In the News

Menopause brings additional complications to sleep disturbances

Women’s sleep in midlife can be influenced by general aging and menopause — often at the same time — but health care providers can learn to spot differences to more effectively treat patients. Sleep disturbances are common for aging men and women, but hormonal changes brought on by menopause are unique and can require different, or additional, forms of treatment.

Sleep changes with age

From sleep interruption to early sleep and wake times, changes in sleep begin in midlife and continue to progress as people age.

“The largest difference [with age] is the inability to stay asleep,” said Phyllis C. Zee, MD, PhD, chief of sleep medicine in the department of neurology at Northwestern University Feinberg School of Medicine. “[Older people] have more awakenings … and also wake up earlier than desired. That is true for both sexes. Some individuals also have difficulty falling asleep, but with age, the factor is really difficulty staying asleep.”

Although these sleep disturbances begin to become more common around age 55 years, they progress over time.

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University researchers investigate relationship between poor sleep and cognitive decline

Could a good night’s sleep help to prevent future cognitive decline in older adults? A professor at the University hopes to find out if individuals with mild cognitive impairment could delay the effects of dementia by improving their sleeping habits.

Meghan Mattos, an associate professor at the University’s School of Nursing, is working to establish a feasible method of determining the relationship between sleep and mild cognitive impairment. She is using an internet intervention program known as Sleep Healthy Using the Internet for Older Adult Sufferers of Insomnia and Sleeplessness, or SHUTi OASIS, developed by her colleague and mentor Lee Ritterband, a professor of psychiatry and neurobehavioral sciences at the University.

Over the course of his career, Ritterband focused on developing internet-based interventions to bridge his interests between clinical psychology and computer science. Upon arriving at to the University in 1997, as the internet was starting to become mainstream, Ritterband saw the potential to use it to broaden the reach of his work.

Mattos and her colleagues have developed a trial for older adults suffering from mild cognitive impairment around the SHUTi program, with funding from the National Institutes of Health and a Translational Health Institute of Virginia grant.

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Southwest Virginia Residents Sought to Direct Region’s Battle Against Cancer

A new University of Virginia Cancer Center initiative will empower Southwest Virginia residents to lead projects to better detect and prevent cancer in the region. The effort has earned $244,589 in funding from the Eugene Washington Engagement Award Program at the Patient-Centered Outcomes Research Institute (PCORI).

With the funding in hand, the UVA Cancer Center Without Walls team is now seeking Southwest Virginia residents who will be trained to guide these cancer research projects.

Their goal is to address two cancer disparities in the Appalachian counties of Southwest Virginia:

  • the lack of early screening and detection
  • high death rates (between 15 and 36 percent higher compared with urban non-Appalachian residents) caused by later detection and lack of access to treatment and support programs

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Online CBT May Improve Daytime Effects of Insomnia

Adding digital cognitive-behavioral therapy (dCBT) to treatment as usual for insomnia disorder, compared with sleep hygiene education alone, can significantly improve multiple daytime effects from poor sleep, including moodiness and lower cognitive functioning, new research suggests.

In a randomized clinical trial, the large improvement in insomnia associated with dCBT mediated small improvements in functional health and psychological well-being, as well as large improvements in sleep-related quality of life. Significant improvements in these factors occurred at 4, 8, and 24 weeks following initiation of dCBT.

“Insomnia is the most common expression of mental ill health in the world. It presents mostly in primary care, but also in association with disorders such as depression and psychosis,” principal investigator Colin A. Espie, PhD, Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, United Kingdom, told Medscape Medical News.

“For decades it has been a disorder in search of a solution. Sleeping pills are less effective for chronic sleep problems than CBT, the treatment recommended by the American College of Physicians [ACP],” Espie added.

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Some Apps May Help Curb Insomnia, Others Just Put You To Sleep

Paige Thesing has struggled with insomnia since high school. “It takes me a really long time to fall asleep — about four hours,” she says. For years, her mornings were groggy and involved a “lot of coffee.”

After a year of trying sleep medication prescribed by her doctor, she turned to the internet for alternate solutions. About four months ago, she settled on a mobile phone meditation app called INSCAPE.

“It’s about a 30-minute soundtrack, and it starts with a woman kind of telling you to relax and instructing your breathing,” explains Thesing. “Then it goes into sounds — relaxing noises. There’s wind chimes, some atmospheric music playing…”

She uses the app every night and falls asleep within 15 or 20 minutes. “So, definitely a big improvement from four hours,” she says.

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Clinical Challenges: Delivering CBT to the Sleepless

Few people escape the occasional restless night of tossing and turning, followed by the inevitable crushing fatigue the following day. But for the as many as one in 10 adults who suffer from chronic insomnia, the experience is all too common.

In addition to the short-term harms of excessive daytime sleepiness and dysfunction, chronic insomnia — defined as disrupted sleep that occurs at least three nights a week, lasting for at least 3 months — has been linked in epidemiological studies to an increased risk for obesity, diabetes, heart disease, and other life-threatening chronic conditions

Cognitive behavioral therapy (CBT) has been recognized as the gold standard therapy for adults with insomnia by the American Academy of Sleep Medicine and, more recently, the American College of Physicians (ACP).

In 2016 guideline revisions, ACP recommended CBT alone, without medication, as the first-line therapy for chronic insomnia. A 2015 meta-analysis of 20 randomized, controlled trials involving more than 1,100 participants showed CBT to be an effective therapy for chronic insomnia.

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Bedtime: A Boon For The Aging Brain?

Could teaching individuals with mild cognitive decline how to sleep better actually stave off their descent into dementia?

That’s Meghan Mattos’ focus. And with support from a $300,000 Translational Health Research Institute grant, Mattos – an assistant professor of nursing at the University of Virginia who’s studied rural-dwelling adults with mild cognitive impairment – will determine the feasibility of an online sleep education program developed by UVA psychology professor Lee Ritterband in older adults with this early form of dementia.

The hypothesis, Mattos explained, is not only that the six-week program may offer non-pharmacological insomnia relief to patients with mild cognitive impairment, but that purposefully improving their sleep patterns through an accessible online program may slow their otherwise likely decline towards dementia.

“We don’t know if bad sleep is causing dementia, or dementia is causing bad sleep,” Mattos said, “but we do know that there’s a relationship between them, and we hope to find out what is causing what” – and what difference a program like Ritterband’s SHUTi OASIS (Sleep Healthy Using the Internet for Older Adult Sufferers of Insomnia and Sleeplessness) might make.

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What Lies Ahead for the Treatment of Insomnia (Theravive)

Although CBTi is a promising long-term solution because patients can practice the skills on their own, there is a limit to the number of professionals that are certified to deliver CBT specifically for insomnia. Startups addressing mental health have the potential to help people who struggle with insomnia and seek an alternative to a drug only treatment. For example, SHUTi describes itself as “an industry-leading online CBTi program with unsurpassed, proven results”.

Research on SHUTi was done at the University of Virginia and published in the journal JAMA Psychiatry. In this study, half the participants received general education on insomnia and the other half were provided online therapy with SHUTi. The researchers found that those who received the internet therapy improved compared to those who did not.

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THRIV Welcomes Second Class of Scholars (University of Virginia School of Medicine)

The Translational Health Research Institute of Virginia(THRIV) began in January 2017 to promote excellence in clinical and translational research across UVA. One of its first major milestones was to create a mentored career-development program to support training for junior faculty. The THRIV Scholars Program provides innovative training for highly motivated, talented junior faculty representing the next generation of clinical and translational researchers across Grounds at UVA. Scholars are prepared to excel in a clinical translational research environment in which digital data drives healthcare hypotheses, interventions, and health quality evaluation.

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An End to Insomnia…and All You Need Is Wi-Fi (BottomLineInc)

With so much self-help available online for free, it can be hard to know when paying for a program makes sense. But the effectiveness of Internet-based cognitive behavioral therapy for insomnia, or Internet-based CBTI, backed by more than a decade of research, makes it valuable for many people who struggle to get needed sleep. In fact, these programs can be downright economical compared to office visits with a therapist—should you be fortunate enough to even have a therapist nearby who practices CBTI. Researchers in the field began to develop Internet-based programs starting in the early 2000s precisely because there aren’t enough therapists trained in CBTI to care for the millions of people with insomnia who could benefit from it.

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