Kai Spiegelhalder

University Medical Center Freiburg · Department of Psychiatry and Psychotherapy

Background Insomnia is a highly prevalent disorder associated with numerous adverse health outcomes. Cognitive behavioural therapy for insomnia (CBT-I) is recommended as first-line treatment by clinical guidelines but is accessible to only a minority of patients suffering from insomnia. Internet-delivered CBT-I (iCBT-I) could contribute to the wide...

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...

Insomnia is a primary symptom of shift work disorder, yet it remains undertreated. This randomised‐controlled pilot trial examined the efficacy of a digital, guided cognitive behavioural therapy for insomnia adapted to shift work (SleepCare) in nurses with shift work disorder. The hypothesis was that SleepCare reduces insomnia severity compared wit...

Recent genome-wide association studies (GWASs) of several individual sleep traits have identified hundreds of genetic loci, suggesting diverse mechanisms. Moreover, sleep traits are moderately correlated, and together may provide a more complete picture of sleep health, while also illuminating distinct domains. Here we construct novel sleep health...

The last ten years have seen the development and publication of numerous national and international guidelines devoted to the diagnosis and treatment of insomnia. These include guidelines by the American College of Physicians (ACP), the American Academy of Sleep Medicine (AASM), the British Sleep Society (BSS), the German Sleep Society (GSS), and t...

To the Editor, Stolicyn et al. analyzed cross-sectional associations between self-reported sleep duration and insomnia symptoms with brain structure using data from 32 119 individuals from the UK Biobank [1]. Among other findings, sleeping more than 9 hours was associated with lower global grey and white matter volumes and a reduced volume of the h...

Background Excessive daytime sleepiness (EDS), experienced in 10% to 20% of the population, has been associated with cardiovascular disease and death. However, the condition is heterogeneous and is prevalent in individuals having short and long sleep duration. We sought to clarify the relationship between sleep duration subtypes of EDS with cardiov...

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...

Insomnia disorder signifies a major public health concern. The development of neuroimaging techniques has permitted to investigate brain mechanisms at a structural and functional level. The present systematic review aims at shedding light on functional, structural, and metabolic substrates of insomnia disorder by integrating the available published...

The importance polysomnography (PSG) in the diagnosis and treatment process of insomnia disorder (ID) remains highly disputed. This review summarises the state of the science regarding PSG indications and findings in ID, and the indications to conduct PSG in ID as stated by relevant guidelines. It then highlights the most relevant questions regardi...

As suggested by previous research, sleep health is assumed to be a key determinant of future morbidity and mortality. In line with this, recent studies have found that poor sleep is associated with impaired cognitive function. However, to date, little is known about brain structural abnormalities underlying this association. Although recent finding...

Sleep restriction, a key element of cognitive behavioural therapy for insomnia, involves considerable behavioural changes in patients' lives, leading to side-effects like increased daytime sleepiness. Studies on sleep restriction rarely report adherence, and when assessed it is often limited to the average number of therapy sessions attended. This...

This paper summarizes the position statement of the World Sleep Society (WSS) International Guidelines Committee regarding the Clinical Practice Guidelines on the Behavioral and Psychological Treatments for Chronic Insomnia Disorder in Adults prepared by a task force of the American Academy of Sleep Medicine (AASM). The practice guidelines were rev...

The neurobiological underpinnings of insomnia disorder (ID) are still poorly understood. A previous meta-analysis conducted by our research group in 2018 revealed no consistent regional alterations based on the limited number of eligible studies. Given the number of studies published during the last few years, we revisited the meta-analysis to prov...

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...

Introduction The RU-SATED model – regularity, satisfaction, alertness, timing, efficiency, and duration – captures the 24-hour experience of sleep to asses multidimensional sleep health (MSH). However, most prior evidence comes from middle-aged adults. We provide updated MSH data in adolescents by leveraging objective and self-reported sleep measur...

Introduction The hyperarousal model suggests that insomnia is characterized by increased cortical, cognitive, and physiological arousal. However, the relationship between these domains of arousal remains insufficiently studied. The aim of the current observational study was to investigate pre-sleep cognitive arousal, cortical arousal during the nig...

Obwohl KVT-I als First-Line-Behandlung bei Insomnie empfohlen wird, findet sie häufig keine Anwendung. Internetgestützte KVT-I (iKVT-I) könnte den Zugang zu evidenzbasierter Behandlung deutlich erleichtern. iKVT-I hat sich bereits im Vergleich mit passiven Kontrollgruppen als effektiv erwiesen mit Effektstärken, die denen einer Behandlung vor Ort v...

Insomnia disorder (ID) is a prevalent mental illness. Several behavioral and neuroimaging studies suggested that ID is a heterogenous condition with various subtypes. However, neurobiological alterations in different subtypes of ID are poorly understood. We aimed to assess whether unimodal and multimodal whole-brain neuroimaging measurements can di...

Study objectives: The long-term effects of sleep health and shift work on cognitive performance are unclear. In addition, research has been limited by small sample sizes and short follow-up periods. We conducted one of the largest examinations of the longitudinal influence of sleep health dimensions and shift work on cognitive performance in peopl...

Existing neuroimaging studies have reported divergent structural alterations in insomnia disorder (ID). In the present study, we performed a large-scale coordinated meta-analysis by pooling structural brain measures from 1085 subjects (mean [SD] age 50.5 [13.9] years, 50.2% female, 17.4% with insomnia) across three international Enhancing NeuroImag...

Objectives: Thus far, the diagnosis of insomnia is based on purely clinical criteria. Although a broad range of altered physiological parameters has been identified in insomniacs, the evidence to establish their diagnostic usefulness is very limited. Purpose of this WFSBP Task Force consensus paper is to systematically evaluate a series of biomark...

[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...

The norepinephrine locus coeruleus system (LC NE) represents a promising treatment target in patients with insomnia disorder (ID) due to its well understood links to arousal and sleep regulation. However, consistent markers of LC NE activity are lacking. This study measured three potential indirect markers of LC NE activity – REM sleep, P3 amplitud...

According to the hyperarousal model, insomnia is characterised by increased arousal in the cortical, cognitive, and physiological domains. However, the interaction between these arousal domains is poorly understood. The present observational case–control study aimed to investigate cortical arousal during the night, pre-sleep cognitive arousal and t...

Given the limited availability and accessibility of onsite cognitive behavioral therapy for insomnia (CBT-I), other CBT-I settings, such as internet-delivered CBT-I (iCBT-I), have been proposed. The primary aim of the study was to compare the efficacy of available CBT-I settings on insomnia severity. A systematic review and frequentist network meta...

An increasing number of studies harness resting‐state fMRI functional connectivity analysis to investigate the neurobiological mechanisms of insomnia. The results to date are inconsistent and the detection of minor and widely distributed alterations in functional connectivity requires large sample sizes. The present study investigated associations...

Our objective was to assess the agreement and linear relationships amongst multiple measures of sleep duration in a sample of patients with insomnia disorder and good sleeper controls. We retrospectively analysed data from 123 patients with insomnia disorder and 123 age‐ and gender‐matched good sleeper controls who completed a simple subjective hab...

Insomnia disorder (ID) is very common, around 10% of the general population meet the diagnostic criteria with the prevalence being 50% higher among women compared to men. ID has a substantial negative impact on daytime functioning, mood and quality of life. Today, it is most commonly treated pharmacologically, although guidelines recommend cognitiv...

Existing neuroimaging studies have reported divergent structural alterations in insomnia. Here, we performed a large-scale coordinated meta-analysis by pooling structural brain measures from 1,085 subjects with and without insomnia symptoms across three international ENIGMA-Sleep cohorts. The influence of insomnia on MRI-based brain morphometry usi...

Insomnia disorder (ID) is a prevalent mental illness, which is associated with poor quality of life, an increased rate of motor vehicle accidents, depressive symptoms, emotion dysregulation, and memory impairment. Several behavioural and neuroimaging studies suggested that various subtypes of ID are existing. However, the neurobiological underpinni...

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...

Group CBT‐I aims at disseminating the first‐line treatment for insomnia by increasing cost‐effectiveness in comparison to individual CBT‐I. Since less therapist time is usually needed per patient in group therapy, each therapist can treat a larger number of patients per time. Meta‐analytical data clearly shows that group CBT‐I is an effective treat...

Introduction It is unclear how internet-delivered cognitive-behavioural therapy for insomnia (CBT-I) can be integrated into healthcare systems, and little is known about the optimal level of therapist guidance. The aim of this study is to investigate three different versions of a stepped care model for insomnia (IG1, IG2, IG3) versus treatment as u...

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...

High prevalence rates of sleep disorders and related symptoms among shift workers probably reflect the temporal misalignment of the homeostatic and circadian processes of sleep in this group of people. The health and safety consequences of shift work and insufficient sleep are very similar, suggesting that they share common mechanisms. In the scree...

https://doi.org/10.1176/appi.ajp.21050466

Over the past decades, numerous neuroimaging studies have been conducted in insomnia disorder (ID), which yielded divergent findings. Interestingly, no consistent regional abnormality has been observed in our previous neuroimaging meta-analysis (Masoud et al. 2018). Thus, we revisited our former meta-analysis by including recent ID studies to updat...

A large number of mobile health applications claiming to target insomnia are available in commercial app stores. However, limited information on the quality of these mobile health applications exists. The present study aimed to systematically search the European Google Play and Apple App Store for mobile health applications targeting insomnia, and...

https://doi.org/10.1016/j.biopsych.2022.05.023

We systematically reviewed the association between objective sleep quality and postural control based on objective measurements. We searched the electronic databases PUBMED, CINAHL, SCOPUS and Web of Science for studies assessing the relationship between objective measurements of sleep and postural control or gait performance among adults above age...

Insomnia disorder comprises symptoms during night and day that strongly affect quality of life and wellbeing. Prolonged sleep latency, difficulties to maintain sleep and early morning wakening characterize sleep complaints, whereas fatigue, reduced attention, impaired cognitive functioning, irritability, anxiety and low mood are key daytime impairm...

In the present study, we performed a meta-analysis of structural MRI using three international cohorts within the ENIGMA-Sleep working group (N=912) to measure cortical and subcortical brain changes between subjects with and without insomnia symptoms.

Refugees are exposed to multiple stressors affecting their mental health. Given various barriers to mental healthcare in the arrival countries, innovative healthcare solutions are needed. One such solution could be to offer low-threshold treatments, for example by culturally adapting treatments, providing them in a scalable format, and addressing t...

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...

Insomnia is a highly prevalent disorder and a state of 24h hyperarousal is considered as a key factor of this condition. Various physiological markers of hyperarousal have been investigated, including the activity of the HPA axis. However, these studies yielded heterogenous results. The aim of this study was to qualitatively and quantitatively eval...

Insomnien sind in westlichen Industrieländern mit einer Prävalenz von 5–10 % sehr häufig und führen zu psychischen und körperlichen Folgeerkrankungen. Die Schlafstörungen werden trotz gravierender Nebenwirkungen oft mit Schlafmitteln behandelt, obwohl Leitlinien die kognitiv-verhaltenstherapeutische Therapie der Insomnie empfehlen. Die psychotherap...

Zusammenfassung Verschiedene Autorinnen und Autoren nehmen an, dass es klinisch nützlich und wissenschaftlich erkenntnisbringend sein könnte, Subtypen der Insomnie zu identifizieren, um diese spezifisch und damit möglicherweise effektiver zu behandeln, als dies derzeit geschieht. Im vorliegenden Beitrag werden folgende exemplarisch ausgewählte Ansä...

Sleep difficulties are widespread among international students. Internet-based interventions are suggested as a low-threshold treatment option but may require cultural adaptation among culturally diverse populations. The present pilot study investigated the effectiveness and acceptance of an internet-based intervention to improve sleep difficulties...

Oscillatory activities of the brain and heart show a strong variation across wakefulness and sleep. Separate lines of research indicate that non-rapid eye movement (NREM) sleep is characterised by electroencephalographic slow oscillations (SO), sleep spindles, and phase–amplitude coupling of these oscillations (SO–spindle coupling), as well as an i...

Background The evidence base for internet-based cognitive behavioral therapy for insomnia (iCBT-I) is firm; however, little is known about iCBT-I’s health-economic effects. Objective This study aimed to evaluate the cost-effectiveness and cost–utility of iCBT-I in reducing insomnia among schoolteachers. Methods Schoolteachers (N=128) with clinica...

Neuroimaging and genetics studies have advanced our understanding of the neurobiology of sleep and its disorders. However, individual studies usually have limitations to identifying consistent and reproducible effects, including modest sample sizes, heterogeneous clinical characteristics and varied methodologies. These issues call for a large‐scale...

In order to better understand sleep initiation and maintenance disorders research into human chronobiology is necessary. Some patients suffering from insomnia seem to show abnormal circadian rhythms of core body temperature and melatonin onset. These circadian rhythm angles are associated with difficulties falling asleep and with complaints of earl...

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...

BACKGROUND The evidence base for internet-based cognitive behavioral therapy for insomnia (iCBT-I) is firm; however, little is known about iCBT-I’s health-economic effects. OBJECTIVE This study aimed to evaluate the cost-effectiveness and cost–utility of iCBT-I in reducing insomnia among schoolteachers. METHODS Schoolteachers (N=128) with clinica...

[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...

Zusammenfassung Die Insomnie, d. h. eine Ein- und/oder Durchschlafstörung, die sich negativ auf die Leistungsfähigkeit und Tagesbefindlichkeit auswirkt, ist eine der häufigsten Erkrankungen in der Allgemeinbevölkerung. Sie wird derzeit meistens pharmakologisch und/oder psychotherapeutisch behandelt, wobei die pharmakologische Behandlung mit Benzodi...

Sleep disturbances and insomnia are common in college students, and reduce their quality of life and academic performance. The aim of this meta‐analysis was to evaluate the efficacy of psychological interventions aimed at improving sleep in college students. A meta‐analysis was conducted with 10 randomized controlled trials with passive control con...

Purpose of review: Previous research has struggled with identifying clear-cut, objective counterparts to subjective distress in insomnia. Approaching this discrepancy with a focus on hyperarousal and dysfunctional affective processes, studies examining brain structures and neural networks involved in affect and arousal are reviewed and conclusions...

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...

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...

Study Objectives We sought to examine the impact of digital cognitive behavioural therapy (dCBT) for insomnia on both self-reported cognitive impairment and objective cognitive performance. Methods The DISCO trial was an online, two-arm, single-blind, randomised clinical trial of dCBT versus wait-list control. Participants were aged 25 years and o...

In diesem Beitrag hat sich unter „Einhaltung ethischer Richtlinien“ ein Fehler bei der Angabe der Interessenkonflikte eingeschlichen. Korrekt ist: David D. Ebert und Dirk Lehr sind Gesellschafter des GET.ON Instituts. Die fehlende Nennung dieses Interessenkonflikts wurde durch einen …

Zusammenfassung Digital angebotene psychologische Interventionen gegen Schlafstörungen sind aktuell ein sehr intensiv bearbeitetes Forschungsthema. In dieser Übersichtsarbeit werden Originalarbeiten und Metaanalysen zu diesem Thema zusammengefasst. Hierbei zeigt sich, dass die internetbasierte kognitive Verhaltenstherapie für Insomnie (KVT-I) bei E...

Background: Sleep complaints are among the most prevalent health concerns especially amongst workers which may lead to adverse effects on health and work. Internet-delivered cognitive-behavioral therapy for insomnia (iCBT-I) offers the opportunity to deliver effective solutions on a large scale. The efficacy of iCBT-I for clinical samples has been...