Wellness Check: Sleep

Vitamin D deficiency may be associated with sleep disorders in children

1. There was an association between vitamin D deficiency and obstructive sleep apnea, restless leg syndrome, and insomnia.

2. Vitamin D deficiency places children at a greater risk of decreased sleep duration and may delay bedtimes.

Evidence Rating Level: 1 (Excellent)

Vitamin D is a fat-soluble vitamin that may activate mechanisms in the sleep region of the brainstem. Vitamin D deficiency (defined as a value less than 20ng/mL), has been associated with many medical conditions such as cancer, diabetes, and even sleep disorders. Currently, there is a paucity of information regarding the association between vitamin D and pediatric sleep disorders. As a result, the objective of the present systematic review was to evaluate the current literature on the association between vitamin D and sleep disorders in children and adolescents.

This study was a systematic review conducted according to PRISMA guidelines. Of 748 identified articles, 14 articles were included in the review. The exclusion criteria included: adult population studies, lack of sleep relevance, and review articles. No restrictions were applied to the publication period or the country of study. Data extraction was completed by three independent reviewers.

Overall, this study included 14 studies that assessed the relationship between vitamin D levels and sleep disorders in children. Three main themes were identified in the review, including sleep duration and quality of sleep, obstructive sleep apnea (OSA), and other sleep disorders. Results demonstrated that vitamin D deficiency was associated with decreased sleep time and delayed bedtimes, with a potential bidirectional relationship. Furthermore, it was found that vitamin D deficiency may be associated with sleep disorders including OSA and restless leg syndrome. Despite these results, the present study was limited by a large proportion of cross-sectional studies as well as the presence of heterogeneity across studies. Nonetheless, this study provided early insight into the presence of an association between vitamin D and sleep disorders in children.

Weighted blankets may reduce sleep medication use in psychiatric patients

1. Prescription of a weighted blanket for sleep problems in patients with psychiatric disorders was shown to help reduce the use of sleep medications except for melatonin.

2. Decrease in the prescription of sleep medications was most often seen in younger patients, those with unipolar depression, anxiety, attention deficit hyperactivity disorder (ADHD), and post-traumatic stress disorder (PTSD).

Evidence Rating Level: 3 (Fair)

Patients with psychiatric disorders commonly deal with sleep problems. Current management options have typically included psychoeducation, pharmacologic and behavioral interventions. Recently, the use of tactile stimulation, such as the weighted blanket (WB), has gained attention as an intervention for sleep disorders due to its theoretical benefit and safety profile. However, these benefits have not yet been studied. As a result, the objective of the present register-based, observational study was to evaluate whether or not the prescription of a WB could lead to a reduction in sleep medication use.

This population study used a national register of prescriptions in Västra Götaland, Sweden between May 2015-December 2017. A within-individual comparison was used where each individual served as their own control. Patients were included if they were older than 18 years of age and had a registered psychiatric disorder as per ICD-10 codes. Prescriptions for WB were identified as well as common sleep medications including benzodiazepines, antihistamines, melatonin, and mirtazapine. Antipsychotic medications were excluded from the study. The main outcome of the study was pre- and post- index use of sleep medication after prescription of WB.

In this study, 1785 individuals were included. Of these, 66% were prescribed a sleep medication after WB prescription. There was a statistically significant reduction in the prescription rate of benzodiazepines, and antihistamines, and a significant increase in melatonin prescriptions after WB prescriptions. However, this study was limited as its use of administrative data may not have provided an accurate reflection of medication use and patients’ true diagnoses. Nonetheless, this study provided support for the use of WB as an effective intervention for sleep disorders.

Internet cognitive behavioral therapy may improve insomnia in chronic pain patients

1. Internet-delivered cognitive behavioral therapy (CBT) may provide greater immediate improvements in insomnia symptoms compared to applied relaxation.

2. After 6 months post-treatment, both treatment modalities had similar overall improvements in insomnia symptoms in the chronic pain cohort.

Evidence Rating Level: 2 (Good)

Patients with chronic pain often have concurrent symptoms of insomnia. These symptoms of poor sleep may lead to increased pain levels which may in turn worsen sleep. It is well known that cognitive behavioral therapy – insomnia (CBT-I) is an effective treatment option for insomnia. Unfortunately, access to CBT-I therapists may be limited; and therefore a more accessible and cost-effective alternative such as internet-delivered CBTI-I may be warranted. As a result, the objective of the present study was to assess the effectiveness of internet-delivered CBT-I for chronic pain patients.

The present randomized controlled parallel-group study was conducted in Sweden. Patients were selected via the Swedish Quality Registry for Pain Rehabilitation. Patients aged 18-65 years old with moderate to severe insomnia and chronic pain were included. Patients with comorbidities such as psychoses and bipolar disorder were excluded from the study. Participants (n=54) were randomized to either the CBT-I internet treatment or the control treatment of applied relaxation. Treatments lasted no longer than 5 weeks. The primary outcome assessed in the study was improvement in the Insomnia Severity Index (ISI) score after treatment.

Results demonstrated a greater improvement in ISI scores for patients who received internet-delivered CBT-I immediately after treatment. At the 6-month follow-up, there were no differences in the ISI score improvements between the two treatment groups. Although there were improvements in daytime sleepiness, there were no inter-group differences. Furthermore, compliance with the interventions was high in both treatment groups, with no inter-group differences. Despite these findings, this study was limited due to the small study group and lack of objective sleep measures. Nonetheless, this study highlighted the potential for internet-delivered CBT-I as a feasible treatment modality for chronic pain patients suffering from insomnia.

Image: PD

©2022 2 Minute Medicine, Inc. All rights reserved. No works may be reproduced without expressed written consent from 2 Minute Medicine, Inc. Inquire about licensing here. No article should be construed as medical advice and is not intended as such by the authors or by 2 Minute Medicine, Inc.