• Sleep Medicine and Psychophysiology
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• v.2 no.1
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• pp.82-90
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• 1995

Objectives : Insomnia is significantly influenced by the pre-sleep arousal, self efficacy, sleep hygiene, depression and anxiety. The authors tried to explore how these factors are related with the clinical features of sleep. Methods : Fifty three patients diagnosed as insomnia by DSM-IV criteria were studied. They filled up the pre-sleep arousal scale(PSAS), sleep efficacy scale(SES), sleep hygiene awareness and practice scale, BDI, and state and trait anxiety scales. Results: 1) The mean values of sleep-related variables were as follows : Sleep latency,136.89 minutes ; frequences of awakening during a night, 2.28 ; minutes to get back to sleep, 42.70 ; total sleep time, 180.19 minutes ; duration of illness, 72.00 months. 2) The mean scores of scales were as follows : PSAS(cognitive), 22.40 ; PSAS(somatic), 17.32 ; SES, 20.16 ; sleep hygiene knowledge, 25.96 ; caffein knowledge, 59.78 ; sleep hygiene practice, 42.12 ; BDI. 18.2 ; state anxiety, 41.24 ; trait anxiety ; 44.50. 3) In the subjects with superimposed depression, the mean frequency of awakening during a night and the mean pre-sleep arousal scale score were higher than in those without depression. 4) Frequency of awakening were correlated positively with a PSAS(a tight tense feeling in your muscle) and sleep hygiene awareness. PSAS(cognitive) were correlated positively with a PSAS(somatic). BDI correlated positively with a PSAS item(a jittery, nervous feeling in your body)and a SES item (not allow a poor night's sleep to interfere with daily activities). Anxiety scales were correlated positively with sleep hygiene practice scale sleep, and PSAS were correlated negatively with SES. Conclusions : The mean scores of PSAS, SES, sleep hygiene awareness and practice scale, BDI, state and trait anxiety scales of insomniacs were correlated either positively or negatively in insomnia patients. These factors seem to contribute to the development and maintainence of insomnia.

• The Korean Journal of Pain
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• v.28 no.2
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• pp.137-143
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• 2015

Background: Insomnia is becoming increasingly recognized as a clinically important symptom in patients with chronic low back pain (CLBP). In this retrospective study, we have determined risk factors associated with clinical insomnia in CLBP patients in a university hospital in Korea. Methods: Data from four-hundred and eighty one CLBP patients was analyzed in this study. The Insomnia Severity Index (ISI) was used to determine the presence of clinical insomnia (ISI score ${\geq}15$). Patients' demographics and pain-related factors were evaluated by logistic regression analysis to identify risk factors of clinical insomnia in CLBP. Results: It was found that 43% of patients reported mild to severe insomnia after the development of back pain. In addition, 20% of patients met the criteria for clinically significant insomnia (ISI score ${\geq}15$). In a stepwise multivariate analysis, high pain intensity, the presence of comorbid musculoskeletal pain and neuropathic pain components, and high level of depression were strongly associated with clinical insomnia in CLBP. Among these factors, the presence of comorbid musculoskeletal pain other than back pain was the strongest determinant, with the highest odds ratio of 8.074 (95% CI 4.250 to 15.339) for predicting clinical insomnia. Conclusions: Insomnia should be addressed as an integral part of pain management in CLBP patients with these risk factors, especially in patients suffering from CLBP with comorbid musculoskeletal pain.

• Sleep Medicine and Psychophysiology
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• v.2 no.2
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• pp.138-145
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• 1995

The causes of complicated chronic insomnia are very various and interact with vicious circle. Patient with this insomnia has generally a strong fear and frustration about failing to control of sleep and a deep mistrust toward doctor. To solve this complicated problems detailed history taking and sleep questionnaires are needed with objective polysomnography. Through these procedures, doctor should clarify causes of insomnia and explain them to patient in details and kindly. This process would be very helpful to restore the mistrustful relationship between patient and doctor and reduce patient's vague fear for insomnia. In treatment of complicated chronic insomnia, it is most important for patient to understand his problems and participate in the treatment schedule actively with assurance. Also doctor should encourage patient persistently not to be drop out. Most important factor for prognosis is patient's personality. Causes of complicated chronic insomnia are like these, overdose of hypnotics and sedatives, daily drinking alcohol with hypnotics, insomnia associated depression, delayed sleep phase syndrome, sleep state misperception, marked fear for insomnia, hyperarousal at bed, insomnia associated periodic leg movement and sleep apnea, chronic hypnotic insomnia, and immature personality. And possible treatments of these insomnias were discussed.

• Journal of Oriental Neuropsychiatry
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• v.14 no.1
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• pp.117-131
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• 2003

SCL-90-R is a multidimensional self-report symptom inventory devoloped by Derogatis and his coworkers. Since it was standardized into Korean version in 1978 by Won and Kim et aI., but it has been rarely studies for the clinical groups. Objectives : This study sought to define a diagnotic character of SCL-90-R of tension headache and insomnia inpatients groups. Methods : We determined a diagnotic character of 17 tension headache and 23 insomnia patients by means of SCL-90-R, and compared with normal groups in order to characterize subscale of SCL-90-R in patients with tension headache and insomnia from Neurasthenia. Results : 1. Male tension headache group has significant difference in Somatization and Depression subscales, female group in Somatization, Obsessive-Compulsive, Depression and Hostility subscales. 2. Female insomnia group has significant difference in Anxiety subscale. Although there are a little significiant, many subscales such as Somatization, Obsessive-Compulsive, Depression and Hostility are higher than normal group. 3. There are significant difference in GSI and PDSI of Global index, which means that we use that for objective index of tension headache and insomnia from Neurasthenia. Conclusions : All of these results show that SCL-90-R is useful inventory to characterize and screening for Neurasthenia.

• Journal of Yeungnam Medical Science
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• v.38 no.4
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• pp.267-274
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• 2021

Sleep plays a critical role in homeostasis of the body and mind. Insomnia is a disease that causes disturbances in the initiation and maintenance of sleep. Insomnia is known to affect not only the sleep process itself but also an individual's cognitive function and emotional regulation during the daytime. It increases the risk of various neuropsychiatric diseases such as depression, anxiety disorder, and dementia. Although it might appear that insomnia only affects the nervous system, it is also a systemic disease that affects several aspects of the body, such as the cardiovascular, endocrine, and immune systems; therefore, it increases the risk of various diseases such as hypertension, diabetes mellitus, and infection. Insomnia has a wide range of effects on our bodies because sleep is a complex and active process. However, a high proportion of patients with insomnia do not seek treatment, which results in high direct and indirect costs. This is attributed to the disregard of many of the negative effects of insomnia. Therefore, we expect that understanding insomnia as a systemic disease will provide an opportunity to understand the condition better and help prevent secondary impairment due to insomnia.

• Journal of Sleep Medicine
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• v.15 no.2
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• pp.55-61
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• 2018

Objectives: Despite the accumulating evidence of the effectiveness of positive airway pressure (PAP) therapy in obstructive sleep apnea (OSA) syndrome, adherence to PAP therapy is not high. Several factors reportedly affect PAP adherence; however, it remains unclear whether patients' symptoms were detrimental to adherence rate. This study is aimed at investigating the relationship between insomnia symptoms and adherence. Methods: Retrospective analyses were performed in 359 patients with OSA (mean age $58.4{\pm}13.2$ years; females, n=80). Logistic regression analyses were performed between PAP adherence with clinical factors and questionnaires, such as Epworth Sleepiness Scale, Insomnia Severity Index, and Beck Depression Inventory (BDI). Results: PAP adherence was defined as the use of PAP for ${\geq}4h$ per night on 70% of nights during 30 consecutive days. The median follow-up time was 55 days (interquartile range, 30-119 days), and 54.3% showed poor adherence. Non-adherent patients showed more severe sleep onset insomnia, higher BDI, and higher nadir oxygen saturation ($SaO_2$). Patients with good adherence had higher apnea-hypopnea index, oxygen desaturation index, and respiratory arousal to total arousal ratio. Sleep onset insomnia [odds ratio (OR)=1.792, p=0.012], BDI (OR = 1.055, p=0.026), and nadir $SaO_2$ (OR=1.043, p=0.040) were independently associated with PAP non-adherence. Conclusions: Not the severity of insomnia but sleep onset insomnia was associated with PAP adherence, as well as depressive mood. It suggests that different interventions for reducing insomnia and depressive mood are needed to increase PAP adherence in patients with OSA.

• Journal of Acupuncture Research
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• v.32 no.3
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• pp.175-183
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• 2015

Objectives : The purpose of this study is to investigate the effects of Sumsu (Bufonis venenum) pharmacopuncture on insomnia and depression. Methods : We investigated 32 patients with a sleep disorder who had been recruited at a Korean medical hospital from March $1^{st}$, 2014 to April $16^{th}$, 2015. We divided subjects into two groups : The control group(N=15) was treated with Normal Saline and the experimental group(N=17) was treated with Sumsu(Bufonis venenum) pharmacopuncture. The subjects were injected with 0.05 ml~0.1 ml, for a total of 0.6 ml on each acupuncture point. These were Pungbu ($GV_{16}$), Pungi ($GB_{20}$), Gyeonjeong ($GB_{21}$), and Anmyun(EX-$HN_{20}$). Both groups were evaluated with the beck depression inventory(BDI) and given an insomnia score before treatment, after one week, two weeks and four weeks from the initial visit. Results : The Insomnia score and BDI decreased significantly in the experimental group. In comparing the control group with the experimental group, there was a more significant improvement of the insomnia score in the experimental group during all periods of this study. However, the difference of change in BDI between the control group and experimental group was only significant in the first week. Conclusions : Sumsu (Bufonis venenum) pharmacopuncture can be used as an effective treatment for patients with insomnia and depression.

• Korean Journal of Psychosomatic Medicine
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• v.27 no.1
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• pp.50-59
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• 2019

Objectives : Many of the patients with type 2 diabetes are associated with sleep problems, and the rate of insomnia is known to be higher in the general population. The aims of this study were to know the frequency and clnical characteristics of insomnia, and related variables to insomnia in patients diagnosed with type 2 diabetes. Methods : For 99 patients from 18 to 80 years of age (65 males and 34 females) with type 2 diabetes, interviews were performed. Total sleep time and sleep latency was evaluated. Insomnia was evaluated using the Korean Version of the Insomnia Severity Index (ISI-K). Severity of depressive symptoms were evaluted using the Korean version of the Hamilton Depression Scale (K-HDRM). According to the cutoff score of 15.5 on the ISI-K, subjects were divided into the group of type 2 diabetics with insomnia (N=34) and those without insomnia (N=65) at first, and then statistically analyzed. Results : TInsomnia could be found in 34.34% of type 2 diabetics. Type 2 diabetics with insomnia had significantly more single or divorced (respectively 11.8%, p<0.05), higher total scores of the K-HDRS ($11.76{\pm}5.52$, p<0.001), shorter total sleep time ($5.35{\pm}2.00hours$, p<0.001), and longer sleep latency ($50.29{\pm}33.80minutes$, p<0.001). The all item scores of the ISI-K in type 2 diabetics with insomnia were significantly higher than those in type 2 diabetics without insomnia, that is, total ($18.38{\pm}2.69$), A1 (Initial insomnia) ($2.97{\pm}0.76$), A2 (Middle insomnia) ($3.06{\pm}0.69$), A3 (Terminal insomnia) ($2.76{\pm}0.61$), B (Satisfaction) ($3.18{\pm}0.72$), C (Interference) ($2.09{\pm}0.97$), D (Noticeability) ($2.12{\pm}1.09$) and E (Distress) ($2.21{\pm}0.81$) (respectively p<0.001). Variables associated with insomnia in type 2 diabetics were as following. Age had significant negative correlation with A3 items of the ISI-K (${\beta}=-0.241$, p<0.05). Total scores of the K-HDRS had significant positive correlation, while total sleep time had significant negative correlation with all items of the ISI-K (respectively p<0.05). Sleep latency had significant positive correlation with total,, A1, B and E item scores of the ISI-K (respectively p<0.05). Conclusions : Insomnia was found in about 1/3 of type 2 diabetics. According to the presence of insomnia, clinical characteristics including sleep quality as well as quantity seemed to be different. Because depression seemed to be correlated with insomnia, clinicians should pay attention to early detection and intervention of depression among type 2 diabetics.

• Korean Journal of Adult Nursing
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• v.15 no.2
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• pp.296-304
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• 2003

Purpose: This study is to study sleep disorder, sleep pattern, and depression in adult women, and to offer basic data for a program of the improvement of women's health and nursing intervention. Method: A structured questionnaire was carried out from September 1, 2001 to October 30, 2001 on the subject of 441 females, who are above 18 years old and lived in Seoul. This research tool measured insomnia with APA's insomnia scale(1994), sleep pattern and sleep disorder factors scale(Shin et al(1999)'s), and depression with Radloff's CES-D scale (1977). The data were analyzed with a SPSS program for descriptive statistics, ${\chi}^2-test$, and t-test. Result: The result were as follows; 1) 35.1% of all participants have insomnia. 2) Sleep disorder group appeared shorter($50.98{\pm}29.41min$.) than normal group($73.03{\pm}38.7min$.) in daytime sleepiness(p=0.001). 3) Factors of sleep disorder were stress(76.6%), worry(55.6%), without reason(39.6%), and noise outside(37.4%). 4) In relation between sleep disorder and depression, group with sleep disorder($20.20{\pm}11.06$) marked higher depression score than normal group($14.25{\pm}8.81$)(p<0.0001). Conclusion: Based upon these finding, sleep disorder in adult women was influenced by psychological factors, group with sleep disorder showed a higher depression score than normal group, and which indicated correlation with sleep disorder and depression. This study shows that nursing intervention on women's sleep disorder and depression is needed and further research be done to verify the results.

• Journal of the Korea Convergence Society
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• v.12 no.12
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• pp.509-518
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• 2021

This study was conducted to examine the effects of auricular acupressure on quality of sleep and depression. Adults who had insomnia for over 1 month were recruited. Participants were distributed randomly to the experimental group(n=22) and the control group(n=22). The experimental group received auricular acupressure on Shen men(TF2), insomnia 1(SF4), insomnia 2(SF1), and anti-depression(LO8) for 1 week. The contrast group received sleep hygiene education. The mean differences of the quality of sleep were 4.05±2.52 in the experimental group and 1.45±3.77 in the control group. Auricular acupressure significantly decreased insomnia in the experimental group compared to the control group(t=3.07, p=.004). Depression scores after acupressure were not different between the experimental group and the control group. After controlling the religion as a covariate, the mean difference of depression in the experimental group was higher than the control group(F=4.22, p=.046). In conclusion, auricular acupressure decreased insomnia and depression. Therefore, further studies on different acupressure points such as shen men, jiao gan, heart, pi zhi xia, and endocrine are recommended.