Sleep Advances

Study objectives: Aging is associated with increased sleep complaints and changes in sleep architecture, microstructure and rest-activity rhythms. Meditation-based interventions have shown benefits on subjective sleep quality, but their effects on objective sleep parameters remain largely underexplored. This study investigated the effects of an 18-month meditation intervention on sleep combining subjective (questionnaires) and objective (polysomnography and actigraphy) measures in older adults. Methods: A total of 120 cognitively unimpaired older adults ([≥]65 y) with minimal sleep complaint completed questionnaires, one week of actigraphy and in-home polysomnography at baseline, and again 18 months later. Following the baseline visit, participants were randomly assigned to one of 3 groups: meditation training, non-native language training (active control), or passive control. Group-by-visit interactions were examined using mixed-effects models for sleep questionnaires, actigraphy-derived metrics, sleep architecture and microstructure, including slow waves, spindles, and spectral power. Results: Compared to the passive control group only, meditation training was associated with greater ease of morning awakening (p=0.04). No significant intervention effects were observed for any other sleep parameter, including actigraphy- and polysomnography-derived measures. These findings remained unchanged after adjustment for depressive symptoms and trait anxiety. Conclusion: In cognitively unimpaired older adults, this 18-month meditation intervention yielded only limited improvements in subjective sleep assessment. Meditation may therefore have subtle effects on self-reported sleep quality in this healthy older population, although no effects on objective sleep measures were detected. Future studies should examine whether adapting the content, intensity, or timing of meditation practice and enrolling populations with clinically meaningful sleep disturbances or psychoaffective symptoms may yield greater benefits.

Background: Emerging evidence suggested the role of sleep and circadian rhythm in the development of mental resilience, but the association of an integrated analysis of objective sleep and circadian measures with multifaceted mental resilience in healthy adults has been underexplored. Objective: This study aims to explore the associations between multifaceted mental resilience and sleep and circadian rhythm in healthy adults. Methods: A total of 156 healthy adults (Age: Mean (SD): 29.54 (5.28) years; 60.9% female) underwent 14-day actigraphy, one night polysomnography (PSG) and dim light melatonin onset (DLMO) assessments. Resilience was operationalized as both a coping capacity and a positive mental health outcome in the context of accumulative adversity (life stressful events and childhood adversities). We first identified the covariance patterns between multiple sleep and circadian health domains (Sleep macro- and microstructures, dim light melatonin onset, rest activity pattern) and multifaceted mental resilience using partial least squares regression (PLSR), and followed by univariate analysis as complementary to illustrate the distribution trends of sleep and circadian rhythm parameters across integrative resilience score derived from principal component analysis (PCA). Findings: The PLSR model identified a modest but significant association of greater mental resilience with a sleep and circadian profile (Bootstrapping r = 0.15, 95%CI: 0.02-0.28), characterized by greater frontal-central slow waves activity in NREM sleep, greater frontal theta activity in REM sleep, lower occipital spectral power across fast and slow frequency bands in NREM and REM sleep, and probably earlier dim light melatonin onset timing. Conclusions: Sleep and circadian metrics, specifically frontal slow waves and REM theta activity, attenuated overall occipital spectral power during sleep, and earlier dim light melatonin onset time, represent quantifiable targets that may serve to improve resilience and stress-related mental health in adults. Longitudinal and interventional studies are needed to establish whether sleep interventions can be endorsed as evidence-based approaches for resilience enhancement. Clinical implications: Targeting sleep and circadian aspects may be an important approach to promote stress-related mental health.

Sleep disturbances compromise cognition, and overall physical and mental health; however, animal models of these effects remain limited, and typically impose more extreme disturbances than those experienced by humans. Here, we use behavioural interventions in mice to model two common types of sleep disruption: (1) sleep displacement associated with shiftwork and (2) sleep fragmentation associated with aging and disease. C57BL6/J mice were subjected to either a sleep deprivation protocol (n = 8, females = 4) or a fragmentation protocol (n = 8, females = 4), in which they were completely deprived of sleep or awoken every 2 min respectively, for 12 hours during their typical rest phase (lights-on) across 7 consecutive days. Age-matched control mice (n = 14, females = 7) remained undisturbed in their home cages. Activity during the 12-hour active phase was recorded via infrared motion sensors. After protocol completion, mice were injected with bromodeoxyuridine (BrdU, 200mg/kg) 2 hours prior to brain and blood collection; hippocampal neurogenesis and plasma corticosterone were then assessed. Results show that the sleep deprivation and fragmentation protocols had different, dynamic effects on behaviour; sleep deprivation was associated with an accumulating sleep need, operationalized as progressively reduced locomotor activity across the week, whereas fragmentation produced only an acute reduction of locomotor activity. Cell proliferation rates and corticosterone did not differ from controls. These protocols provide a foundation for future research into the mechanistic links between shiftwork and sleep fragmentation on health and cognition.

In characterizing sleep and circadian health, the day-to-day regularity of sleep-wake timing strongly predicts health outcomes, outperforming short sleep duration in prospective associations with mortality and new-onset disease. It is unknown whether biological (e.g., sleep and circadian physiology) and sociocultural (e.g., exposures that affect sleep-wake timing) sex differences lead to differences in day-to-day sleep-wake regularity or modify its prospective associations with health outcomes. Here, we present findings from a UK Biobank study of 506,582 person-days of accelerometer recordings across 73,647 middle-aged adults preceding 549,009 person-years of follow-up. We compared SRI scores between males and females and evaluated whether all-cause, cardiovascular, and cancer mortality differed across SRI groups by sex. Custom contrasts were used to compare estimated marginal means across specific SRI-sex combinations. Females were overrepresented among very high (SRI [&ge;]90) and underrepresented among very low (SRI <60) groups. After adjustment for demographic, health, and behavioral covariates, males still had higher odds than females of exhibiting SRI <60. Low SRI and male sex were synergistically associated with higher mortality rate. Demographic, health, and behavioral covariate-adjusted models showed stronger and more dose-dependent associations between low SRI and mortality among males than females. Although the omnibus SRI x sex interaction terms were not statistically significant, the interaction contrast for SRI <60 versus [&ge;]90 differed by sex, suggesting a possible sex difference in mortality rates at very low SRI. Together, our findings suggest that males may be more vulnerable than females to the mortality risk associated with highly irregular sleep-wake schedules.

This study investigated bidirectional associations between maternal sleep and depressive symptoms from preconception to postpartum, and whether infant sleep mediated or moderated these associations. We used data from the Generation R Next Study (N=2,294). Maternal sleep (specifically general sleep disturbance, latency, quality, duration, and midpoint) and depressive symptoms were prospectively assessed at five timepoints from preconception to 12-month postpartum. Sleep was self-assessed with the General Sleep Disturbance Scale and Munich Chronotype Questionnaire; depressive symptoms with the Adult Self Report depression/anxiety subscale and Edinburgh Postnatal Depression Scale. Infant sleep (specifically night awakenings, nocturnal sleep duration, and latency) was parent-reported at 1-month postpartum using the Brief Infant Sleep Questionnaire. Bidirectional associations were examined using Autoregressive Latent Trajectory Models with Structured Residuals. The role of infant sleep was examined using mediation and moderation analyses. We found that maternal sleep and depressive symptoms were both stable over time. For sleep quality and disturbance, bidirectional associations suggested slightly stronger effects from depression to sleep (sleep quality:{beta}depression[-&gt;]sleep quality=0.11, 95%CI:0.07 - 0.14; general sleep disturbance:{beta}depression[-&gt;]sleep disturbance=0.14, 95%CI:0.10 - 0.18) than from sleep to depression ({beta}sleep quality/disturbance[-&gt;]depression=0.07 for both, 95%CIs:0.03 - 0.11). For latency, effects were comparable in both directions ({beta}depression[-&gt;]sleep latency=0.06, 95%CI:0.03 - 0.09; {beta}sleep latency[-&gt;]depression=0.05, 95%CI:0.01 - 0.09). The association between depressive symptoms and sleep latency was both mediated (9.7%) and moderated (p<0.05) by infant sleep latency. In conclusion, general maternal sleep disturbance, sleep quality, and sleep latency showed bidirectional associations with depressive symptoms from preconception/early pregnancy onwards. Infant sleep latency may represent a potential modifiable factor within this cycle.

Background: Although sleep disorders are generally associated with cognitive decline, definitions of sleep conditions and cognitive function vary greatly across studies. Therefore, we evaluated associations between consensus definitions of sleep and cognitive outcomes across multiple studies. Methods: Consensus sleep measures were ascertained at baseline visits in three cohort studies (HCHS/SOL, MESA and ARIC, N=11,563): short and long sleep ([&le;]6hours and [&ge;]9hours), insomnia (Women's Health Initiative Insomnia Rating Scale [&ge;]10 or [&ge;]6 for 3 questions), daytime sleepiness (Epworth Sleepiness [&ge;]11) and obstructive sleep apnea (OSA, Apnea-Hypopnea Index [&ge;]15). Cognitive measures were ascertained at baseline and follow-up visits in each study and used to calculate harmonized outcomes: global cognitive function (GCF) at baseline, change in GCF between baseline and follow-up, poor GCF at baseline ([&ge;]1SD below the median), and incident poor GCF at follow-up. Study-specific analyses were adjusted for age, sex, center, education, race/ethnicity, APOE4 and language of cognitive assessments as needed. Results were meta-analyzed across studies. Results: Long sleep was consistently associated with lower baseline GCF ({beta}=-0.19, SE=0.03, p=3.78x10-14, FDR p=7.56x10-13, p-heterogeneity=0.78) and increased odds of poor baseline GCF (OR=1.77, 95% CI=1.49-2.09, p=2.96x10-11, FDR p=2.96x10-10, p-heterogeneity=0.22) across cohorts. Insomnia was also suggestively associated with lower baseline GCF ({beta}=-0.051, SE=0.02, p=0.01, FDR p=0.07, p-heterogeneity=0.005) and increased odds of poor baseline GCF (OR=1.22, 95% CI=1.06-1.41, p=6.76x10-3, FDR p=0.05, p-heterogeneity=0.03). Sleep measures were not associated with change in cognitive function. Discussion: Associations of long sleep and insomnia with harmonized cross-sectional GCF across three large, multiethnic cohorts suggest that cognitive function may be associated with distinct sleep phenotypes.

Background: Shiftwork disrupts natural sleep-wake cycles, alters light exposure patterns, and contributes to circadian misalignment. Detrimental health consequences associated with shift work include elevated risk for metabolic disorders, cardiovascular disease, cancer and all-cause mortality. Healthcare workers have one of the highest rates of shift work exposure, yet there are relatively few non-pharmacological interventions (with good evidence) developed to improve sleep outcomes in this population. Objective: A pre-post pilot interventional study assessed the acceptability and perceived effectiveness of commercial noise-masking earbuds on improving subjective sleep characteristics among National Health Service (NHS) healthcare staff working fast rotating shifts. Methods: Noise-masking sleep earbuds (Kokoon NightBuds) were worn for a pilot six-week intervention by twenty-seven NHS nurses (aged 26-43 years, 88.9% female) working fast rotating shifts from the EClocker Study. Sensors inside the earbuds were paired with a smartphone app to monitor sleep. An audio library in the smartphone app delivered personalised relaxation exercises and sleep techniques drawn from cognitive behavioural therapy for insomnia (CBT-I). A pre-post two-week monitoring period with daily smartphone-based Experience Sampling Methods (ESM) captured perceived daily sleep patterns. Acceptability and perceived effectiveness of the earbuds in promoting better sleep outcomes was assessed. Results: Use of the noise-masking sleep earbuds over a six-week period was associated with positive sleep improvement trends and elicited promising acceptability. Almost two thirds of NHS fast rotating shift nurses (63%) subjectively reported reductions in general sleep disturbance symptoms (PSQI Global), one in four experienced perceived sleep quality improvements (SQ; 25.9%), one in five reported sleeping longer (TST; 22.2%), and a third perceived falling asleep faster (SOL; 33.3%), had better sleep efficiency (SE; 33.3%) and improved daytime dysfunction (33.3%) (PSQI subcomponent scores). Sleep diaries (CSD) collected daily using smartphone-based ESM also demonstrated small improvements post-sleep earbud use; nurses reported sleeping an average 18 minutes longer (TST) and fell asleep more easily, on average 11 minutes faster (SOL). Sleep earbuds were generally well tolerated; 56% of nurses reported the earbuds as (somewhat to very) helpful, 52% reported (somewhat to strongly) falling asleep more easily (SOL), 44% felt (somewhat to strongly) their sleep quality was improved (SQ) and 30% agreed (somewhat to strongly) they slept longer (TST) and had less disturbed sleep. Conclusions: To our knowledge, this is the first study in Europe to pilot noise-masking earbuds as a potential non-pharmacological aid to improve sleep-wake behaviours or mitigate fatigue for healthcare staff. Preliminary results showed promising acceptability and (small) perceived sleep improvement trends following a targeted six-week earbud intervention in NHS fast rotating shift nurses.

Sleep expression in wild animals is regulated by their ecological context. Yet, how populations of a species differ in their sleep in response to environmental challenges such as urbanization, remains to be fully understood. Robust quantification of sleep in small animals, such as lizards, has so far been methodologically difficult, limiting population-level assessments. Using recently developed miniature loggers, we recorded sleep in 19 wild-caught individuals of the Peninsular rock agama lizard (Psammophilus dorsalis). We compared individuals from urban and rural environments and measured electro-oculogram (EOG)-derived sleep parameters: sleep duration, bout frequency, bout duration, and interval between bouts. We then subjected all individuals to an acute stressor (handling-restraint) and examined changes in sleep expression. We found that this species slept mostly at night, with an average total sleep time of 11h 10min. EOG-derived sleep characteristics did not differ substantially between populations, although daytime sleep bouts were more consolidated (shorter interval between bouts) in urban lizards. Contrary to evidence from mammals, acute restraint stress did not impact sleep, overall or for either population. To complement these measures, we also measured the latency to arousal after exposure to vibration stimuli in a separate set of urban and rural lizards (n = 12 each), and found that urban individuals responded marginally quicker at night compared rural individuals, demonstrating greater vigilance and/or more fragmented sleep. Overall, we show that sleep characteristics of wild animals in a common garden condition can be conserved within a species, with limited context-dependent variation between populations.

Background Sleep, mood, and affective states are mutually connected. There is a paucity of studies, however, that have considered bidirectional relationships between daily sleep-affective dyads in naturalistic settings, particularly for shift workers. Objective To evaluate the dynamic and temporal interplay of daily smartphone-based self-reported sleep measurements, dimensions of affective experience and cognitive processing in UK shift working nurses. Methods The EClocker Study prospectively monitored 102 National Health Service (NHS) nurses (aged 25-61 years, 83.3% female) working standard (day shift) and non-standard (fast rotating shifts) schedules over a two-week period. Smartphone-based Experience Sampling Methodology (ESM) recorded daily sleep, mood, momentary affect and cognitive attentional functioning. Self-reported burnout, emotional dysregulation, emotion reactivity and affective dimensions (positive and negative) were also collected. Findings Overall, NHS nurses reported a high prevalence of depressive symptoms, stress, burnout and sleep-circadian rhythm disturbances. Generalised Additive Modelling (GAMs) revealed that NHS nurses higher perceived sleep quality predicted better next-day mood state, while better daytime mood was associated with reduced sleep onset latency, such that participants reported falling asleep faster. In contrast, daytime mood or affect (positive and negative) had no substantial, direct impact on nurses subjective sleep parameters (sleep quality, sleep duration, sleep efficiency). Exposure to fast rotating night shifts across the two-week study was associated with more frequent response errors on a Choice Reaction Time (CRT) cognitive task, while daytime somnolence did not adversely influence nurses momentary reaction time speeds or attentional function. Conclusions Clinically relevant sleep impairments, insomnia-related symptoms, elevated stress, and poor mood were pervasive in a sample of UK NHS nurses, regardless of shift type. Sleep quality impacted next-day mood and daytime mood impacted sleep latency, while rotating shifts led to an increase in cognitive errors. Recognising the impact of shiftwork and designing interventions to promote better sleep quality offer potential to enhance mood and performance in healthcare professionals. Clinical implications We need to implement and evaluate interventions that regularise sleep patterns and promote sleep quality to alleviate mood symptoms among frontline NHS shift workers.

Sleep health reflects interacting demographic, clinical, micro- and macroarchitectural, and neurophysiological factors that may not be captured by single metrics or diagnostic categories. We applied hierarchical clustering to longitudinal Sleep Heart Health Study data from 1,468 adults with complete polysomnographic, demographic/clinical, and pre-sleep electroencephalographic data at two visits separated by 5.19 {+/-} 0.27 years. Forty nonredundant features selected from candidate demographic/clinical, sleep-stage, and pre-sleep spectral measures were clustered independently at each visit. Four reproducible sleep-health phenotypes emerged: a group with preserved deep sleep and favorable mental-health ratings; a large light-sleep group with low N3 and high N1; an older, physically unhealthy group with shorter total and rapid-eye-movement sleep; and a younger, physically healthy group with longer total and rapid-eye-movement sleep. The same population-level structure was evident at both visits, although only 37.7% of participants retained the same cluster assignment, with transitions most directed toward the light-sleep phenotype. An independent analysis of slow-wave morphology, excluded from cluster construction, differentiated all four phenotypes after false-discovery-rate correction. Groups with preserved or healthier sleep showed more numerous, higher-amplitude, steeper, and shorter slow waves, whereas the light-sleep and physically unhealthy groups showed weaker and more prolonged slow waves. Pre-sleep spectral features did not differ significantly across clusters after correction. These findings identify reproducible but individually dynamic sleep-health phenotypes and demonstrate that macro-architectural cluster structure is reflected in independent measures of NREM sleep microarchitecture.

Study Objectives: To characterize neural correlates of memory and emotion reactivity in individuals with insomnia disorder (INS) compared to good sleepers (GS) and to investigate associated short- and long-term changes following cognitive-behavioural therapy for insomnia (CBTi). Methods: This randomized controlled trial included 56 INS and 20 GS. At baseline, participants underwent resting-state and task-based functional magnetic resonance imaging, including working memory, emotion reactivity, and face-name associative memory tasks. They filled out sleep diaries and self-report questionnaires about sleep, cognition, and emotions, and underwent in-lab polysomnography. Subsequently, participants with INS were randomized to either the 3-month treatment group (TX) or wait-list control group (WL). Both TX and WL groups repeated baseline assessments at three months post-randomization and completed sleep diaries and questionnaires one year after finishing CBTi. Results: At baseline, the INS group reported higher insomnia severity, greater subjective cognitive impairment, and perceived sleep-related stimuli as more negative than GS. Contrasting with these subjective evaluations, no group differences were found in memory performance, task-based brain activity, or resting-state functional connectivity. At three months post-randomization and one-year follow-up, CBTi significantly improved subjective, but not objective, cognitive functioning and sleep in adults with INS. No significant treatment-related changes were observed in valence ratings of sleep images, task-based brain activity, or resting-state functional connectivity. Conclusions: Beyond its primary role in improving insomnia symptoms, CBTi may have long-term benefits for individuals with INS who experience concerns about their cognitive functioning, even in the absence of objective changes in neural processing of cognitive and emotional tasks.

Study Objectives. Sleep characteristics are often estimated using self-reports, which may differ from objective measurements, a phenomenon known as sleep discrepancy. However, the factors associated with the degree of sleep discrepancy remain poorly understood. Methods. In the current study, a large healthy participant sample of the Budapest Sleep, Experiences and Traits Study (total N=267, 1899 nights) completed a 7-day protocol including mobile EEG recordings and sleep diaries, and also provided questionnaire-based reports of habitual sleep. We compared analogous sleep metrics from these three modalities, and used cross-validated LASSO regression to investigate demographic, psychological and lifestyle-related factors associated with increased sleep discrepancy across all three modalities, at both between- and within-participant levels. Results. Daily diaries estimated EEG-based sleep timing accurately (mean r=0.83), but were less accurate for sleep onset latency and quality. In contrast, questionnaire reports of habitual sleep provided inaccurate measures of even sleep timing (mean r=0.49) and considerably misestimated sleep timing and duration. Insomnia and depressive symptoms, napping, co-sleeping and personality traits were associated with increased sleep discrepancy. Conclusion. In healthy adults, questionnaires about habitual sleep provide only moderately accurate and biased estimates of actual sleep. Daily diaries provide considerably more accurate estimates, but sleep onset latency and physiological sleep quality is estimated by all self-reports less accurately than sleep timing. Sleep discrepancy is also present in healthy participants, it is particularly and its degree is affected by non-pathological characteristics. Long-term monitoring by daily diaries or wearables should be preferred to self-report questionnaires to measure sleep.

We investigated life satisfaction in relation to sleep health among U.S. college students, and determined whether the relationship varied by age, sex, race, and ethnicity. Using 2022 National Health Interview Survey data, we assessed life satisfaction (satisfied vs. dissatisfied), recommended sleep duration ([&le;]7 vs. <7 hours), few insomnia symptoms (IS), and restorative sleep. Adjusted Poisson regression with robust variance was employed for the overall population and then stratified by the aforementioned sociodemographic characteristics. Overall (N = 1,426, mean age {+/-} SE = 27.7 {+/-} 0.3) years), 97.1% of college students reported life satisfaction, which was associated with a higher prevalence of recommended sleep duration (PR = 1.96 [95% CI:1.19-3.22]), few IS (PR = 2.48 [1.36-4.52]), and restorative sleep (PR = 3.62 [1.49-8.83]). There was no evidence of differences in the relationship by age, sex, race, and ethnicity. Life satisfaction was associated with favorable sleep among U.S. college students.

Background: Non-motor symptoms, including sleep and cognitive dysfunction, are major contributors to reduced quality of life in people with Parkinsons disease (PwPD). Dance has been proposed as a promising intervention to improve quality of life in PwPD. Previously, we reported longitudinal trajectories of global cognition following community-based dance; however, little is known about its long-term influence on sleep-related non-motor symptoms and their relationship with global cognitive performance. Objective: We examined the six-year trajectories of sleep and overall non-motor symptom severity among PwPD participating in weekly community-based dance classes compared to a sedentary Reference group. As a secondary objective, we evaluated their association with global cognitive performance as a functional outcome. Methods: This longitudinal observational study followed PwPD engaged in community dance participation as well as a matched sedentary control group from the Parkinsons Progression Markers Initiative database over six years. Generalized estimating equations (GEE) were used to model group-level trends, with sensitivity analyses conducted to assess the robustness of the findings. Results: Non-motor outcomes showed that insomnia worsened significantly within the Reference group (p = .003) but improved among dancers (p = .005), with daytime sleepiness remaining stable across both groups. When sleep was used as a predictor of cognition, global cognitive performance trended to improve in the Dance group (p = .078) and declined mid-period in the Reference group (p = .014). In addition, overall non-motor symptom severity worsened in the Reference group (p = .011) but remained stable in the Dance group. Constipation also worsened significantly in the Reference group (p = .012) compared to the Dance group. Conclusion: The present study demonstrates that community-based dance may support select non-motor symptoms, including insomnia, and cognitive resilience in PwPD. Findings reinforce dance as a valuable, real-world, non-pharmacological approach to slow functional decline in PD.

Background. Alcohol use impacts sleep; however, sleep is also impacted by other 24-hour movement behaviors, including sedentary behavior (SB) and physical activity (PA). This study used compositional data analysis (CoDA) to simultaneously account for SB and PA and investigate within- and between-person associations between sleep and alcohol use behaviors. Methods. Participants were 21-44-year-old overweight/obese adults. Across 21 days, participants wore an activPAL monitor to assess sleep, PA, and SB hours, and completed morning surveys of past day alcohol use to assess drinks/day. CoDA identified the daily proportions of time spent in sleep, PA, and SB. Multilevel models investigated within- and between-person associations between sleep, demographic factors, and alcohol use. Differences in sleep, SB, and PA across drinking versus non-drinking days were investigated with individual MANOVAs for each participant. Results. Participants (N=91, Mage=30.7{+/-}6.5, 57% female, 75% White) reported drinking on 23% (n=437) of days, consumed 1 drink/day, and averaged 8.5{+/-}2.3 sleep hours, 7.4{+/-}2.8 SB hours, and 8.0{+/-}2.7 PA hours per day. Multilevel models indicated that participants slept 16.6 fewer minutes on drinking days (p=.046) each additional drink corresponded with 4.4 fewer minutes of sleep (p=.04). There was large between-person variability in time use allocations across drinking versus non-drinking days. For many the change was non-significant; however, three participants spent significantly less time sleeping on drinking days (1.16-4.74 fewer hours of sleep) and one participant spent significantly (2.62) more hours sleeping on drinking versus non-drinking days. Conclusions. Drinking days and greater alcohol consumption were associated with fewer minutes of sleep within-people; however, shifts towards PA and SB were inconsistent. Investigating contextual factors, such as the physical/social context of alcohol use, the time-of-day drinking occurs, the type of alcohol consumed, or the type of PA a person engages in could provide deeper insight into the conditions under which alcohol use detrimentally impacts sleep.

Background: Complementary and Alternative Medicine (CAM) therapies, such as massage, meditation, and yoga, are widely used to promote wellness, including sleep improvement. Although some CAM therapies may improve sleep through stress reduction, relaxation, and relief of physical discomfort, little is known about associations between individual CAM modalities and sleep health at the population level. Therefore, we investigated the associations between CAM therapies and short sleep duration as well as insomnia symptoms. Methods: Participants from the nationally-representative 2012 National Health Interview Survey (NHIS) self-reported the use of CAM therapies and short sleep duration (<7 hours vs. 7-9 hours) as well as insomnia symptoms (yes vs. no). Poisson regression with robust variance was used to estimate adjusted prevalence ratios (aPRs) and 95% confidence intervals (CIs) for cross-sectional associations between CAM therapy use and sleep outcomes. Results: Among 30,405 participants, the average age was 46.1 +/- 0.2 years and 51% were women. Adults reporting any vs. no CAM therapy use had a higher prevalence of short sleep duration (aPR: 1.11; 95% CI: 1.05-1.16) and insomnia symptoms (aPR: 1.56; 95% CI: 1.47-1.65) after adjustment for sociodemographic and clinical characteristics. Herbal supplements (aPR: 1.13; 95% CI: 1.07-1.19) and massage (aPR: 1.14; 95% CI: 1.05-1.23) were associated with higher prevalence of short sleep duration. Most CAM therapies were associated with higher prevalence of insomnia symptoms, with the strongest associations observed for meditation/guided imagery/progressive relaxation (aPR: 1.84; 95% CI: 1.68-2.02). Conclusion: The higher prevalence of short sleep duration and insomnia symptoms among CAM users may reflect reverse causation, as adults with more severe or persistent sleep disturbances may be more likely to seek CAM therapies. Longitudinal studies are needed to clarify directionality.

Background: Circadian syndrome (CircS) comprises metabolic abnormalities, short sleep, and depressive symptoms, and is associated with cardiovascular, liver, and lung diseases and mortality; evidence on digestive disease is scarce. We assessed its association with incident non-neoplastic digestive disease in Chinese adults. Methods: In this prospective analysis of the China Health and Retirement Longitudinal Study (CHARLS), we included 2011 baseline participants aged >=45 years free of digestive disease, with follow-up to 2018. CircS (>=4 of 7 components) was analysed as a continuous score and as a binary exposure. Cox models estimated hazard ratios (HRs) adjusting for demographic factors, BMI, smoking, and alcohol use. We did dose-response, component, subgroup, and sensitivity analyses; hs-CRP mediation was explored. Findings: 907 (19.0%) of 4 771 participants developed digestive disease over a median 84 months. Each additional CircS component raised the risk by 9.1% (HR 1.091, 95% CI 1.041-1.144, P<0.001); CircS positivity (36.1%) was associated with a 25.7% higher risk (HR 1.257, 1.084-1.456, P=0.002). Risk rose approximately linearly to about 70% higher at 5-7 components. Short sleep (HR 1.178, 1.017-1.365) and depressive symptoms (HR 1.570, 1.367-1.803) were the only independently associated components; no metabolic component was associated. Results were robust across sensitivity analyses; hs-CRP did not mediate the association. Interpretation: CircS is associated with incident non-neoplastic digestive disease, driven by its circadian-emotional rather than metabolic components. Sleep and mood may be targets for prevention. Funding: This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. Keywords: circadian syndrome; digestive diseases; cohort study; sleep; depression; brain-gut axis

Study Objectives: Poor maternal sleep is associated with adverse health outcomes for women and their offspring, and perturbations to tryptophan metabolism through the kynurenine pathway (KP) may contribute. Kynurenic acid (KYNA), a neuroactive KP metabolite and endogenous modulator of glutamatergic and cholinergic neurotransmission, is of particular interest because elevated KYNA has been linked to altered sleep-wake behavior and neurodevelopmental outcomes. Because sleep patterns and KP metabolism change during pregnancy, we tested whether pregnancy modifies the effects of kynurenine supplementation on sleep-wake architecture. Methods: To model enhanced KP metabolism, we used the embryonic kynurenine (EKyn) model, in which the maternal diet is supplemented with kynurenine, the initial KP metabolite, during the last week of gestation. Using a within-subject design, we evaluated sleep-wake parameters in pregnant and non-pregnant female rats and assessed KYNA in brain and saliva. Results: Pregnancy increased dark phase NREM and REM sleep in control-fed (ECon) dams, a pattern largely maintained in EKyn dams. However, near parturition, EKyn dams exhibited reduced light phase REM sleep that was not observed in controls. In non-pregnant females, kynurenine supplementation produced a stronger phenotype, consistently reducing light phase REM sleep across treatment days. During pregnancy, kynurenine-associated sleep effects were detectable only when compared to within-subject non-pregnant baseline. Salivary KYNA distinguished kynurenine-fed females from matched controls and correlated with brain KYNA levels. Conclusion: These findings show that pregnancy reshapes sleep-wake architecture and attenuates, but does not eliminate, kynurenine-associated REM sleep disruption, implicating KP metabolism and potentially elevated brain KYNA in maternal sleep regulation.

. Abstract Objectives. Prior research has identified associations between sleep health and cognitive function. Our aim was to investigate multiple domains of sleep health and their associations with cognitive function in a diverse sample of older adults. Methods. These data are from an observational study in Chicago, USA, that enrolled adults aged 55 years and older without cognitive impairment at baseline and followed a subset for up to 2 years. Sleep was measured with 7 days of wrist actigraphy and we examined sleep duration (amount), sleep fragmentation (an index of restlessness and sleep quality), sleep start time and sleep regularity (based on the within-subject standard deviation of sleep start time). . Participants also completed tasks from the NIH Toolbox to estimate fluid cognition and the Trail Making Test (Trails B) to assess attention and processing speed. A subset of participants was examined at a follow-up visit that included only the NIH Toolbox assessment. Results. Our sample included 324 participants (63.6% women, 37.3% African American/Black, 13.6% Hispanic/Latino). Greater sleep fragmentation and less sleep regularity were associated with worse fluid cognition and Trails B scores (all p<.01). Longer sleep duration and earlier sleep start times were associated with better performance on Trails B. No sleep measures were associated with change in the fluid cognition score over an average of 1.9 years (n=133). Discussion. These findings support a cross-sectional association between cognitive function and multiple domains of sleep health, including duration, quality, timing and regularity, in a diverse sample of older adults.

Sleep disturbances are a significant but underrecognized burden for individuals with Lennox-Gastaut Syndrome (LGS) and their caregivers. We conducted a large LGS caregiver survey to assess sleep quality, duration, specific sleep-related issues, and management strategies. Quantitative analysis revealed a significant association between nocturnal seizures and overall seizure frequency, but general sleep metrics in individuals with LGS (e.g., sleep hours, sleep quality) were not associated with seizure burden. In contrast, caregiver sleep was frequently disrupted - particularly in families who co-slept or reported frequent seizures. Nearly 40% of caregivers experienced nightly sleep disturbances. Respondents reported a range of strategies to manage sleep problems, including medication, environmental adjustments, and behavioral routines. Many also expressed frustrations over the limited effectiveness of strategies and inadequate support for sleep issues. These findings underscore the dual impact of LGS-related sleep disturbances on patients and caregivers, and highlight the need for comprehensive, family-centered approaches to sleep health.