Chiara Baglioni

University Medical Center Freiburg · Department of Psychiatry and Psychotherapy

Background/Objectives: Based on previous data reporting the status of health professionals’ training about sleep clinical psychophysiology, insomnia, and its treatment in the US and Canada, this paper aims at providing a snapshot of the Italian situation, considering health professionals qualified to offer cognitive behavioral therapy (CBT). Adding...

Investigating the mechanisms of action of cognitive‐behavioural therapy for insomnia (CBT‐I), the first‐line treatment for chronic insomnia disorder (ID), can contribute to the overall understanding of insomnia and its treatment. To date, no study has examined the relationship between K‐complexes (KC) and CBT‐I, despite the known homeostatic and pr...

College students often experience sleep–wake alterations. Different factors can contribute to insomnia symptoms in this population. The present study aims at investigating pre-sleep behaviours and strategies used to aid sleep onset in young college students and their association with insomnia symptoms. A total of 548 Italian college students (mean...

Eating disorders (ED) are psychological disorders characterized by dangerous eating behaviours, including protracted fasting and binge eating. Mental disorders comorbidities (e.g., anxiety and depression), as well as sleep difficulties, are common and might interfere with treatment response. This work investigated sleep quality, circadian preferenc...

Background Sleep is vital for maintaining individuals’ physical and mental health and is particularly challenged during pregnancy. More than 70% of women during the gestational period report insomnia symptoms. Sleep dysfunction in the peripartum increases the risk for a cascade of negative health outcomes during late pregnancy, birth, and postpartu...

The world‐wide prevalence of insomnia disorder reaches up to 10% of the adult population. Women are more often afflicted than men, and insomnia disorder is a risk factor for somatic and mental illness, especially depression and anxiety disorders. Persistent hyperarousals at the cognitive, emotional, cortical and/or physiological levels are central...

Progress in the field of insomnia since 2017 necessitated this update of the European Insomnia Guideline. Recommendations for the diagnostic procedure for insomnia and its comorbidities are: clinical interview (encompassing sleep and medical history); the use of sleep questionnaires and diaries (and physical examination and additional measures wher...

Despite cognitive behaviour therapy for insomnia (CBT-I) being the first-line intervention for the disorder, it is often not readily available to patients in need. The stepped care model (SCM) represents an approach to facilitating efficient and wide-ranging provision of evidence-based care to those with insomnia. The SCM reflects a pyramid of ther...

Previous studies indicated that further investigation is needed to understand how insomnia disorder interacts with emotional processes. The present study is an ecological momentary assessment evaluating the link between emotional and sleep alterations in patients with insomnia. Physiological (heart rate and heart rate variability) and subjective (s...

The objective of this umbrella review is to present a comprehensive summary of systematic reviews and meta-analyses on the longitudinal association between insomnia and the risk of developing somatic disorders. Pubmed, Medline, CINAHL, PsycInfo and PsycArticles were searched until 16 December 2022. Fourteen systematic reviews and meta-analyses met...

Theoretical models of insomnia disorder recognise an emotional component in the maintenance of the disorder. Nonetheless, the field of emotions is vast and different processes are involved in psychological well-being. The present narrative review focusses on emotion regulation and affect dynamics, synthesising some of the most recent and relevant e...

Insomnia and emotion dysregulation (ED) are intricately related, yet their aggregate association across different domains of ED and the effect of moderating factors such as health status, age, and gender on their relationship remain unclear. This meta-analysis synthesized data from 57 studies, pooling 119 effect sizes from correlational and 55 from...

Sleep initiation and maintenance problems are common in the pediatric population and while behavioral interventions are recommended, their efficacy remains to be evaluated in clinical trials. We conducted a systematic review and network meta-analysis to assess the efficacy of non-pharmacological treatments and melatonin for sleep initiation and mai...

Longitudinal studies observed that individuals suffering from insomnia disorder have a higher vulnerability to develop symptoms of psychopathology compared with good sleepers. Particularly, insomnia disorder has been associated with an increased risk for depression. Previous studies indicate relatively stable effects; however, replication is needed...

While difficulties with emotion regulation (ER) are consistently linked to poor mental health in adulthood, findings in adolescence have been more mixed. Cognitive ER strategies, which involve the ability to manage emotions through mental processes, may be particularly important during different stages of development due to age-specific adjustments...

Young adults (18-30 years) are vulnerable to sleep-wake disturbances and substance use, which are bi-directionally associated. The present work aims to organise the literature that deals with the association between sleep and substance use in young adults, also considering self-medication behaviours. We adopted a framework that accounts for the mul...

Introduction Various transdiagnostic factors have been associated with insomnia severity. The current study aimed to predict insomnia severity based on a group of transdiagnostic factors including neuroticism, emotion regulation, perfectionism, psychological inflexibility, anxiety sensitivity, and repetitive negative thinking after controlling for...

[In Press]. Perfectionism is related to insomnia and objective markers of disturbed sleep. This study examined whether multidimensional perfectionism is related to dysfunctional beliefs about sleep, sleep-effort, pre-sleep arousal, and polysomnography-determined markers of sleep amongst individuals with insomnia. The effects of cognitive behavioral...

Introduction: Various transdiagnostic factors have been associated with insomnia severity. The current study aimed to predict insomnia severity based on a group of transdiagnostic factors including neuroticism, emotion regulation, perfectionism, psychological inflexibility, anxiety sensitivity, and repetitive negative thinking after controlling for...

Heatwaves are occurring more frequently and are known to affect particularly night-time temperatures. We review here literature on how night-time ambient temperature changes affect body temperature and sleep quality. We then discuss how these temperature effects impact particularly vulnerable populations such as older adults, children, pregnant wom...

The clinical picture of insomnia encompasses day‐ and night‐time symptoms. Typical night‐time complaints are prolonged sleep latency, increased frequency of awakenings, difficulties getting back to sleep and early morning awakening. Day‐time sequelae encompass fatigue, tiredness, reduced attention, impaired cognition, irritability, nervousness, anx...

Insomnia and circadian dysregulation during adolescence represent important risk factors for emotional and psychological problems. Recent studies have shown that the coronavirus disease 2019 (COVID‐19) pandemic has been linked to a high prevalence of behavioural sleep problems in the general population. This study aimed to provide two pictures of t...

Theoretical models of insomnia underline the role of heightened emotional reactivity to sleep‐related stimuli in the maintenance of symptoms. Nevertheless, standard CBT‐I protocol does not include specific strategies that target emotional aspects of the disorder. In 2009, Ong, Shapiro and Manber proposed a clinical protocol that suggested the appli...

European clinical guidelines clearly identified Cognitive Behavioural Therapy for Insomnia (CBT‐I) as first line of treatment for insomnia disorder. Yet, despite these indications, so far CBT‐I is rarely offered in clinical practice and pharmacotherapy is still the dominant clinical practice. In order to promote a change in clinical practice, a Tas...

The prevalence of insomnia is higher in women than in men. Menarche, pregnancy and menopause are specific periods of women's lifespan and are associated with marked gender differences in the prevalence of insomnia. Complex interactions between hormonal, psychological, societal and environment factors are associated with peaks of insomnia prevalence...

Sleep plays a crucial role in healthy human development. Nevertheless, burgeoning societal data from many countries indicates that significant proportions of children and adolescents do not regularly achieve the recommended sleep duration outlined in clinical guidance. Furthermore, there is a high prevalence of sleep initiation and maintenance diso...

Poor sleep and insomnia are important factors influencing the quality of life of patients with other sleep disorders. Patients suffering from co‐morbid insomnia experience the additive detrimental night‐time and day‐time symptoms of each disorder with greater impairments to day‐time functioning and quality of life. Implementing CBT‐I adaptations in...

Insomnia symptoms are frequent during peripartum and are considered risk factors for peripartum psychopathology. Assessing and treating insomnia and related conditions of sleep loss during peripartum should be a priority in the clinical practice. The aim of this paper was to conduct a systematic review on insomnia evaluation and treatment during pe...

Almost 70% of patients with mental disorders report sleep difficulties and 30% fulfil the criteria for insomnia disorder. Cognitive behavioral therapy for insomnia (CBT-I) is the first-line treatment for insomnia according to current treatment guidelines. Despite this circumstance, insomnia is frequently treated only pharmacologically especially in...

Sleep hygiene rules are a set of behavioural and environmental recommendations that promote healthy and good quality sleep, playing a role in insomnia disorder. The Sleep Hygiene Index (SHI) is a self-report questionnaire developed to evaluate the practice of sleep hygiene behaviours with adequate psychometric properties in different samples. The p...

Study Objectives Insomnia is defined by the subjective complaint of poor sleep as well as daytime impairments. Since polysomnography (PSG) typically shows only modest sleep impairment, some still unidentified property of sleep, not mirrored in PSG, may be modified in insomnia.One possible mechanistic hypothesis is that insomnia patients may be more...

Sleep promotes health, well‐being, recovery and athletic performance. As a consequence, sleep problems in athletes may have detrimental effects. Previous investigations showed that professional athletes often reported to suffer of poor sleep quality and insomnia (e.g. difficulties falling asleep and/or maintaining sleep). However, psychological var...

Objective: Italy faced one of the first large clusters of COVID-19 infections worldwide. Home confinement and social distancing could have negatively impacted sleep habits and prevalence of sleep disorders in children, which may be also linked with altered emotional processes. The present study focused on clinical aspects related to sleep, insomnia...

Patients with multiple sclerosis (MS) often experience reduced health-related quality of life and mental health comorbidity. The prevalence of insomnia disorder and sleep quality impairments in MS patients ranges from 47% to 62%. Nevertheless, these problems often remain underdiagnosed and undertreated. This review systematically and critically ass...

Current diagnostic systems for insomnia, in contrast to earlier systems, stress that insomnia is a distinct disease entity now named “insomnia disorder”. Symptoms of insomnia are frequent whereas insomnia disorder as a diagnostic entity afflicts between 6% and 10% of the adult population in industrialized countries. The prevalence increases with ag...

Objectives: One of the largest clusters of Covid-19 infections was observed in Italy. The population was forced to home confinement, exposing individuals to increased risk for insomnia, which is, in turn, associated with depression and anxiety. Through a cross-sectional online survey targeting all Italian adult population (≥18 yrs), insomnia preval...

Background Improving maternal’s health is a worldwide priority. Sleep is a fundamental operating state of the central nervous system and it may be one of the most important psychophysiological processes for brain function and mental health. The study of maternal sleep problem including insomnia, however, implies deepening our understanding of famil...

Background: Childcare programs often include mandatory naptime during the day. Loss of daytime sleep could lead to a moderate-to-large decrease in self-regulation, emotion processing, and learning in early childhood. Nevertheless, daytime sleep has been less accurately studied than nighttime sleep. This study aims to explore the relationship betwe...

[In Press] According to the World Health Organization, cardiovascular diseases are the leading cause of death in the world. Therefore, early prevention of these diseases is a public health priority. Epidemiological data suggest that insomnia may be a modifiable risk factor for cardiovascular diseases. A randomised controlled trial in a sample of in...

Repetitive negative thinking (RNT), i.e., worry, rumination, and transdiagnostic repetitive thinking, is thought to exacerbate and perpetuate insomnia in cognitive models. Moreover, RNT is a longitudinal precursor of depression and anxiety, which are often co-present alongside insomnia. Whilst accumulating evidence supports the efficacy of cognitiv...

Insomnia is a prevalent disorder and it leads to relevant impairment in health-related quality of life. Recent clinical guidelines pointed out that Cognitive-Behavior Therapy for Insomnia (CBT-I) should be considered as first-line intervention. Nevertheless, many other interventions are commonly used by patients or have been proposed as effective f...

Insomnia disorder, defined by nocturnal and daytime symptoms, is highly prevalent worldwide and is associated with the onset of mental illness. Although daytime symptoms are often the reason insomnia patients seek help, it is not clear whether recommended treatment is effective on daytime symptoms. We aimed to investigate the efficacy of cognitive...

In the current global home confinement situation due to the COVID-19 outbreak, most individuals are exposed to an unprecedented stressful situation of unknown duration. This may not only increase daytime stress, anxiety and depression levels, but also disrupt sleep. Importantly, because of the fundamental role that sleep plays in emotion regulation...

The current study was designed to further clarify the influence of brain morphology, sleep oscillatory activity and age on memory consolidation. Specifically, we hypothesized, that a smaller volume of hippocampus, parahippocampal and medial prefrontal cortex negatively impacts declarative, but not procedural, memory consolidation. Explorative analy...

In the current global home confinement situation due to the COVID‐19 outbreak, most individuals are exposed to an unprecedented stressful situation of unknown duration. This may not only increase daytime stress, anxiety and depression levels but also disrupt sleep. Importantly, because of the fundamental role that sleep plays in emotion regulation,...

Insomnia, the most prevalent sleep disorder worldwide, confers marked risks for both physical and mental health. Furthermore, insomnia is associated with considerable direct and indirect healthcare costs. Recent guidelines in the US and Europe unequivocally conclude that cognitive behavioural therapy for insomnia (CBT-I) should be the first-line tr...

Sleep problems during pregnancy are prevalent and could be linked to negative outcomes during pregnancy or post-partum. However, these complaints are often underdiagnosed and undertreated. This review aimed to systematically assess the effectiveness of different interventions to ameliorate poor sleep quality and insomnia during pregnancy. Pubmed, P...

Background: Arousal and sleep represent basic domains of behavior, and alterations are of high clinical importance. Objective/hypothesis: The aim of this study was to further elucidate the neurobiology of insomnia disorder (ID) and the potential for new treatment developments, based on the modulation of cortical activity through the non-invasive br...

Background: During the first years of life, parental sleep strongly depends on child’s sleep quality. Poor parental sleep may relate to increased stress and negative mood. However, there is a lack of sleep studies focusing on all family members. This study aimed to investigate the relationship between sleep, mood, and stress in mothers, fathers and...

Introduction Previous research has identified insomnia as a predictor for the onset of major depression. The aim of this meta-analysis is to corroborate this finding and investigate whether insomnia as a disorder also predicts the onset of other mental disorders and pain. Methods The databases PubMed, Medline, PsycInfo, and PsycArticles were searc...

Study Objectives: Reference data for sleep are needed for the interpretation of clinical sleep parameters. This analysis aimed to provide polysomnographymeasured, spectral analytic and subjective reference data based on a sample of healthy adults. In addition, effects of age and sex were investigated. Methods: The sample was selected from the archi...

Study Objectives Insomnia disorder (ID) is a frequent sleep disorder coupled with increased risks for somatic and mental illness. While subjective complaints are severe, polysomnography (PSG) parameters show only modest differences between groups. REM sleep as the most aroused sleep state may be especially vulnerable to be perceived as wake. To dir...

Study objectives: Perfectionism has been suggested to represent a predisposing factor for poor sleep. However, previous studies have relied on self-reported measures. The association between perfectionism and poor sleep measured by polysomnography (PSG) warrants further investigation. Methods: The current retrospective exploratory study used the...

This European guideline for the diagnosis and treatment of insomnia was developed by a task force of the European Sleep Research Society, with the aim of providing clinical recommendations for the management of adult patients with insomnia. The guideline is based on a systematic review of relevant meta-analyses published till June 2016. The target...

Healthy sleep restores the brain's ability to adapt to novel input through memory formation based on activity‐dependent refinements of the strength of neural transmission across synapses (synaptic plasticity). In line with this framework, patients with primary insomnia often report subjective memory impairment. However, investigations of memory per...

Study objectives To replicate the association between insomnia with objective short sleep duration and hypertension, type 2 diabetes and duration of insomnia. Design Retrospective case-control study. Setting Department of Psychiatry and Psychotherapy, Medical Center—University of Freiburg. Participants 328 patients with primary insomnia classifi...

Introduction Hypnotics may have different effects on subjective (sleep diary [SD]) and objective (PSG) measures of sleep continuity. Thus, the concurrent examination of both measurement strategies, while rarely done, is important because improvement in one domain may not be paralleled by improvement in the other domain. Meta-analytic data were used...

Introduction Reference data for sleep in healthy individuals are needed for the interpretation of polysomnography and subjective sleep parameters. The aim of this analysis was to provide polysomnographic and subjective reference data for two consecutive nights based on a large sample of healthy adults. Methods The sample was selected from the arch...

Introduction While there have been at least three meta-analyses on the subject of placebo effects in insomnia and several theory papers addressing the factors that may account for such effects, little is known about the relative magnitude of placebo effects on sleep continuity as assessed both objectively (PSG) and subjectively (Sleep Diaries). The...

Introduction Little is known about the relative efficacy of the medications used to treat insomnia. Accordingly, a meta-analysis was undertaken to examine how objective (PSG) and subjective (sleep diary) measures of sleep continuity vary by drug class. Methods PubMed searches, from 1967-June 2016, yielded 327 possible articles. Inclusion criteria w...

Objective/background: Sleep-related attentional bias has been suggested to represent an important factor for the maintenance of chronic insomnia. However, little is known about potentially underlying psychological mechanisms such as threat or craving. As these are associated with distinguishable brain activation patterns, we performed a functional...

This network meta-analysis examined the effectiveness of cognitive behavioural therapies for insomnia (CBT-I) on decreasing daytime symptoms of fatigue. PubMed, Scopus and Web of Science were searched from 1986 to May 2015. Inclusion criteria were: randomised controlled trials integrating sleep restriction within the treatment, an adult insomnia sa...

Investigating sleep in mental disorders has the potential to reveal both disorder-specific and transdiagnostic psychophysiological mechanisms. This meta-analysis aimed at determining the polysomnographic (PSG) characteristics of several mental disorders. Relevant studies were searched through standard strategies. Controlled PSG studies evaluating s...

Chronic insomnia is one of the most prevalent central nervous system disorders. It is characterized by increased arousal levels, however, the neurobiological causes and correlates of hyperarousal in insomnia remain to be further determined. In the current study, magnetic resonance spectroscopy was used in the morning and evening in a well-character...

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Background: Research on sleep after stroke has focused mainly on sleep disordered breathing. However, the extend to which sleep physiology is altered in stroke survivors, how these alterations compare to healthy volunteers, and how sleep changes might affect recovery as well as physical and mental health has yet to be fully researched. Motivated b...

Insomnia is defined as a difficulty initiating or maintaining sleep with daytime impairments like increased fatigue, decreased attention, and increased mood irritability for at least three nights a week for a period of 3 months. DSM 5 has established a new overarching category of insomnia disorder, thus replacing the old primary vs. secondary dicho...

Background: Psychological models highlight the bidirectional role of self-referential processing, introspection, worry and rumination in the development and maintenance of insomnia; however, little is known about the underlying neural substrates. Default mode network (DMN) functional connectivity has been previously linked to these cognitive proce...

Beeinträchtigungen des Schlafes als Symptom psychischer Störungen sind ein wichtiges Forschungsfeld. Folgender Artikel wertet die Ergebnisse zweier Metaanalysen aus der Universität Freiburg aus, bei denen Polysomnographie als wichtige Methode zur Erkennung von Schlafauffälligkeiten eingesetzt wurde. Untersucht wurden die polysomnographischen Daten...

This study sought to characterize the impact of sleep location (own sleeping environment vs. partner's sleeping environment), social setting (sleeping in pairs vs. sleeping alone), and sex on sleep. An experimental 2 x 2 (sleep location x social setting) within-subject design was employed with 15 young heterosexual couples. The results suggest that...

OBJECTIVES: Recent findings suggest that poor sleep quality is associated with mood instability, mood disorders and enhanced negative emotions. Sleep and emotion seem to be related by a bidirectional link. However, research exploring the relationship between sleep quality and emotion in daily life is almost lacking. The aim of the present study was...

The relationship between insomnia and other mental disorders is still not fully understood. Yet, symptoms of insomnia are frequently observed in patients with other mental disorders and often precede the onset of other conditions. In some cases, symptoms of insomnia persist even after the successful treatment of other mental disorders. This observa...

In den vergangenen Jahren wurde eine beachtliche Anzahl an Studien publiziert, die nahelegen, dass Insomnien ein Risikofaktor für körperliche Folgeerkrankungen sind, insbesondere für kardiovaskuläre Erkrankungen. Dies wirft die Frage auf, ob eine Behandlung von Schlafstörungen bei Patienten mit einer Insomnie als Präventionsmaßnahme für kardiovasku...