Department of Psychosocial Science, University of Bergen, P.O. Box 7807, N-5020 Bergen, Norway; Norwegian Competence Center for Sleep Disorders, Jonas Lies vei 65, 5021 Bergen, Norway. Electronic address: firstname.lastname@example.org.
We aimed to investigate the 10-year trend in the prevalence of insomnia symptoms, insomnia cases, and use of hypnotic agents in the adult Norwegian population.
Data from two representative surveys assessing identical insomnia symptoms in the adult population of Norway, one conducted in 1999-2000 (N=2001) and one conducted in 2009-2010 (N=2000), were compared.
Controlling for basic demographic variables, significant increases were found over the 10-year study period in the prevalence of sleep-onset insomnia from 13.1% to 15.2%, dissatisfaction with sleep from 8.2% to 13.6%, daytime impairment from 14.8% to 18.8%, Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) insomnia cases from 11.9% to 15.5%, and hypnotic agent use from 6.9% to 11.1%. No secular trend was found for maintenance insomnia or for early morning awakening insomnia. Across the two surveys, women reported a higher prevalence of insomnia than men. Age was positively associated with the prevalence of nocturnal sleep problems and use of hypnotic agents but was inversely associated with daytime impairment. Individuals with low socioeconomic status (SES) reported a higher prevalence of several insomnia symptoms.
Insomnia seems to be on the rise in the general adult population, which gives reason for concern. Prevention of insomnia and cost-effective interventions should receive higher priority in the future.
Norwegian Competence Center for Sleep Disorders, Haukeland University Hospital, Norway.; Department of Global Public Health and Primary Care, University of Bergen, Norway.. Electronic address: email@example.com.
Major age and sex differences are reported in bedroom habits and bedroom characteristics. However, few studies have investigated whether such bedroom habits and characteristics differ between patients with chronic insomnia disorder and good sleepers.
We assessed the association between several bedroom habits (i.e. electronic media use, bed sharing) and bedroom characteristics (i.e. bedroom temperature, blackout curtains) and chronic insomnia disorder among 1001 randomly selected adults responding to a telephone survey in Norway. Response rate was 63%. Insomnia symptoms were evaluated with the validated Bergen Insomnia Scale (with ICSD-3/DSM-5 criteria).
Chronic insomnia disorder was associated with reporting worse bed comfort, having newer beds, more noise stemming from both within and outside the building, higher bedroom temperature during the summer, and not preferring the supine position when trying to sleep. However, we found no associations between chronic insomnia disorder and electronic media use in bed, reading in bed, how important the mattress, pillow and comforter were rated, bed sharing, bedroom temperature during winter, open or closed bedroom window, use of blackout curtains, and most self-reported preferred body positions for sleep.
We found few and small differences in bedroom habits and bedroom characteristics between respondents with and without chronic insomnia disorder. Future studies with experimental and longitudinal designs should investigate whether and how such habits and characteristics are causally and temporally linked to insomnia.
Night work has been reported to be associated with various mental disorders and complaints. We investigated relationships between night work and anxiety, depression, insomnia, sleepiness and fatigue among Norwegian nurses.
The study design was cross-sectional, based on validated self-assessment questionnaires. A total of 5400 nurses were invited to participate in a health survey through the Norwegian Nurses' Organization, whereof 2059 agreed to participate (response rate 38.1%). Nurses completed a questionnaire containing items on demographic variables (gender, age, years of experience as a nurse, marital status and children living at home), work schedule, anxiety/depression (Hospital Anxiety and Depression Scale), insomnia (Bergen Insomnia Scale), sleepiness (Epworth Sleepiness Scale) and fatigue (Fatigue Questionnaire). They were also asked to report number of night shifts in the last 12 months (NNL). First, the parameters were compared between nurses i) never working nights, ii) currently working nights, and iii) previously working nights, using binary logistic regression analyses. Subsequently, a cumulative approach was used investigating associations between NNL with the continuous scores on the same dependent variables in hierarchical multiple regression analyses.
Nurses with current night work were more often categorized with insomnia (OR = 1.48, 95% CI = 1.10-1.99) and chronic fatigue (OR = 1.78, 95% CI = 1.02-3.11) than nurses with no night work experience. Previous night work experience was also associated with insomnia (OR = 1.45, 95% CI = 1.04-2.02). NNL was not associated with any parameters in the regression analyses.
Nurses with current or previous night work reported more insomnia than nurses without any night work experience, and current night work was also associated with chronic fatigue. Anxiety, depression and sleepiness were not associated with night work, and no cumulative effect of night shifts during the last 12 months was found on any parameters.
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Shift work is associated with negative health effects. Increased prevalence of several cardiovascular risk factors among shift workers/night workers compared with day workers have been shown resulting in increased risk of cardiovascular events among shift workers and night workers. Previous studies have taken a dichotomous approach to the comparison between day and night workers. The present study uses a continuous approach and provides such a new perspective to the negative effects of night work load as a possible risk factor for undesirable health effects.
This cross sectional study (The SUrvey of Shift work, Sleep and Health (SUSSH)) uses data collected from December 2008 to March 2009. The study population consists of Norwegian nurses. The study collected information about demographic and lifestyle factors: Body Mass Index (BMI), smoking habits, alcohol consumption, caffeine consumption and exercise habits. The lifestyle parameters were evaluated using multiple hierarchical regression and binary logistic regression. Number of night shifts worked last year (NNL) was used as operationalization of night work load. Adjustment for possible confounders were made. Obesity was defined as BMI > 30. Alcohol Consumption was evaluated using the short form of the Alcohol Use Disorders Identification Test Consumption (AUDIT-C). Data were analyzed using SPSS version 22.
We had data from 2059 nurses. NNL was significantly and positively associated with BMI, both when evaluated against BMI as a continuous parameter (Beta = .055, p
To examine the prevalence of self-reported symptoms of obstructive sleep apnoea (OSA) in relation to asthma, respiratory symptoms and pulmonary function. A secondary objective was to determine how sex impacted these relationships.
A random sample of all adults aged 47-48 and 71-73 years living in Bergen, Norway, were invited. Participants (3506, 69%) underwent spirometry testing and completed a questionnaire on sleep, respiratory symptoms and past medical history. OSA was defined by positive answers to questions on snoring, breathing cessations and daytime sleepiness. Current asthma was defined by ever having received a physician's diagnosis of asthma and current use of anti-asthma medication. Logistic regression analyses, including interaction analyses between sex and the different explanatory variables, were used to examine associations between OSA and current asthma, pre- and post-bronchodilator pulmonary function tests, smoking habits and respiratory symptoms. All models were adjusted for age, sex, waist-hip ratio and smoking.
OSA was more prevalent in the middle-aged compared to the elderly (6.2% vs 3.6%), and in subjects reporting respiratory symptoms. 4.8% had OSA and 6.1% had current asthma. Current asthma and the lowest quartile of post-bronchodilator FVC were significantly associated with OSA with ORs of 2.5 (1.5, 4.2) and 1.7 (1.1, 2.7), respectively. In interaction analyses, women with post-bronchodilator FEV1 /FVC?
The hypothesis of whether day length (photoperiod) is an important zeitgeber (time-giver) for keeping the circadian rhythm entrained to a 24-hour cycle was examined, as was its association with sleep patterns and mood problems. Data were collected prospectively from a site with very large differences in daylight duration across seasons (Troms? in Norway, 69?39'N) and a site with very small seasonal differences in daylight duration (Ghana in Accra, 5?32'N). Two hundred subjects were recruited from both sites in January. At the follow-up in August, 180 and 150 subjects in Ghana and Norway participated, respectively. Use of a weekly sleep diary indicated low to moderately strong seasonal changes in rise- and bedtime, sleep efficiency and sleep onset latency only in the northern latitude. No seasonal changes in sleep duration or night awakenings were observed. The self-report measures indicated moderate to strong seasonal differences in insomnia and fatigue, and weaker differences in depressed mood in Norway, but small to non-existing seasonal differences in Ghana. Lack of daylight was related to phase-delayed rise- and bedtimes, increased problems falling asleep, daytime fatigue and depressive mood. However, total sleep duration and sleep quality appeared unaffected.
Department of Psychosocial Science, Faculty of Psychology, University of Bergen, Christiesgt. 12, 5015 Bergen, Norway; Norwegian Competence Center for Sleep Disorders, Haukeland University Hospital, Norway.
The aim of the present study was to investigate the prevalence of "behaviorally induced insufficient sleep syndrome (BIISS)" which is a newly defined hypersomnia, among adolescents. BIISS is characterized by excessive daytime sleepiness, short habitual sleep duration and sleeping considerably longer than usual during weekend/vacations. The study was conducted in the Hordaland County, Norway using a cluster sampling procedure. In all, 1285 high school students (aged 16-19 years) participated by completing self-report questionnaires on a computer. The estimated prevalence of BIISS was 10.4%. The results from logistic regression analyses showed that use of alcohol and living in an urban area were positively related to BIISS, whereas a high level of education in mothers was negatively related to BIISS. BIISS was associated with poor grades and symptoms of anxiety and depression.
Insomnia and depression are strongly interrelated. This study aimed to describe changes in sleep across childbirth, and to evaluate whether insomnia in pregnancy is a predictor of postpartum depression.
A longitudinal, population-based study was conducted among perinatal women giving birth at Akershus University Hospital, Norway. Women received questionnaires in weeks 17 and 32 of pregnancy and eight weeks postpartum. This paper presents data from 2,088 of 4,662 women with complete data for insomnia and depression in week 32 of pregnancy and eight weeks postpartum. Sleep times, wake-up times and average sleep durations were self-reported. The Bergen Insomnia Scale (BIS) was used to measure insomnia. The Edinburgh Postnatal Depression Scale (EPDS) was used to measure depressive symptoms.
After delivery, sleep duration was reduced by 49 minutes (to 6.5 hours), and mean sleep efficiency was reduced from 84% to 75%. However, self-reported insomnia scores (BIS) improved from 17.2 to 15.4, and the reported prevalence of insomnia decreased from 61.6% to 53.8%. High EPDS scores and anxiety in pregnancy, fear of delivery, previous depression, primiparity, and higher educational level were risk factors for both postpartum insomnia and depression. Insomnia did not predict postpartum depression in women with no prior history of depression, whereas women who recovered from depression had residual insomnia.
Depression and insomnia were not verified by clinical interviews. Women with depressive symptoms were less likely to remain in the study.
Although women slept fewer hours at night after delivery compared to during late pregnancy, and reported more nights with nighttime awakenings, their self-reported insomnia scores improved, and the prevalence of insomnia according to the DSM-IV criteria decreased. Insomnia in pregnancy may be a marker for postpartum recurrence of depression among women with previous depression.
The stress hormone cortisol shows a pronounced endogenous diurnal rhythm, which is affected by the sleep/wake cycle, meals and activity. Shift work and especially night work disrupts the sleep/wake cycle and causes a desynchronization of the natural biological rhythms. Therefore, different shift schedules may have different impact on performance at work and health.
The purpose was to study if health, reaction time, and the cortisol rhythm were negatively affected when a group of shift workers changed their work schedule from ordinary day-night shift (fixed shift) to "swing shift".
19 healthy workers on a Norwegian oil rig participated in the study. They worked 2 weeks offshore followed by 4 weeks off work. The ordinary schedule consisted of 12-h day shift and 12-h night shift every other work period (14 days or nights=fixed shift). "Swing shift" involved 1 week of night shift, followed by 1 week of day shift during the work period. All participants worked ordinary day-night shift when baseline data were collected (questionnaires, saliva cortisol, and reaction time during work). After collection of baseline data the workers changed their work schedule to "swing shift", for every working period, and 9 months later the same data were collected.
"Swing shift" did not give any negative health effects or any negative changes in reaction time during the day they shifted from night work to day work. Personnel adapted to night shift within a week regardless of schedule, but recovery from night shift took longer time. During swing shift the cortisol rhythm went back towards a normal rhythm in the second week, but it was not returned completely to normal values when they returned home for the 4 weeks off period. However, the cortisol rhythms were readapted to normal values after 1 week at home. For personnel returning home directly from 14 consecutive night shifts, cortisol adaptation was not complete after 1 week at home.
We found no increase in health complaints from swing shift or reaction time in the shift from night to day work. Recovery from night shift takes longer time.
Effect of antipsychotic withdrawal on behavior and sleep/wake activity in nursing home residents with dementia: a randomized, placebo-controlled, double-blinded study. The Bergen District Nursing Home Study.
Thirty patients (mean age 83.5) taking haloperidol, risperidone, or olanzapine for nonpsychotic symptoms.
Study participants were randomly assigned to withdrawal (intervention group) or continued treatment with antipsychotic medications (reference group) for 4 consecutive weeks.
Behavioral rating using the Neuropsychiatric Inventory Questionnaire (NPI-Q) and actigraphy.
After antipsychotic withdrawal, behavioral scores remained stable or improved in 11 of 15 patients, whereas four had worsening scores. Actigraphy revealed decreased sleep efficiency after drug discontinuation and increased 24-hour and night activity in both groups. Actigraphy records of nighttime and daytime activity indicated sleep problems and restlessness, in terms of the NPI-Q. One patient was restarted on antipsychotics.
Antipsychotic drug withdrawal affected activity and sleep efficiency over the short term. Increases in total activity and impaired sleep quality after drug discontinuation should be monitored, because the long-term effect of these changes is not known. The NPI-Q and actigraphy are feasible tools that disclose relevant changes occurring during antipsychotic withdrawal in NH patients with dementia. Their use in clinical practice should be substantiated by larger studies.