Insomnia Severity is Associated with Morning Cortisol and Psychological Health.

Studies suggest associations between cortisol and sleep, and cortisol shows a profound diurnal rhythm. The evidence about the relationship between chronic insomnia and cortisol is mixed. Chronic insomnia is associated with the risk of mental health disorders. The aim of this study was to evaluate the association of insomnia severity and objective sleep pattern with morning cortisol level and psychological health. The instruments used were the Insomnia Severity Index (ISI), polysomnography, Beck Depression Inventory (BDI), and Profile of Mood States (POMS). Serum cortisol was analyzed by chemiluminescence. The data revealed significant positive correlations of ISI with morning cortisol level (r = 0.37, p = 0.03), BDI score (r = 0.44, p < 0.01), and POMS-tension anxiety (r = 0.39, p = 0.02). Sleep stages N2 and N3 were correlated with POMS-fatigue (r = 0.46, p < 0.01; r = -0.37, p = 0.04). Sleep stage N3 was also negatively correlated with POMS-tension-anxiety (r = -0.36, p = 0.04). Higher insomnia severity was associated with higher morning cortisol, depression, and tension-anxiety. Sleep stage N2 was associated with higher fatigue and N3 was associated with lower tension-anxiety and fatigue.

Exercise as an Adjunct Treatment to Cognitive Behavior Therapy for Insomnia.

The question that guided this review is whether exercise can add to the improvements in insomnia in patients treated with cognitive behavioral therapy for insomnia (CBT-I). CBT-I has long been recommended as the first-line treatment of chronic insomnia. However, CBT-I is not effective for as many as 30% to 40% of patients with insomnia. There is accumulating evidence for positive effects on insomnia following acute and chronic exercise. However, to the best of our knowledge, the effects of CBT-I combined with exercise have not been explored in clinical trials. In this article, we develop a rationale for combining CBT-I with exercise.

Effects of exercise training and exercise plus acupuncture on chronic insomnia: a feasibility study.

Objective: The aim of this study was to investigate the effects of exercise and exercise plus acupuncture on chronic insomnia. Material and Methods: suggest replacing with "effects of" no feasibility things are reported chronic insomnia were randomized to a 12-week treatment with exercise or exercise plus acupuncture. Exercise treatment included 50 minutes of moderate-intensity aerobic exercise (50% of reserve heart rate), on a treadmill, 3 times/wk. Exercise plus acupuncture treatment included the exercise protocol plus acupuncture once per week. Pre- and post-treatments measures included insomnia severity index (ISI), Pittsburgh sleep quality index (PSQI), polysomnography (PSG), 10 days-sleep diary, state-trait anxiety inventory, Beck depression inventory, quality of life (SF-36), and morning cortisol level. Results: No group by time interaction was found for insomnia severity, sleep, mood or quality of life. Significant time differences (p<0.05) were observed for ISI, PSQI, and some variables of sleep diary. Polysomnography data showed a decrease in rapid eye movement (REM) latency after the interventions. Significant time improvements were also observed for mood, anxiety, depression, and quality of life. A significant moderate correlation was found between changes in the ISI and morning cortisol level. Conclusion: There were no significant differences between treatments on insomnia severity, sleep, mood or quality of life. Exercise and exercise plus acupuncture were efficacious for decreasing insomnia severity to subthreshold insomnia. Greater reduction in morning cortisol was associated with a greater reduction on insomnia severity across both treatments.

Effects of Xbox Kinect exercise training on sleep quality, anxiety and functional capacity in older adults.

The aim of this study was to examine the effects of an Xbox Kinect exercise program on sleep quality, anxiety and functional capacity in older adults. Twenty-nine older adults were randomized into two treatment groups: XBOX (n = 15) or CONTROL (n = 14). The XBOX group performed exercise with an Xbox Kinect for 60 min, three times per week for 6 weeks. The CONTROL group did not exercise. Improvements in sleep quality (p = 0.04), anxiety (p = 0.007), aerobic endurance (p = 0.003), agility/balance (p = 0.02), and lower limb strength (p = 0.05) were observed in the XBOX group compared with the CONTROL. Xbox Kinect exercise program improved sleep quality, reduced anxiety, and increased the functional capacity of older adults. These results support the value of exercise in the Xbox Kinect for sleep quality and anxiety in older adults. (Clinical Trials Registration NCT04692272).

Testing the sleep hygiene recommendation against nighttime exercise.

PURPOSE: Experts have recommended exercise for improved sleep, but often with the caveat that one should avoid nighttime exercise. The aim of this study was to challenge this recommendation in a sample who might be most prone to sleep impairment after nighttime exercise. The secondary aims were to assess whether or not post-treatment sleep was correlated with anxiolytic effects or downregulation of body temperature. METHODS: Twelve sedentary adults with insomnia completed two treatments (separated by 2-5 days) in counterbalanced order: (1) 30 min of moderate treadmill exercise (60-70% maximum heart rate) + 15 min of moderate resistance exercise and (2) a control treatment (reading). Each treatment was completed 2 h before bedtime and followed by a 10-min shower, a light snack, 8 h of polysomnographic recording, and a sleep questionnaire. State anxiety was assessed before and 30 min after each treatment and 10 min before bedtime. Body temperature was assessed from pre-exercise to wake time. RESULTS: No significant treatment differences in sleep were found, and Hedges g paired comparisons indicated small effect sizes; however, two participants had severely disturbed objective sleep following exercise. Significant correlations were found between change in state anxiety from pre-exercise to bedtime and TST (r = 0.69, p = 0.03). Stage 1 (r = 0.67, p = 0.03), WASO (r = 0.69, p = 0.03), and sleep efficiency (r = 0.66, p = 0.02). No significant correlations were found of sleep with temperature decline. CONCLUSIONS: Profound sleep disturbance after exercise in some participants, and no marked sleep improvement in the others, provides some support for caution regarding late-night exercise for sedentary individuals with insomnia.

Efeito de video games ativos sobre a capacidade funcional e o humor de idosos: revisão sistemática e meta-análise / Effect of active video games on functional capacity and mood in older adults: systematic review and meta-analysis

Nos últimos anos, os video games ativos (VGAs) têm sido utilizados pela população geral como uma alternativa para a prática de exercício físico associada ao entretenimento. O objetivo deste estudo foi realizar uma revisão sistemática sobre o efeito dos VGAs na capacidade funcional e no estado de humor de idosos. Para a seleção dos artigos, considerou-se estudos publicados entre 2006 e 2017, realizados com idosos (> 60 anos); que utilizaram como intervenção, exercícios realizados em VGAs Nintendo Wii ou Xbox Kinect. Os resultados observados sugerem melhoras no equilíbrio, na força muscular de membros inferiores e na mobilidade funcional. No perfil de humor, os resultados são controversos. Sendo assim, podemos concluir que o exercício realizado em VGAs pode melhorar a capacidade funcional, no entanto, os benefícios no humor precisam ser mais investigados, especial-mente em estudos de longo prazo.

In the last years, the active video games (AVGs) have been used by the general population as an alternative to exercise and entertainment. The aim of this study was to do a systematic review about the effects of AVGs on the functional capacity and the mood in older adults. We selected studies published between 2006 and 2017, with older adults (> 60 years) and only that had interventions with Nintendo Wii or Xbox Kinect. The results suggested improvements in the balance, muscle strength of lower limbs and functional mobility. In the mood profile, the results are controversial. We could conclude that AVGs exercising may improve functional capacity, however, the benefits in the mood, need further investigations, especially in the long-term studies.

Exercise improves immune function, antidepressive response, and sleep quality in patients with chronic primary insomnia.

The aim of this study was to evaluate the effects of moderate aerobic exercise training on sleep, depression, cortisol, and markers of immune function in patients with chronic primary insomnia. Twenty-one sedentary participants (16 women aged 44.7 ± 9 years) with chronic primary insomnia completed a 4-month intervention of moderate aerobic exercise. Compared with baseline, polysomnographic data showed improvements following exercise training. Also observed were reductions in depression symptoms and plasma cortisol. Immunologic assays revealed a significant increase in plasma apolipoprotein A (140.9 ± 22 to 151.2 ± 22 mg/dL) and decreases in CD4 (915.6 ± 361 to 789.6 ± 310 mm(3)) and CD8 (532.4 ± 259 to 435.7 ± 204 mm(3)). Decreases in cortisol were significantly correlated with increases in total sleep time (r = -0.51) and REM sleep (r = -0.52). In summary, long-term moderate aerobic exercise training improved sleep, reduced depression and cortisol, and promoted significant changes in immunologic variables.

Is exercise an alternative treatment for chronic insomnia?

The purposes of this systematic/critical review are: 1) to identify studies on the effects of exercise on chronic insomnia and sleep complaints in middle-aged and older adults and to compare the results of exercise with those obtained with hypnotic medications and 2) to discuss potential mechanisms by which exercise could promote sleep in insomniac patients. We identified studies from 1983 through 2011 using MEDLINE, SCOPUS and Web of Science. For systematic analyses, only studies assessing the chronic effects of exercise on sleep in people with sleep complaints or chronic insomnia were considered. We used the following keywords when searching for articles: insomnia, sleep, sleep complaints, exercise and physical activity. For a critical review, studies were selected on the effects of exercise and possible mechanisms that may explain the effects of exercise on insomnia. We identified five studies that met our inclusion criteria for systematic review. Exercise training is effective at decreasing sleep complaints and insomnia. Aerobic exercise has been more extensively studied, and its effects are similar to those observed after hypnotic medication use. Mechanisms are proposed to explain the effects of exercise on insomnia. There is additional documented evidence on the antidepressant and anti-anxiety effects of exercise. Exercise is effective to decrease sleep complaints and to treat chronic insomnia. Exercise presented similar results when compared with hypnotics; however, prospective studies comparing the effects of exercise with medical and non-medical treatments are warranted before including exercise as a first-line treatment for chronic insomnia are necessary.

Is exercise an alternative treatment for chronic insomnia?

The purposes of this systematic/critical review are: 1) to identify studies on the effects of exercise on chronic insomnia and sleep complaints in middle-aged and older adults and to compare the results of exercise with those obtained with hypnotic medications and 2) to discuss potential mechanisms by which exercise could promote sleep in insomniac patients. We identified studies from 1983 through 2011 using MEDLINE, SCOPUS and Web of Science. For systematic analyses, only studies assessing the chronic effects of exercise on sleep in people with sleep complaints or chronic insomnia were considered. We used the following keywords when searching for articles: insomnia, sleep, sleep complaints, exercise and physical activity. For a critical review, studies were selected on the effects of exercise and possible mechanisms that may explain the effects of exercise on insomnia. We identified five studies that met our inclusion criteria for systematic review. Exercise training is effective at decreasing sleep complaints and insomnia. Aerobic exercise has been more extensively studied, and its effects are similar to those observed after hypnotic medication use. Mechanisms are proposed to explain the effects of exercise on insomnia. There is additional documented evidence on the antidepressant and anti-anxiety effects of exercise. Exercise is effective to decrease sleep complaints and to treat chronic insomnia. Exercise presented similar results when compared with hypnotics; however, prospective studies comparing the effects of exercise with medical and non-medical treatments are warranted before including exercise as a first-line treatment for chronic insomnia are necessary.

Effects of moderate aerobic exercise training on chronic primary insomnia.

OBJECTIVE: To evaluate the effect of long-term moderate aerobic exercise on sleep, quality of life, and mood of individuals with chronic primary insomnia, and to examine whether these effects differed between exercise in the morning and exercise in the late afternoon. METHODS: Nineteen sedentary individuals with chronic primary insomnia, mean age 45.0 (standard error [SE] 1.9) years, completed a 6-month exercise training protocol, randomized to morning and late-afternoon exercise groups. RESULTS: Combining polysomnographic data across both time points, this study found a significant decrease in sleep onset latency (from 17.1 [SE 2.6] min to 8.7 [SE 1.4] min; P<0.01) and wake time after sleep onset (from 63.2 [SE 12.8] min to 40.1 [SE 6.0] min), and a significant increase in sleep efficiency (from 79.8 [SE 3.0]% to 87.2 [SE 1.6]%) following exercise. Data from sleep diaries revealed significant improvement in sleep onset latency (from 76.2 [SE 21.5] min to 80.3 [SE 7.4] min) sleep quality (from 41.5 [SE 5.2]% to 59.4 [SE 6.6]%) and feeling rested in the morning (from 50.8 [SE 5.3] to 65.1 [SE 5.0]). There were generally no significant differences in response between morning and late-afternoon exercise. Following exercise, some quality-of-life measures improved significantly, and a significant decrease was seen in the following Profile of Mood State measures: tension-anxiety (from 7.2 [SE 1.0] to 3.5 [SE 1.0]), depression (from 5.9 [SE 1.2] to 3.3 [SE 1.1]) and total mood disturbance (from 9.2 [SE 4.8] to -1.7 [SE 4.8]). These effects did not vary between morning and late-afternoon exercise. CONCLUSION: Long-term moderate aerobic exercise elicited significant improvements in sleep, quality of life and mood in individuals with chronic primary insomnia.

Tratamento não farmacológico para a insônia crônica / Nonpharmacologic treatment of chronic insomnia

O objetivo deste artigo é descrever, resumidamente, quais são as terapias não farmacológicas e também a atualização do uso destas para o tratamento da insônia crônica. Além da insônia ser o mais prevalente distúrbio do sono, ela está diretamente associada aos transtornos psiquiátricos. Embora o tratamento farmacológico seja o mais comumente utilizado, as terapias não farmacológicas vêm sendo amplamente estudadas, em particular as relacionadas às mudanças de comportamento. Entre estas estão a cognitiva; a higiene do sono; a do controle de estímulos; a de restrição do sono; a do relaxamento muscular; a da intenção paradoxal e, mais recentemente, a prática regular de exercícios físicos. Inicialmente, o principal objetivo dos estudos realizados com as intervenções comportamentais foi o de melhorar a qualidade do sono dos pacientes. No entanto, alguns estudos recentes têm sido desenvolvidos com o objetivo de avaliar o efeito de tais terapias auxiliando à redução da dose e da freqüência de uso de medicamentos utilizados, bem como à melhora da qualidade de vida dos pacientes. Como a insônia é um problema crônico, os tratamentos de longo prazo têm sido alvos de estudos e de uso comum entre os clínicos.

The purpose of this manuscript is to briefly describe the main modalities of non-pharmacological therapy and its utilization on the chronic insomnia treatment. Insomnia is the most frequent sleep disorder and that is more associated with psychiatry disorders. The pharmacotherapy is the most frequent treatment, but the nonpharmacologic therapy has been studied. The most common therapy modalities include behavioral approaches, stimulus control, sleep restriction, paradoxical intention, sleep hygiene, progressive muscle relaxation and biofeedback and, more recently, physical exercise practices. At first behavioral therapy aimed to improve sleep quality, however, recent studies have been emphasizing the effect of behavioral and cognitive approaches on quality of life, on decrease of dosage and frequency of drugs intake. Since insomnia is a chronic condition, long-term and safe treatments are warranted.

[Nonpharmacologic treatment of chronic insomnia]. / Tratamento não farmacológico para a insônia crônica.

The purpose of this manuscript is to briefly describe the main modalities of non-pharmacological therapy and its utilization on the chronic insomnia treatment. Insomnia is the most frequent sleep disorder and that is more associated with psychiatry disorders. The pharmacotherapy is the most frequent treatment, but the nonpharmacologic therapy has been studied. The most common therapy modalities include behavioral approaches, stimulus control, sleep restriction, paradoxical intention, sleep hygiene, progressive muscle relaxation and biofeedback and, more recently, physical exercise practices. At first behavioral therapy aimed to improve sleep quality, however, recent studies have been emphasizing the effect of behavioral and cognitive approaches on quality of life, on decrease of dosage and frequency of drugs intake. Since insomnia is a chronic condition, long-term and safe treatments are warranted.