Underlying Mechanisms
Basta, Maria, et al. “Chronic insomnia and the stress system.” Sleep medicine clinics vol. 2, no.2 2007, pp. 279-291. doi: 10.1016/j.jsmc.2007.04.002. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2128619/
- What is the underlying mechanism of stress-induced insomnia?
Basta, Chrousos, Vela-Bueno, and Vgontzas (2007) explored the topic of insomnia, a common sleep disorder, as a disorder of hyperarousal rather than a state of sleep loss. They also focused on the factors that contribute to the onset and perpetuation of the condition.
- What is the hypothesis of the article?
The article hypothesized that insomnia is not a state of sleep loss, but a state of sleep loss. They suggested that effective intervention should focus on the underlying emotional and physiologic hyperarousal to overcome insomnia.
- Which research method did the researchers use?
Basta, Chrousos, Vela-Bueno, and Vgontzas (2007) used current research to understand the factors that cause insomnia as a disorder of hyperarousal. Thus, their study was a review of literature that focused on the mechanisms underlying insomnia.
- What evidence did the authors provide to support their claims?
The article used data from studies on “objective sleep, EEG activity, physiologic findings, neuroimaging, neuro-cognitive function and HPA axis and inflammation markers” to support their hypothesis that insomnia is a disorder of hyperarousal that occurs during daytime and nighttime. For example, they used the “Hyperarousal” Model to show the emotional and physiological factors that cause insomnia.
- Evaluate the quality of evidence in the article
The article provides quality evidence that mental health experts can use to understand and treat insomnia. For example, they should approach using the emotional and physiological causes instead of a simple state of sleep loss.
Neurobiology: Cortisol Hormone
Vargas, Ivan, et al. “Altered ultradian cortisol rhythmicity as a potential neurobiologic substrate for chronic insomnia.” Sleep medicine reviews vol. 41, 2018, pp. 234-243.doi: 10.1016/j.smrv.2018.03.003. https://www-sciencedirect-com.libproxy.aucegypt.edu/science/article/pii/S108707921730179X?via%3Dihub
- What is the neurobiology of insomnia?
Research suggests that high levels of cortisol hormones are common among individuals who have insomnia. Therefore, it is important to study the role of the hormone in insomnia, such as whether it is a cause of consequence of insomnia.
- What is the hypothesis of the article?
Vargas et al. (2018) hypothesized that ultradian cortisol pulses play a role in maintaining wakefulness during the daytime, and since they are absent at night, one falls asleep. Therefore, the abnormal occurrence of cortisol pulses at night could be a cause of chronic insomnia.
- Which research method and evidence did the researchers use?
Vargas et al. (2018) conducted a review of literature to obtain evidence of the role of cortisol rhythmicity in chronic insomnia. They provided proof from literature and concluded that abnormalities in the ultradian instead of circadian cortisol is the cause of the pathophysiology of insomnia. The graph below shows the difference in the sleep patterns for a normal (A) and a person with insomnia (B).
- Analyze the validity of the findings from the article
The article provides valid and quality evidence obtained through a review of various articles and comparing their findings to obtain the most accurate. Therefore, the article contains reliable information from exploring ultradian cortisol pulsatility in individuals with chronic insomnia to understand the underlying mechanisms and propose effective interventions, such as altering cortisol rhythmicity.
Psychobiology: Resilience
Palagini, Laura, et al. “Lack of resilience is related to stress-related sleep reactivity, hyperarousal, and emotion dysregulation in insomnia disorder.” Journal of clinical sleep medicine: JCSM: official publication of the American Academy of Sleep Medicine vol. 14, no.5, 2018, pp. 759-764. doi: 10.5664/jcsm.7100. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5940426/
- What role does a lack of resilience play in insomnia?
The section focuses on the psychobiology of insomnia, including the role that lack of resilience plays in the condition. People with poor response to stress are vulnerable to and can easily suffer from insomnia. Resilience is a psychobiological factor that governs a person’s ability to adapt to stress and prevent the possibility of developing a mental disorder.
- What is the hypothesis of the article?
Palagini et al. tested the hypothesis that low resilience increases the risk of development and perpetuation of insomnia.
- Which research method did the researchers use?
The research collected data from individuals confirmed to have insomnia to test their level of their resilience. They collected data quantitatively using “clinical evaluation and sleep questionnaires, Insomnia Severity Index [ISI], Resilience Scale for Adults [RSA], Pre-sleep Arousal Scale [PSAS], Ford Insomnia Response to Stress Test [FIRST], Difficulties in Emotion Regulation Scale [DERS] and anxiety (Self-rating Anxiety Scale [SAS]” (761). They used t-test to determine the difference in the level of resilience and determine its role in causing insomnia.
- What evidence did the authors provide to support their claims?
The researchers used evidence from quantitative assessment to determine the role of poor resilience in causing insomnia. As the data in the table below indicates, poor resilience is an essential factor in the development of insomnia.
- Assess the quality of evidence in the article
Palagini et al. (2018) used sufficient research evidence to prove the role of poor resilience in the development and perpetuation of insomnia. They conducted their quantitative analysis using reliable and valid tools.
Impact
Cognitive Performance
Wardle-Pinkston, Sophie, Danica C. Slavish, and Daniel J. Taylor. “Insomnia and cognitive performance: A systematic review and meta-analysis.” Sleep Medicine reviewsm 2019. https://www.sciencedirect.com/science/article/pii/S1087079219300851#bib24
- What is the effect of insomnia on cognitive performance?
Research focuses on the impact of insomnia on cognitive performance. The effect could inform the need for intervention to restore performance and ensure that the patient recovers cognitive performance.
- What is the hypothesis of the article?
Wardle-Pinkston, Slavish, and Taylor tested the hypothesis that insomnia is associated with impairment in subjective and objective cognitive performance.
- Which research method did the researchers use?
The researchers conducted a systematic review and meta-analysis of 48 studies to determine the effect of insomnia on cognitive performance.
- What evidence did the authors provide to support their claims?
Wardle-Pinkston, Slavish, and Taylor used findings from previous studies to establish a possible relationship between insomnia and objective and subjective cognitive performance. Their study affirmed the relationship and indicated the need for effective interventions to improve cognitive performance in a person who has insomnia.
- Evaluate the quality of findings
The article contains high-quality evidence to support the connection between insomnia and cognitive performance. They conducted a systematic review and meta-analysis to understand and standardize the various perspectives of past researchers on the topic. Therefore, their recommendation to treat insomnia to improve cognitive outcomes is informed by quality evidence.
Health conditions: Insomnia and Depression
Riemann, Dieter, et al. “Sleep, insomnia, and depression.” Neuropsychopharmacology vol. 45, no.1, 2020, pp. 74-89.https://www.nature.com/articles/s41386-019-0411-y
- What is the association between insomnia and depression?
The study examined the relationship between insomnia and depression. Researchers have been interested in establishing whether depression cause insomnia and the role of insomnia in depression
- What is the hypothesis of the article?
Reimann et al. tested the hypothesis that insomnia is a cause of depression and suicidality. The study would establish whether people with insomnia are at the risk of developing depression.
- Which research method did the researchers use?
Reimann et al. conducted their study using review of past studies on the relationship between depression and insomnia.
- What evidence did the authors provide to support their claims?
The study indicated various dimensions of the relationship between insomnia and depression. For example, they revealed that sleep disturbance is common in people with depression, including Slow Wave Sleep and rapid eye movement (REM) sleep. Reimann et al. provided evidence of the use of anti-depressants to suppress REM sleep.
- Assess the quality of evidence in the article
Reimann’s et al. article provides quality evidence of the association between insomnia and depression. They included numerous studies that supported the relationship between the two variables, including the impact of insomnia on Slow Wave Sleep and REM sleep.
Recommendations
Behavioral
Talbot, Lisa S et al. “Cognitive behavioral therapy for insomnia in posttraumatic stress disorder: a randomized controlled trial.” Sleep vol. 37, no. 2, 2014, pp. 327-41. 1 Feb. 2014, doi:10.5665/sleep.3408. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3900619/?report=reader
- What are some recommended interventions for people with insomnia?
Research focuses on some behavioral interventions that can help people with insomnia and help them to heal and get adequate sleep. Interventions are necessary because they help the affected person to recover their cognitive performance.
- What is the hypothesis of the article?
Talbot et al. tested the hypothesis that cognitive-behavioral therapy is an effective intervention in the treatment of insomnia by improving sleep among individuals with posttraumatic stress disorder (PTSD).
- Which research method did the researchers use?
Talbot et al. used a randomized controlled trial to test the efficacy of cognitive behavioral therapy for insomnia (CBT-I) in improving sleep. The approach involves the use of an experimental and control groups to test the efficacy of the approach.
- What evidence did the authors provide to support their claims?
The article used quality evidence from research to support the effectiveness of cognitive behavioral therapy for insomnia among individuals with PTSD. They conducted a quantitative study that provided evidence of efficacy and support for the use of the intervention in real-life settings to control the insomnia symptoms and improve the quality of sleep.
- Evaluate the quality of evidence provided in the article
Talbot et al. provided quality evidence to support the use of cognitive behavioral therapy for insomnia in the treatment of insomnia. The intervention is effective because it helps the patient to overcome the underlying behavioral and cognitive dysfunctions caused by traumatic experiences.
During the cognitive behavior therapy, the client could use the below worksheet to improve outcomes.
Pharmacological
Cunnington, David, Moira F. Junge, and Antonio T. Fernando. “Insomnia: prevalence, consequences and effective treatment.” Medical Journal of Australia vol. 199m 2013, pp. S36-S40. https://www.mja.com.au/journal/2013/199/8/insomnia-prevalence-consequences-and-effective-treatment
- What are the pharmacological interventions in insomnia?
The research focused on the use of pharmacological interventions in the treatment of insomnia. Besides behavioral interventions, people suffering from insomnia could benefit from pharmacological therapies to improve the quality of sleep.
- What is the hypothesis of the article?
Cunnington, Junge, and Fernando tested the hypothesis that acute and chronic insomnia require adjunctive use of medications such as hypnotics to improve the quality of sleep.
- Which research method did the researchers use?
Cunnington, Junge, and Fernando used previous research evidence to explore the differences between acute and chronic insomnia, assessment and diagnosis of insomnia, non-pharmacological treatments like mindful exercise, and medications such as hypnotics. The study sued the studies to understand the different dimensions in the treatment and management of insomnia.
- What evidence did the authors provide to support their claims?
Cunnington, Junge, and Fernando used quality evidence and perspectives of other researchers who have explored various aspects of insomnia, including non-pharmacological and pharmacological treatments. The research suggests that among patients with chronic insomnia can benefit from non-pharmacological but if the symptoms persist, they can combine the therapy with pharmacological treatments.
- Evaluate the quality of findings
The study uses quality evidence to support the use of non-pharmacological and pharmacological
Treatments for chronic insomnia. results of the study can inform the application of proper treatment of individuals with insomnia to improve the quality of sleep and restore their cognitive functioning.
Sateia, Michael J., et al. “Clinical practice guideline for the pharmacologic treatment of chronic insomnia in adults: an American Academy of Sleep Medicine clinical practice guideline.” Journal of Clinical Sleep Medicine vol. 13, no.02, 2017, pp. 307-349. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5263087/
- What is the effect of pharmacologic treatment on insomnia?
Research focuses on the effect of pharmacologic treatment of chronic insomnia to improve sleep and overcome the negative cognitive outcomes. Therefore, experts should understand the best practice guidelines in the use of pharmacologic treatment.
- What is the hypothesis of the article?
Sateia et al. focused on the clinical practice recommendations that practitioners should follow in the treatment of insomnia. FDA-approved drugs are commonly used, but they should follow the clinical guidelines for safe use.
- Which research method did the researchers use?
Sateia et al. conducted a systematic review of randomized controlled trials. They used evidence from The American Academy of Sleep Medicine’s review using Grading of Recommendations Assessment, Development, and Evaluation (GRADE) in assessing the quality of evidence.
- What evidence did the authors provide to support their claims?
The article uses evidence from the review of randomized controlled trials and expert recommendations for best practice in the use of FDA-approved pharmacologic agents in the treatment of insomnia.
- Assess the quality of evidence in the article
Literature reviews provided quality evidence from different perspective. The study focused on the review of randomized controlled trials which involve different authors’ comparison of two groups, one using the pharmacologic agents in insomnia treatment and a control group. Thus, it makes quality recommendations regarding the use of such agents.
Prevalence and the Best Approach
Bhaskar, Swapna, D. Hemavathy, and Shankar Prasad. “Prevalence of chronic insomnia in adult patients and its correlation with medical comorbidities.” Journal of family medicine and primary care vol. 5, no.4, 2016, pp. 780-785. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5353813/
- How prevalent is insomnia in adults?
Research focuses on the prevalence of insomnia to understand the extent of the problem and the necessary interventions to overcome its impact. Prior evidence shows that insomnia is a common, but largely neglected in research.
- What is the hypothesis of the article?
Bhaskar, Hemavathy, and Prasad hypothesized that chronic insomnia is highly prevalent in adult patients. The study focused on adult patients who visit family medicine outpatient departments (OPDs) to examine risk factors and comorbidities related to chronic insomnia.
- Which research method did the researchers use?
Bhaskar, Hemavathy, and Prasad conducted a cross‑sectional study at St. Philomena’s Hospital, Bengaluru. They studied all adult patients attending family medicine OPD at the hospital. They used Athens Insomnia Scale to diagnose the condition and collected data about medical comorbidities.
- What evidence did the authors provide to support their claims?
Bhaskar, Hemavathy, and Prasad used research evidence to establish the relationship between age and diabetes and the high risk of insomnia in adults. They also used the evidence that primary physicians mostly miss insomnia regardless of the fact that it is a common condition.
- Interpret the finding of the study
The research suggested that regardless of the high prevalence of insomnia among adults suffering from other conditions such as diabetes, primary care physicians normally miss it. The study suggests the importance of being cautious to diagnose insomnia and treat it effectively. The figure below affirms the prevalence of insomnia.
Winkelman, J. W. (2019). Overview of the treatment of insomnia in adults. UpToDate. https://www.uptodate.com/contents/overview-of-the-treatment-of-insomnia-in-adults
- What are some of the effective treatments of insomnia?
Given the prevalence of insomnia, effective treatment is necessary. Therefore, experts provide some of the tested and approved treatments.
- Which research method did the researchers use?
Winkelman used experts advise to assess the effective treatment approaches for insomnia. researcher indicated the need for proper assessment to identify the factors that cause insomnia, to implement the stepwise approach to the management of the condition.
- What evidence did the authors provide to support their claims?
The researcher uses expert evidence to recommend the most effective approach for the treatment and management of insomnia. the process begins with elimination or minimizing contributing factors and comorbidities and then implementation of treatment, such as medication directed towards sleep. The patient could also use behavioral or psychological approaches to treat insomnia.
- Assess the quality of the article
Although the article is not a research study, it provides vital information to understand, treat and manage insomnia. It provides the steps involved in the identification of risk factors and proper treatment.
Objectives:
- Interpret and analyze numerical and graphical data, and draw conclusions to inform decision making within disciplinary or multidisciplinary contexts
- Analyze logical and scientific arguments, while identifying premises, evidence, assumptions, conclusions and biases.
Brief Summary:
Sara, a senior architectural engineering student, has been suffering from sleeplessness. However, when she falls asleep, she wakes up in the middle of the night numerous times, and struggles to drift off to sleep again. As a consequence of sleep disruption, she feels sleepy and fatigued during the day. Her symptoms of sleep disturbance increased during the past week. She couldn’t keep up with the workload of the university with her deprivation adequate of sleep, especially with the remote learning due to the outbreak of the Corona pandemic. Therefore, she decided to take an appointment with Dr Ahmed, a neurobiologist, to put an end to her constant sleep disturbance.
Works Cited
Basta, Maria, et al. “Chronic insomnia and the stress system.” Sleep medicine clinics vol. 2, no.2 2007, pp. 279-291. doi: 10.1016/j.jsmc.2007.04.002. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2128619/
Bhaskar, Swapna, D. Hemavathy, and Shankar Prasad. “Prevalence of chronic insomnia in adult patients and its correlation with medical comorbidities.” Journal of family medicine and primary care vol. 5, no.4, 2016, pp. 780-785. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5353813/
Cunnington, David, Moira F. Junge, and Antonio T. Fernando. “Insomnia: prevalence, consequences and effective treatment.” Medical Journal of Australia vol. 199m 2013, pp. S36-S40. https://www.mja.com.au/journal/2013/199/8/insomnia-prevalence-consequences-and-effective-treatment
Palagini, Laura, et al. “Lack of resilience is related to stress-related sleep reactivity, hyperarousal, and emotion dysregulation in insomnia disorder.” Journal of clinical sleep medicine: JCSM: official publication of the American Academy of Sleep Medicine vol. 14, no.5, 2018, pp. 759-764. doi: 10.5664/jcsm.7100. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5940426/
Riemann, Dieter, et al. “Sleep, insomnia, and depression.” Neuropsychopharmacology vol. 45, no.1, 2020, pp. 74-89.https://www.nature.com/articles/s41386-019-0411-y
Sateia, Michael J., et al. “Clinical practice guideline for the pharmacologic treatment of chronic insomnia in adults: an American Academy of Sleep Medicine clinical practice guideline.” Journal of Clinical Sleep Medicine vol. 13, no.02, 2017, pp. 307-349. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5263087/
Talbot, Lisa S et al. “Cognitive behavioral therapy for insomnia in posttraumatic stress disorder: a randomized controlled trial.” Sleep vol. 37, no. 2, 2014, pp. 327-41. 1 Feb. 2014, doi:10.5665/sleep.3408. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3900619/?report=reader
Vargas, Ivan, et al. “Altered ultradian cortisol rhythmicity as a potential neurobiologic substrate for chronic insomnia.” Sleep medicine reviews vol. 41, 2018, pp. 234-243.doi: 10.1016/j.smrv.2018.03.003. https://www-sciencedirect-com.libproxy.aucegypt.edu/science/article/pii/S108707921730179X?via%3Dihub
Wardle-Pinkston, Sophie, Danica C. Slavish, and Daniel J. Taylor. “Insomnia and cognitive performance: A systematic review and meta-analysis.” Sleep Medicine reviewsm 2019. https://www.sciencedirect.com/science/article/pii/S1087079219300851#bib24
Winkelman, John. W. Overview of the treatment of insomnia in adults. UpToDate, 2019. https://www.uptodate.com/contents/overview-of-the-treatment-of-insomnia-in-adults
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