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Study suggests insomnia is persistent more often than situational

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Tossing, turning and can’t fall asleep? The answer isn’t waiting it out — it’s getting help so your insomnia doesn’t persist, a new Canadian study shows.

Among more than 3,000 adults followed for five years, researchers found that 37.5% of those who started the study with insomnia still had it five years later. The persistence of that insomnia was higher in those who had worse insomnia at the beginning.

They also discovered that nearly 14% of participants who had no insomnia to start developed insomnia by their five-year follow-up.

“We know that when insomnia persists all the time, that it may be associated with a number of negative health outcomes,” said study author Charles Morin, a professor of psychology at Laval University in Quebec City.

Insomnia can include trouble falling asleep or staying asleep during the night, or waking up too early in the morning.

The researchers wanted to document the natural history of insomnia, Morin said, knowing it was a common condition, but not understanding how it evolved over time.

In addition to understanding that trajectory, the research might provide information on the likelihood insomnia would develop in a previously good sleeper.

“I think that we were quite amazed to see how persistent this condition is for so many people. We have long thought … insomnia is mostly a situational problem and if you leave it alone, it will go away on its own. But what we find here is that the persistence rate is particularly high,” Morin said. “It really goes against what many people thought, that this is a fairly situational problem.”

It’s important to identify and intervene early, the study suggests.

Morin’s team categorized insomnia syndrome as those who had trouble sleeping at least three nights a week. A less severe category included those who took sleep medications at least once a week, but not more than three times a week or those who reported being dissatisfied with sleep without all the typical insomnia symptoms.

The findings were published this month in the journal JAMA Network Open.

Insomnia can lead to or go hand in hand with a range of other health problems, including depression, anxiety, hypertension, diabetes, heart disease and even suicide, said Jennifer Martin, a board member on the American Academy of Sleep Medicine and a professor of medicine at UCLA’s David Geffen School of Medicine.

“One of the things that, that I see clinically and in my own research is that by the time most people come in for treatment, they’ve been struggling for a very long time,” Martin said. “I think studies like this help us to understand that as health care providers, we probably should be asking people as opposed to waiting until they come for help.”

Fortunately, there is hope. Both Morin and Martin talked about cognitive behavioral therapy, or CBT, as a first-line treatment for insomnia.

CBT is a form of psychotherapy that can focus on changing poor sleep habits, sleep scheduling and the way people with insomnia think about sleep.

“Sometimes people develop almost an obsession with their sleep and with the fear of not sleeping and the daytime consequences of insomnia. And that just feeds into the sleep problem. And it perpetuates over time,” Morin said. “This form of counseling really teaches people to change some of their behaviors and their thinking patterns.”

With CBT, most people come in for four to eight sessions with a trained specialist, Martin said. About 70% of people experience significant response.

“That’s pretty good if you think about how many people get better over, say, four to eight weeks,” Martin said. “A good number of people, maybe as many as half, actually have their insomnia symptoms completely resolved by the end. It’s a pretty powerful approach.”

Unlike with medications, people tend to stay better after therapy ends, Martin said.

“Sleep medication can be very beneficial in the short term, but in the long run it’s not the answer,” Morin said, “because it’s just like putting a Band-Aid on the problem and it does not address the underlying issues.”

Still unknown is whether treating chronic insomnia effectively will reduce those other health risks. Also needed are resources to train more professionals to offer this treatment and more research on the best treatment for specific types of patients, Morin said.

“Not all individuals with insomnia are alike,” Morin said. “There are different reasons why people are not sleeping and we need to find a way to do a better match of individual characteristics with specific treatment modalities.”

More information

Read more about insomnia from the U.S. National Institutes of Health.

Copyright 2020 HealthDay. All rights reserved.



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‘Green prescriptions’ could cancel mental health benefits for some

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So-called “green prescriptions” may end up being counterproductive for people with mental health conditions, researchers say.

Spending time in nature is believed to benefit mental health, so some doctors are beginning to “prescribe” outdoor time for their patients.

That led researchers to investigate whether being in nature helps actually does help people with issues such as anxiety and depression. They collected data from more than 18,000 people in 18 countries.

The takeaway: Time in nature does provide several benefits for people with mental health conditions, but only if they choose on their own to visit green spaces.

While being advised to spend time outdoors can encourage such activity, it can also undermine the potential emotional benefits, according to the authors of the study published this month in the journal Scientific Reports.

The researchers said they were surprised to find that people with depression were spending time in nature as often as folks with no mental health issues, and that people with anxiety were doing so much more often.

While in nature, those with depression and anxiety tended to feel happy and reported low anxiety. But those benefits appeared to be undermined when the visits were done at others’ urging, the investigators found.

The more external pressure people with depression and anxiety felt to visit nature, the less motivated they were to do so and the more anxious they felt.

“These findings are consistent with wider research that suggests that urban natural environments provide spaces for people to relax and recover from stress,” said study leader Michelle Tester-Jones, a postdoctoral research associate at the University of Exeter in the United Kingdom.

But the findings also show that health care practitioners and loved ones should be sensitive about recommending time in nature for people who have mental health issues.

“It could be helpful to encourage them to spend more time in places that people already enjoy visiting, so they feel comfortable and can make the most of the experience,” Tester-Jones said in a university news release.

More information

For more on the benefits of green spaces, go to the National Recreation and Park Association.

Copyright 2020 HealthDay. All rights reserved.



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Study: Nearly half of ‘essential workers’ in U.S. at risk for severe COVID-19

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Nov. 9 (UPI) — Nearly half of those classified as “essential workers” in the United States are at increased risk for severe COVID-19, according to an analysis published Monday by JAMA Internal Medicine.

This means that more than 74 million workers and those with whom they live could be at risk for serious illness, based on disease risk guidelines developed by the U.S. Centers for Disease Control and Prevention, the researchers said.

“Many parts of the country face high and rising infection rates, [and] we should not think about work exposure and health risks in isolation, given that workers and persons at increased risk often live in the same households,” study co-author Thomas M. Selden told UPI.

“Insofar as we can reduce the prevalence of COVID-19 in our communities, we can reduce the extent to which policymakers have to choose between the economy and keeping the population safe,” said Selden, an economist with the U.S. Department of Health and Human Services’ Agency for Healthcare Research and Quality.

Since the COVID-19 pandemic spread to the United States in March, states and cities across the country have instituted lockdown measures designed to limit the spread of the disease.

Many of these measures entailed closing schools and non-essential businesses, with only banks, grocery stores, pharmacies and other businesses deemed to provide vital services allowed to stay open.

For this study, Selden and his colleagues analyzed data on the U.S. workforce to examine how many people were in essential jobs, how often they were able to work at home, their risk for severe COVID-19 and the potential health risks for their household members.

Of the more than 157 million workers across the country, 72% are in jobs deemed essential — based on U.S. Department of Homeland Security criteria — and more than three-fourths of all essential workers are unable to work at home, Selden said.

Essential workers include those in the medical and healthcare, telecommunications, information technology systems, defense, food and agriculture, transportation and logistics and energy, water and wastewater industries, as well as those in law enforcement and public works, the DHS criteria stipulates.

The study notes that up to 60% of these workers have underlying health issues, placing them at increased risk for severe COVID-19 if they get infected, as defined by U.S. Centers for Disease Control and Prevention guidelines.

Those with diabetes, heart disease, high blood pressure and chronic respiratory conditions like asthma are considered to be at high risk for serious illness, the CDC says.

Based on these findings, between roughly 57 million and 74 million adults working in on-site essential jobs — and their families — are at increased risk for serious illness, Selden and his colleagues estimated.

“Policymakers face important decisions about how to balance the economic benefits of keeping workers employed and the public health benefits of protecting those with increased risk of severe COVID-19,” Selden said.

“These issues arise in the context of decisions to close segments of the economy and decisions about how to distribute vaccines, which will initially be available only with limited supply, [and] become all the more difficult when the prevalence of infection rises in parts of the country,” he said.



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Study: Hydroxychloroquine no better than placebo for hospitalized COVID-19 patients

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Nov. 9 (UPI) — COVID-19 patients treated with hydroxychloroquine showed no signs of significant improvement in “clinical status” compared with those given a placebo, a study published Monday by JAMA found.

Patients given a five-day course of the drug were scored as “category six” based on the World Health Organization’s seven-category COVID Ordinal Outcomes Scale, the same as those given a placebo, the researchers said.

Also, 28 days after they started treatment, 10.4% of those treated with hydroxychloroquine died, just slightly lower than the 10.6% fatality rate in the placebo group.

“The results show that hydroxychloroquine did not help patients recover from COVID-19,” study co-author Dr. Wesley H. Self told UPI.

“In the study, patients treated with hydroxychloroquine and those treated with a placebo had nearly identical outcomes, [so] I do not foresee any role for hydroxychloroquine in acutely ill patients hospitalized with COVID-19,” said Self, an infectious disease specialist at Vanderbilt University Medical Center.

Hydroxychloroquine is an immunosuppressive and anti-parasitic drug that is used to treat malaria.

Early in the COVID-19 pandemic, it was touted by President Donald Trump and others as a potential treatment for the virus, despite the lack of any scientific data supporting its use.

Given its effectiveness helping those sickened with malaria — a mosquito-borne infection — to recover, “there was a strong rationale for why hydroxychloroquine may have been beneficial for patients with COVID-19,” according to Self.

However, in July, the U.S. Food and Drug Administration warned against the drug’s use in the treatment of those infected with the new coronavirus, due to potentially serious heart-related side effects.

For this study, Self and his colleagues treated 433 COVID-19 patients at 34 hospitals across the United States with either the drug or a placebo for a period of five days.

Patients assigned to the hydroxychloroquine group received 400 milligrams of the drug in pill form twice a day for the first two doses and then 200 mg. in pill form twice a day for the next eight doses, for a total of 10 doses over the five days.

All of the patients were then assessed based on the WHO’s COVID Ordinal Outcomes Scale, which categorizes those infected according to disease severity.

Most of the patients in both the hydroxycholorquine group and the placebo group were in “category six,” meaning they were hospitalized and receiving extracorporeal membrane oxygenation or invasive mechanical ventilation to maintain their breathing, the researchers said.

“Our results, especially when combined from other studies conducted in the United Kingdom and Brazil, are good evidence that hydroxychloroquine does not provide benefit for patients hospitalized with COVID-19,” Self said.



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