements in sleep health, a holistic, multidimensional pattern of sleep-wakefulness that promotes wellbeing. A secondary aim was to describe the protocol for Transdiagnostic SUD Therapy and how it may be implemented into a real-world addiction treatment setting.

Method

Participants were 163 adults (M_age  = 43.23; 95.1% White; 39.93% female) participating in an intensive outpatient program for SUD who attended at least three of four Transdiagnostic SUD Therapy sessions. Participants had diverse SUDs (58.3% alcohol use disorder, 19.0% opioid use disorder) and nearly a third of the sample met criteria for two SUDs and comorbid mental health diagnoses (28.9% anxiety disorder, 24.6% major depressive disorder).

Results

As anticipated, anxiety and insomnia reduced significantly across the 4-week intervention period from clinical to subclinical severity, and sleep health significantly improved (ps < 0.001). These statistically significant improvements following Transdiagnostic SUD Therapy demonstrated medium to large effects (ds > 0.5).

Conclusion

Transdiagnostic SUD Therapy is designed to be flexibly administered in "real-world" clinical settings and, preliminarily, appears to be effective in improving emotional and behavioral factors that increase risk for return to substance use and poor SUD treatment outcomes. Additional work is needed to replicate these findings, determine the feasibility of widespread uptake of Transdiagnostic SUD Therapy, and examine whether the treatment effects translate to improvement in substance use outcomes.

Network structure of insomnia and depressive symptoms among shift workers in China

A bidirectional relationship between insomnia and depression has been observed. However, few studies have used network analysis to explore the interaction patterns in that association at the symptom level. This study aimed to estimate network structures of insomnia and depressive symptoms among shift workers, as well as to compare the differences in network properties between individuals without and with insomnia symptoms and/or at risk of depression. A total of 1883 shift workers were included in our study. Insomnia symptoms were evaluated by three items based on the criteria of the Diagnostic and Statistical Manual of Mental Disorders, and depressive symptoms were assessed by the Center for Epidemiologic Studies Depression Scale. Network analyses were used for the statistical analysis. "Difficulty initiating sleep", "Hard to get started", and "Depressed mood" with higher expected influence (EI) values were identified as the most central symptoms within the insomnia-depressive networks among shift workers. The significant differences between individuals without and with insomnia symptoms and/or at risk of depression were observed in symptoms of "Difficulty initiating sleep" and "Hard to get started". "Depressed mood", "Difficulty initiating sleep", or "Hard to get started" were the most key symptoms that trigger and sustain the structure of insomnia and depressive symptom among shift workers. Hence, timely intervention for the above three symptoms in future research or clinical practice (e.g., cognitive behavioral therapy for insomnia) may be crucial in alleviating insomnia and depressive symptoms among shift workers.

Effects of an internet-delivered insomnia intervention for older adults: A secondary analysis on symptoms of depression and anxiety

OBJECTIVE

To test whether an Internet-delivered cognitive behavioral therapy for insomnia (CBT-I) program for older adults attenuates symptoms of depression and anxiety.

METHODS

Adults aged ≥ 55 with insomnia were randomized to SHUTi-OASIS (Sleep Healthy Using the Internet for Older Adult Sufferers of Insomnia and Sleeplessness; N = 207) or Patient Education (PE; N = 104). Depression and anxiety were assessed (HADS-D and HADS-A, respectively) at baseline, post-assessment, and 6- and 12-month follow-ups.

RESULTS

Multilevel modeling of HADS-D showed a condition by time interaction (F[3,779] = 3.23, p = .02): SHUTi-OASIS participants reported lower symptoms than PE at post-assessment. There was no such interaction effect for HADS-A (F[3,779] = 2.12, p = .10). Generalized linear modeling showed no moderation of effects by baseline symptom severity.

CONCLUSIONS

Participants randomized to Internet-delivered CBT-I showed stable depression and anxiety across time, while control participants' depressive symptoms briefly increased. CBT-I may help prevent development or worsening of psychological distress among older adults with insomnia.

TRIAL REGISTRATION

[Registered at ClinicalTrials.gov; identifier removed for anonymity].

Visualizing Research Trends and Identifying Hotspots of Traditional Chinese Medicine (TCM) Nursing Technology for Insomnia: A 18-Years Bibliometric Analysis of Web of Science Core Collection

Objective

To explore the research hotspot and frontier direction of TCM nursing of insomnia and provide reference for the follow-up study of the optimal scheme of TCM nursing of insomnia.

Background

Insomnia is a common sleep-wake disorder, affects 6–10% of adults and was associated with independent higher risks of cardiovascular disease and diabetes. TCM Nursing Techniques of insomnia has a long history and has shown a definite impact. However, it's still lack of analysis in the field of the most commonly used and effective techniques, as well as the co-morbidities associated with insomnia. Therefore, the database was searched and analyzed to find effective TCM Nursing Techniques for insomnia and related diseases related to insomnia.

Method

Randomized controlled trials on the intervention of TCM Nursing Techniques in insomnia were retrieved from Web of Science Core Collection and imported into CiteSpace 5.6.R5 visualization software. The works of literature were co-cited by keywords authors and institutions for visual analysis, and the co-morbidities associated with insomnia of TCM Nursing Techniques in literature was extracted manually. The symptoms of co-morbidities associated with insomnia were imported into Cytoscape 3.9.0 software and clustered by CytoHubba.

Result

As of October 20, 2021, the literature published in the last 20 years from Web of Science Core Collection was screened, and the publication period of the included literature was from 2004 to 2021. From 2016 to now, the total number of articles has been increasing. A total of 146 articles were included, and the highest production year was 2020. There is little cooperation between states, institutions, and authors. China (including Hong Kong and Taiwan) and Hong Kong Polytech University are leading countries and institutions in this area. MYUNGHAENG HUR is the most cited author, and J ALTERN COMPLEM MED is the most cited journal. According to cluster analysis and keyword frequency, auricular therapy, aromatherapy, and acupressure are the three most commonly used techniques. While the top five co-morbidities are fatigue, anxiety, depression, pain and hemodialysis. The three frontier topics and the main research directions are sleep quality, comorbid insomnia and clinical trial design.

Conclusion

We found that acupressure, aromatherapy, and auricular acupoint therapy are the most commonly used nursing methods of TCM to intervene in insomnia. However, these studies have limitations such as small sample size, lack of objectivity in evaluating sleep quality, and high heterogeneity of intervention measures, which are not conducive to forming TCM clinical nursing guidelines. Therefore, it is necessary to adopt objectified sleep quality evaluation methods, select suitable acupoints according to TCM theories, and design multi-center large-sample clinical trials based on the safety principle of randomized blind control. This study provides an in-depth perspective for insomnia research on TCM Nursing Techniques and includes information for follow-up research on TCM Nursing Techniques of insomnia.