National Sleep Foundation

Abstract Introduction National Sleep Foundation population research indicates that the majority of adults are not getting enough sleep and are dissatisfied with their sleep. Numerous potential solutions for sleep difficulties continue to be introduced to the public, ranging from digital therapeutics to prescription and over-the-counter medicines, to nutritional supplements and cannabis-based products. Among consumers, use of products generalized as cannabis (i.e., CBD, CBN, THC) represents a growing paradigm in sleep aids. Given the lack of established guidelines on cannabis use and sleep, it is important to monitor the public’s current use and willingness to use cannabis-based products to promote sleep. Methods Data were drawn from an online, national survey utilizing a probability-based, random sample of 1,372 U.S. adults, oversampled for both Black and Hispanic individuals. The survey was administered in English or Spanish, and included demographic information, questions probing sleep duration and quality, and three items asking about (a) current, (b) past, and (c) future likelihood of cannabis use to help sleep. Descriptive statistics were used to summarize rates of cannabis use to help sleep. Sleep differences between individuals who did and did not endorse current or past use or a willingness to try cannabis to help sleep were examined via t-tests. Results Current and past use of cannabis to help with sleep was reported at 9% and 17%, respectively. Twenty-three percent of adults said they were likely to consider use of a cannabis product to help them sleep. Adults who currently use, have used, or are willing to use cannabis to help with sleep had significantly shorter sleep durations and lower sleep quality than their counterparts (p<.05 for all comparisons). Conclusion Over 23 million US adults currently use cannabis-based products to help them sleep, while nearly twice that number have previously tried cannabis-based products for sleep. Over 60 million adults are likely to consider cannabis products in attempts to improve their sleep. Unfortunately, there is a dearth of evidence-based guidelines on the use of cannabis for sleep. Much more work is needed to determine the short-term and long-term effects of cannabis products on sleep health to best inform public recommendations. Support (if any)

Abstract Introduction Decades of research and public education have focused on the negative consequences of poor sleep health, which spans mood deficits, cognitive challenges, a host of physical complications, and social difficulties. Less is known about the potential positive effects of healthy sleep, which could include wellness, productivity, goal achievement, and social functioning—all of which can be cumulatively referred to as “flourishing.” This study aimed to document the public’s experiences with the myriad benefits of getting healthy sleep. Methods Data were drawn from an online, national survey utilizing a probability-based, random sample of 1,372 U.S. adults, oversampled for both Black and Hispanic individuals. The survey was administered in English or Spanish, and included demographic information and questions probing about the potential personal, occupational, home, goal achievement, and social benefits of good sleep. Measures of central tendency were used to characterize responses, and χ2 were used to examine group differences in the benefits of good sleep health. Results The overwhelming majority of adults in the US reported positive impacts of getting healthy sleep on their happiness (87%), work productivity (90%), home productivity (87%), goal achievement (86%), and social life (80%). The positive impact of getting healthy sleep was robust, observed across all groups; however, interesting group differences were observed with older adults and males generally reporting lower rates of positive benefits of getting healthy sleep compared to younger adults and females. Interestingly, no group differences emerged regarding the positive impact of getting healthy sleep on work productivity, while women and people working full-time were more likely to report positive impacts of healthy sleep on home productivity. People with a Bachelor’s degree or more and those working full-time reported higher rates of getting healthy sleep positively impacting their goal achievement. Finally, women were more likely to report a positive impact of healthy sleep on their social life. Conclusion Getting healthy sleep has a meaningful, positive impact on people’s happiness, work and home productivity, goal achievement, and social life. While the sleep field has traditionally focused on reducing deficits, sleep appears to serve as a crucial tool to help people flourish. Support (if any)

Abstract Introduction Objective markers of sleepiness that can be collected passively, such as through voice data, can be helpful for detecting sleepiness in individuals with suspected sleep disorder and in situations in which sleepiness can pose health or occupational risk. We assessed verbal reaction time (VRT) as a vocalic marker of sleepiness in older adults with history of insomnia and Benzodiazepines receptor agonist (BZRA) use who were undergoing cognitive testing to determine whether VRT accurately reflected patient-perceived sleepiness. Methods Adults aged > 55 years without a diagnosis of dementia were recruited from within a BZRA deprescribing clinical trial (NCT03687086) into this ancillary study designed to test the feasibility of cognitive testing using out-of-office, self-directed mobile apps. Participants’ working and episodic memory were assessed through recorded verbal responses to Verbal Paired Associates (VPA) tests, and patient reported sleepiness was assessed using ecological momentary assessments (EMA) of self-reported sleepiness (range: 1[not at all] to 4[more prominent]). Using a Generalized Additive Model (GAM), we examined the association between VRT during VPA testing and sleepiness, adjusting for sex, age, race, education, test parameters (difficulty, pass/fail status), caffeine intake, cognition, mood, and recent BZRA use (yes/no). Results 2230 audio samples from 19 patients were analyzed. VRT was operationalized as the time duration between recording start time and first epoch of speech. In the GAM model, longer (delayed) VRTs were positively associated with greater EMA sleepiness (p=0.00151). Our prediction model achieved 95% accuracy in classifying sleepiness levels after adjusting for other variables. Conclusion We found that longer VRTs are correlated with more self-reported sleepiness during cognitive testing. Voice data have the potential be used as a marker of sleepiness in patients undergoing cognitive testing and in situations during which a method for capturing sleepiness that does not require patient input can inform care. Support (if any) NIA R01AG057929, NHLBI K24HL143055, VA RCS20-191, UCLA CTSI UL1TR001881

Sleep issues are prevalent among women receiving medication for opioid use disorder (OUD). However, there is limited data about subjective sleep experiences and how they relate to OUD trajectories. This mixed-methods study explored the intersection of sleep and OUD recovery from the patient perspective among a sample of women receiving medication for OUD. This study enrolled non-pregnant women aged 18-65 who were stabilized on buprenorphine from an outpatient OUD program. Participants were recruited during their routine treatment visits, and enrollment occurred from February 2022 through September 2023. Study participants who endorsed clinically elevated insomnia symptoms on the Insomnia Severity Index (ISI) (≥11 score) (n=50) were included in current study analyses. A sub-sample (n=11) who met the ISI threshold participated in semi-structured interviews. Survey responses were analyzed using descriptive statistics, and interviews were analyzed using applied thematic analysis. The average length of time on buprenorphine for the overall sample was 30 months (range: 2 months – 245 months). Participants reported engagement in healthy sleep behaviors, grouped into four domains: positive sleep related cognitions, sleep environment, sleep restriction, and reducing stimulating activities. Respondents characterized the multidimensional relationship between sleep and health. Women also described how sleep evolves through addiction into recovery, and how good sleep reduces risk of return to substance use. Finally, women discussed the impacts that medication for OUD have on sleep, specifically how they might time their buprenorphine to align with sleep and how it might impact their energy levels. We found that sleep is a dynamic process among this sample of women receiving medication for OUD. Findings are intended to inform future investigations of the mechanisms underlying the sleep-OUD intersection. In addition, this study reflects the importance of incorporating patient perspectives into the development of therapeutics targeting this patient population.

BackgroundTo determine whether objective markers of sleepiness can be collected passively using voice data to detect sleepiness in individuals undergoing testing in situations where sleepiness is not the focal point of assessment. We assessed verbal reaction time (VRT) as a vocalic marker of subjective sleepiness in middle aged and older adults with history of insomnia and benzodiazepine-receptor-agonist (BZRA) use.MethodsAdults aged ≥55 without a diagnosis of dementia were recruited from a BZRA deprescribing clinical trial and enrolled in the present study that tested the feasibility of cognitive testing using out-of-office, self-directed mobile apps. Participants’ working/episodic memory were assessed through recorded verbal responses to Verbal Paired Associates (VPA) tests, and ecological momentary assessments (EMA) of self-reported sleepiness (1[not at all] to 4[more prominent]). Using a generalized additive model, we examined the association between VRT during VPA testing and self-reported sleepiness, adjusting for demographic, test parameters, caffeine intake, cognition, mood, and BZRA-use (p≤0.05 was considered significant). A stratified k-fold cross-validation/random forest (SKCV/RF) was performed to classify sleepiness levels, adjusting for other variables.ResultsWe analyzed 1,513 observations from 16 patients. VRT was operationalized as the time duration between recording start time and first speech epoch. Longer VRTs were positively associated with greater EMA sleepiness (p≤0.05). The SKCV/RF model yielded a mean F1-score of 0.80 ± 0.08 across folds.ConclusionsLonger VRTs correlated with greater self-reported sleepiness, indicating that voice data can be used as a marker of sleepiness in patients undergoing cognitive testing in out-of-office settings.

BackgroundDepression and anxiety symptoms among medical students are often a concern. The Patient Health Questionnaire-Four (PHQ-4), an important tool for depression and anxiety screening, is commonly used and easy to administer. This study aimed to assess and update the longitudinal measurement invariance and psychometric properties of the simplified Chinese version.MethodsA three-wave longitudinal survey was conducted among healthcare students using the PHQ-4. Structural validity was based on one-factor, two-factor, and second-order factor models, construct validity was based on the Self-Rated Health Questionnaire (SRHQ), Sleep Quality Questionnaire (SQQ), and Rosenberg Self-Esteem Scale (RSES), and longitudinal measurement invariance (LMI), internal consistency, and test–retest reliability were based on structural consistency across three time points.ResultsThe results of the confirmatory factor analysis indicated that two-factor model was the best fit, and LMI was supported at three time points. Inter-factor, factor-total, and construct validity correlations of the PHQ-4 were acceptable. Additionally, Cronbach’s alpha, McDonald’s omega, and the intraclass correlation coefficient demonstrated acceptable/moderate to excellent reliability of the PHQ-4.ConclusionsThis study adds new longitudinal evidence that the Chinese version of the PHQ-4 has promising LMI and psychometric properties. Such data lends confidence to the routine and the expanded use of the PHQ-4 for routine screening of depression and anxiety in Chinese healthcare students.