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Positive effects of a weighted blanket on insomnia

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Insomnia is a common occurrence and can have a negative impact on physiological, psychological and social well-being. There is a need for simple, effective solutions to increase sleep quality. It has been suggested that weighted blankets and vests can provide a beneficial calming effect, especially in clinical disorders. Hence, we aimed to investigate the effects of a chain weighted blanket on insomnia, using objective and subjective measures. Objectively, we found that sleep bout time increased, as well as a decrease in movements of the participants, during weighted blanket use. Subjectively, the participants liked sleeping with the blanket, found it easier to settle down to sleep and had an improved sleep, where they felt more refreshed in the morning. Overall, we found that when the participants used the weighted blanket, they had a calmer night's sleep. A weighted blanket may aid in reducing insomnia through altered tactile inputs, thus may provide an innovative, non-pharmacological approach and complementary tool to improve sleep quality.
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Journal of Sleep Medicine & Disorders
Cite this article: Ackerley R, Badre G, Olausson H (2015) Positive Effects of a Weighted Blanket on Insomnia. J Sleep Med Disord 2(3): 1022.
Central
*Corresponding author
Gaby Badre, SDS Kliniken, Vasaplatsen 8, 411 34
Gothenburg, Sweden, Tel: 46-31-107-780; Fax: 46-31-107-
781; Email:
Submitted: 09 May 2015
Accepted: 22 May 2015
Published: 25 May 2015
Copyright
© 2015 Badre et al.
OPEN ACCESS
Keywords
•Sleep
•Insomnia
•Treatment
•Pressure
•Touch
•Blanket
Research Article
Positive Effects of a Weighted
Blanket on Insomnia
Ackerley R1,2, Badre G1,2* and Olausson H1,2,3
1Institute of Neuroscience and Physiology, University of Gothenburg, Sweden
2SDS Clinic, ESRS accredited Sleep Research Laboratory, Gothenburg, Sweden
3Clinical and Experimental Medicine, University of Linköping, Sweden
Abstract
Insomnia is a common occurrence and can have a negative impact on physiological,
psychological and social well-being. There is a need for simple, effective solutions to
increase sleep quality. It has been suggested that weighted blankets and vests can
provide a benecial calming effect, especially in clinical disorders. Hence, we aimed
to investigate the effects of a chain weighted blanket on insomnia, using objective and
subjective measures. Objectively, we found that sleep bout time increased, as well as a
decrease in movements of the participants, during weighted blanket use. Subjectively,
the participants liked sleeping with the blanket, found it easier to settle down to sleep
and had an improved sleep, where they felt more refreshed in the morning. Overall, we
found that when the participants used the weighted blanket, they had a calmer night’s
sleep. A weighted blanket may aid in reducing insomnia through altered tactile inputs,
thus may provide an innovative, non-pharmacological approach and complementary
tool to improve sleep quality.
ABBREVIATIONS
ANOVA: Analysis of Variance; ASD: Autism Spectrum
Disorders; BMI: Body Mass Index; ISI: Insomnia Severity Index;
KSS: Karolinska Sleepiness Scale; PSG: Polysomnography; REM:
Rapid Eye Movements; Karolinska Sleepiness Scale; TST: Total
Sleep Time; VAS: Visual Analog Scale; WASO: Wake after Sleep
Onset
INTRODUCTION
According to most epidemiological studies, up to a third of the
population in industrialized countries suffers from poor sleep [1-
5]. This problem affects all categories of people from teenagers
to the elderly, and is increasing due to modern lifestyles and
the associated stressors, especially in cities. The impairment of
sleep has short- and long-term effects. It can lead to depression,
burn-out, psychosomatic disorders and addictions, as well as
other serious health problems (e.g. metabolic, cardiovascular)
[3,4,6,7]. It can affect professional lives (e.g. loss in productivity,
poor judgments, accidents, inadequate emotional reactions),
with great economic consequences. It can also have a negative
impact on social and family life. Pharmacological and behavioral
(e.g. cognitive, relaxation) methods are commonly used to treat
sleep disorders. However, drugs are often addictive or have
side effects, and psychological/behavioral methods require long
treatment sessions and it may take time to achieve satisfactory
results. Hence, there is a need for additional, simpler methods to
promote and maintain better sleep.
The application of deep pressure, through for example
weighted vests and blankets, has been reported to produce a
calming and relaxing effect in clinical conditions such as autism
    
disorder, and pervasive developmental disorders [8-15]. Applying

high levels of anxiety or arousal [16] and deep pressure touch may
also alleviate anxiety (e.g. in dental environments and bipolar
disorder [17,18]). There are also anecdotal reports suggesting

relief from deep pressure touch and many nursing homes are
experimenting with weighted blankets.
A weighted blanket that is more than 10% of a person’s body

Most of the research on weighted blankets has focused on their
use in children with clinical disorders, such as ASD. However, the
majority of these studies do not probe sleep objectively. To our
knowledge only one study has systematically investigated the
use of a weighted blanket during bedtime and this was in children
with ASD and severe sleep problems, using some objective
measures. The study found no increase in the total sleep time;
however, the blanket was favored by both the children and their
parents [20].
There is a need for systematic studies into the potential

those with insomnia. Hence, the aim of the present study was to
investigate whether the use of a weighted blanket may have a
Badre et al. (2015)
Email:
J Sleep Med Disord 2(3): 1022 (2015) 2/7
Central
positive impact on adults with sleeping problems, mainly chronic
insomnia.
MATERIALS AND METHODS
Intervention
There are several weighted blankets on the market. For this
study we used a new type of chain-weighted blanket (Somna AB,
Stenkullen, Sweden), currently used both in nursing homes for
the elderly and in patients with ASD. The weight is provided by a
metal chain construction, which is evenly distributed throughout
the blanket and provides constant tactile stimulation across the
body. The participant can choose to sleep with the chain or the
padding side of the blanket closest to their body (hence provide a
different sensation). They can also use an additional quilt, either
over or under the blanket. The blanket is weighted without being
thick, and the fabric is such that the blanket does not particularly
provide additional warmth. Three weights were available (6, 8
or 10 kg) and the participants could select the most comfortable
one. The majority of the participants in the present study selected
the 8 kg blanket.
Study design
A repeated-measures study was undertaken in two clinical
sites in Sweden, over the course of a year. For each participant,
the study lasted 4 weeks. There was no control group, as the
participants were their own control, with baseline pre-test and
post-test measures. The study was approved by the Ethical
Committee of the Sahlgrenska Academy in Gothenburg and was
conducted according to the Declaration of Helsinki. Written,
informed consent was obtained from all the participants before
taking part and they were paid for their time. Prior to undertaking
the study, an effect size analysis was conducted to ascertain the
      
effects. This was based on statistical analyses from objective
and subjective results of a previous pilot study on 5 participants.
Cohen’s d was used to calculate an effect size of 0.75, with a power
of 0.8 (ratio 4:1 between type 1: type 2 errors); a minimum of 26
participants was required to gain statistical differences. Hence,
we aimed to recruit 30 participants to account for drop-out and
technical failures, due to the complexity of the study and its
design.
Study population
The inclusion criteria were: participants’ of\genders, aged
        
  
nights a week (> 3 days) for more than 3 months, and having
feelings of not being refreshed when waking up in the morning.
If they were on medication upon entering the study, this was
continued throughout the trial period. Otherwise they had to
be healthy. The exclusion criteria were presence of illnesses
or newly discovered problems (<6 months), for example, sleep
apnea, untreated metabolic disorders or high blood pressure.
The participants should not have changed any medication in the
prior 4 weeks to commencing the study.
Participants were selected by advertising at the sleep clinics
lthy participants
complaining of chronic insomnia were recruited for the study;
31 completed the protocol (11 men, 20 women). For further
details about the participants, see Table 1. Prior to the study,
the participants also completed various questionnaires covering
environmental and lifestyle factors, including their health status,
irregularity in sleep-wake patterns and life style, variability of
sleep during the weekend, the presence of any sleep phase delay
or advance, their perception of sleep quality, and if they used any
medication.
The level of insomnia per participant was determined
according to the 7-item Insomnia Severity Index (ISI) [21], which
assesses the nature, severity, and impact of insomnia in their
life. Each question is rated from 0 (no problem) to 4 (severe
problem), with the total possible score being 28. A score of less

threshold insomnia, while 15-21 represents moderate insomnia
and a score greater than 22 indicate severe insomnia. The
         
daytime consequences of insomnia (i.e. daytime sleepiness). This
consisted of a questionnaire with answers ranging from 0 (no
chance of dozing) to 3 (high chance of dozing) to give a total out
of 24 points.
Procedures
After screening and consent, the eligible participants slept
for a week in their habitual environment, which consisted the
pre-test baseline period. The following test period followed
consisted of two consecutive weeks during which the participant
used the weighted blanket every night. They pre-selected a
blanket weight, but if they felt that it was too light or heavy, they
could change it after no more than two nights into the test. The
participant returned the blanket after these two test weeks and
slept for one more week in their ordinary, habitual conditions
(post-test period).
Methods for studying sleep patterns
The trial design included both objective (physiological) and
subjective (self-report) measures.
OBJECTIVE MEASURES
Continuous actigraphy (Actiwatch; Cambridge
Neurotechnology Ltd, Cambridge, UK) and comprehensive
polysomnography (PSG) recordings, in the participants’ own
home, were obtained.
The actigraphy watch consisted of an accelerometer that was
worn on the same wrist continuously during the 4 week period.
Data were stored in the watch unit. Analyses of patterns and
frequencies of movements were done by validated algorithms for
the recognition of basic sleep-wake patterns. The participants’
time-to-bed and waking-up time were reported in their sleep
        
were conducted on these sleep periods. The variables analyzed
included sleep latency, assumed sleep, total wake time, sleep
fragmentation index, number of bouts of immobile time and
their frequency, as well as the number of sleep bouts and their
duration. We did not want to interfere with the ordinary lifestyle
and activities of the participants, though we recommended that
Badre et al. (2015)
Email:
J Sleep Med Disord 2(3): 1022 (2015) 3/7
Central
Characteristic Number Mean ± SD Range
Age (all)
Males
Females
31
11
20
47 ± 14 years

43 ± 13 years
21-66 years
25-60 years
21-66 years
BMI (all)
Males
Females
31
11
20
25.8 ± 5.2

25.4 ± 5.8



ISI(all)
Males
Females
31
11
20
20 ± 5

20 ± 6
5-28
11-23
5-28
Epworth(all)
Males
Females
31
11
20
6 ± 4
6 ± 3
6 ± 4
0-12
2-12
0-11
Weight of blanket/weight of participant 31  12% -38%
Question No Occasionally/Yes Often
Do you take sleep medication? 66% 21% 14%
Do you have an irregular sleep cycle? 66% 21% 14%
Is your sleep different at the weekend? 48% 34% 17%
Do you have a phase delay with sleep?  10%
Do you do shift work?  7%
Table 1: Details about the participants.
Abbreviations: BMI: Body Mass Index; ISI: Insomnia Severity Index
they avoid major irregularities, if it meant a large variation in
their sleep-wake pattern e.g. going to bed late and getting up
late during the weekend. For participants that showed these

deviation for 2 or more days), we restricted the analysis to 5
continuous days/nights for both the pre-test and the test period,
which typically did not include weekends where the larger
sleeping deviations tended to occur.
The PSG was measured using a 23 channel ambulatory
polygraph that recorded electroencephalography (electrical brain
activity), electromyography (muscle activity), electrooculography
(eye movements), electrocardiography (heart beat), respiratory
activity and oxygen content in the blood (pulse oximetry), while
a sensor pad, placed under the sheets, recorded body movements
and positions during the night (Biosaca; Swedsleep AB,
Gothenburg, Sweden). Two comprehensive PSG recordings were

test (no weighted blanket) week and one at the end of the third
week (test period, with the weighted blanket). PSG analysis was
done using the REM Logic software (Embla Systems LLC).
Further to conventional PSG analysis a validated automatic
system for analyzing body movements [23] was used (U-sleep;
Swedsleep AB, Gothenburg, Sweden). Based on the sensor pad it

according to their duration(from < 5 s to >15 s), representing
jerks or twitches, minor or major adjustments, and turns in the
bed. The total number and duration of each of these measures
were calculated, as well as the distribution per recording hour,
with an emphasis on the next-to-last hour prior to waking up.
The following measures were gained: wake after sleep onset
         
latency, latency to deep sleep and rapid eye movements (REM),
number of awakenings, amount of deep sleep and REM, arousal
index, number of stage shifts, of sleep cycles, deep and REM sleep,
average deep sleep period, and sleep spindles index.
Subjective measures
During the whole experimental period, the participants
 
perception together, with any comments about their night’s sleep
and any environmental changes of importance. Each morning,
they also reported their ‘sleep quality’ in a visual analog scale
(VAS; with the end-anchors ‘Very good’ and ‘Very bad’), as well
      
very sleepy) [24].
At the end of the study the participants reported their
subjective feelings about using the weighted blanket in an 8-item

with the blanket (Table 2), where lower scores indicated more
favorable feelings towards the weighted blanket. Two further
questions were asked: (i) ‘Which side of the blanket is closest to
your body most of the time?’ and (ii) ‘Did you use something else
as a cover, in addition to the weighted blanket?’ These were to
assess how the participants used the weighted blanket.
Data analysis
Statistical studies were made using SPSS (version 22; IBM,
Armonk, NY) and Prism (version 6; Graph Pad, La Jolla, CA)
        
analyses have been conducted on normalized data, as most of
the variables were not normally distributed. Hence, parametric,
interval statistics were carried out on the actigraphy, PSG and
U-sleep measures and repeated-measures analysis of variance
(ANOVA) tests were used. We compared the pre- and post-
test data with the weighted blanket data for each variable
     
controlled for multiple comparisons. It was not always possible
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Central
Score between 1 10
1 Comfortable Uncomfortable
2 How is your experienced sleep quality, as compared to having no weighted blanket? Better Worse
3  Awkward
4 Not at all Very
5 Does the blanket affect your temperature in bed? Not at all Very
6 Is it easier to settle down to sleep with the blanket? Very Not at all
7 Does the blanket give you a sense of security? Very Not at all
8 How do you feel in the morning with the blanket? More rested More tired
Table 2: The participants rated their subjective feelings about sleep with the weighted blanket using a visual analog scale for questions 1-8.
to include all of the participants per measure due to issues such
as technical problems. The effects of confounding variables,
such as the participant’s gender, age, use of medication, were
tested as covariates. As the behavioral measures were based on
questionnaires, non-parametric, ordinal tests were used for the
analysis.
Additional analyses were conducted on a sub-set of
participants who rated the weighted blanket favorably, which
was based on their subjective assessment scores, where lower
scores indicated a higher liking. The criteria for exclusion
         
score on questions 1-8 of more than 5, a maximum score of 8 or
more, and scores of 8 or more on more than two questions.
RESULTS
          
SD), which indicated insomnia of moderate severity (see Table
1 for further details).The mean Epworth score was 6.1 (±3.7 SD)
indicating that the participants had minor issues with sleepiness
in the daytime, with further details in Table 1.
OBJECTIVE MEASURES
Actigraphy
The actigraphy was used to determine variables about sleep
metrics; therefore only the sleep period was analyzed, with the
time-in-bed adjusted according to each participant’s sleep diary.
Actigraphy was obtained from 27 participants, from a total of
26 different measures, although some of these measures were
seemingly redundant (e.g. immobility expressed in minutes
        
differences were found in comparing the pre-test period to the
        
         
when using the weighted blanket. Furthermore, the total activity
score during the time in bed (p < 0.001) and the average dark
        
decreased, during weighted blanket use. These measures are
shown in Figure 1.
There was an effect on the results from one of the covariates,
        

blanket, if the participant used medication. The further analysis
    
(A)
(B)
(C)
Pre-Test Blanket Post-Test
0
5
10
15
20
25
30
35
Mean sleep bout time (mins)
* **
Pre-Test Blanket Post-Test
0
50
100
150
200
250
Mean dark activity (mins)
*
Pre-Test Blanket Post-Test
0
5000
10000
15000
20000
25000
Total activ ity score
*** *
Figure 1       
sleep periods from actigraphy measurements.

actigraphy measures, where there was (A) an increase in the mean
sleep bout time, and decreases in (B) the total activity score and (C)
         
where * p < 0.05 and *** p < 0.001.

the results.
The post-test actigraphy period was compared to both the
pre-test and weighted blanket periods. Due to participant drop-
out, only 22 participants completed the post-test, as compared to
the 27 who completed the pre-test and weighted blanket periods.
 differences between the pre- and post-
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J Sleep Med Disord 2(3): 1022 (2015) 5/7
Central

weighted blanket and the post-test periods for the mean sleep

activity score (p = 0.018) and mean activity score (p = 0.015).
PSG
A total of 25 participants completed both PSG tests during
the pre-test stage and while using the weighted blanket. PSG is
a state-of-the-art measure for sleep studies, but the participants
often reported that it was disturbing, due to the equipment

weighted blanket test, as compared to the pre-test: the spindles
      
only the 21 participants (out of the 25 who completed the PSG, i.e.
    
         
=0.016).The effect of confounding variables on the PSG measures
was sought, where an effect of gender was found, but this was
only for the sleep spindles measure. Here, females had a higher
spindles index during use of the weighted blanket, as compared
to males (p = 0.024).
Movement analysis
The U-sleep data consisted of 6 measures collected from
23 of the 25 participants who completed the PSG (in 2 subjects
there were technical problems with the sensor pad). The mean
movements decreased in the next-to-last hour prior to waking
up, both in duration (p =0.001) and in number (p = 0.075).No
        
the U-sleep measures. A further analysis was run using only the
subjects that liked using the weighted blanket (n = 15). Here, the
number of movements in the next-to-last hour prior to waking
      
blanket use.
Subjective measures
   
participants. There were decreases in both of these measures,
meaning a better subjective sleep quality (sleep quality:
          
0.005; KSS decreased from 5.8 (pre-test) to 5.5 (during blanket
         
differences with either the pre-test or weighted blanket periods
    
were found for the confounding variables on the KSS or sleep
quality measures, nor were any further differences found when
only the participants that liked using the blanket (n = 20) were
analyzed.
In Figure 2, the subjective assessment of using the weighted
blanket showed that overall, the participants liked sleeping with
the blanket (p =0.035), found easier to settle down to sleep (p =
0.032) and reported a much better quality of sleep (p = 0.004),
feeling more refreshed in the morning (p = 0.045). They were
not disturbed by the weight of the blanket (p =0.012) and in fact,
felt a sense of security (p = 0.042). Furthermore, the weighted
blanket did not affect their temperature in bed. The majority of
participants (63%) preferred the padding side of the blanket to
be closest to their body during sleep. The majority also just used
the weighted blanket (63%), as compared to 30% who used an
additional quilt under the blanket and 7% who used a quilt over
the blanket.
DISCUSSION
In the present study, a chain weighted blanket was found to
be effective at improving sleep quality in recognized insomniacs,
both in parameters measured objectively and subjectively. The
impact was more pronounced objectively when the participants
reported having a positive experience of using the weighted
blanket and if they used sleep medication. No adverse effects of
using the weighted blanket were found.
Weighted blankets providing a ‘cocooning’ feeling and are
often recommended for young patients with ASD and in the
care of agitated elderly people. However, to our knowledge this
     
insomniacs. The ISI results validated that the selected group had
mild-to-moderate insomnia and their Epworth scores, expected
to be low in this group of subject, though within the normal
range, were also a little elevated (mean = 6, indicating some
tendency for daytime consequences), meaning that the blanket
 
mild sleep problems. Based on sensory integration, it has been
suggested that deep pressure and consistent sensory input,
such as provided by a heavy weight on the body, can reduce
physiological levels of arousal [25].A crucial point is that the
weight should not be too light or heavy, and the weight must
be evenly distributed throughout the fabric to provide constant
tactile stimulation distributed across the body, which the current
weighted blanket design provided.
There are many weighted blankets and vests on the market
with different designs, for example, those with metal chains
          
and ball quilts may provide different sensations (e.g. tactile,
thermal insulation) and have different weights, which need to
be adapted individually, as some patients may be more sensitive
to stimulation, thus requiring a lesser-weighted blanket. The
1
. Sleeping
2. Quality
3. Weight
4. Movement
5. Temperature
6. Settling
7. Security
8. Morning
0
2
4
6
8
10
Rating
* ** * * * *
Figure 2 Ratings of subjective feelings about sleep with the weighted
blanket. Each participant rated their feelings on VASs for eight items
(numbered 1-8, see questions in Table1), where lower numbers are
more favorable ratings towards the weighted blanket. The dotted line
indicates the level between liking and disliking. The asterisks indicate
        

Badre et al. (2015)
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J Sleep Med Disord 2(3): 1022 (2015) 6/7
Central
effectiveness of a weighted blanket has been found to relate to
the mass of a person, where a blanket that weighs more than 10%

in the current study had a weight of blanket/participant
ratio of more than 12% (see Table 1). The longitudinal chain
construction of the present weighted blanket may adjust well to
the participant’s body, where an even weight is delivered over
the body from the whole blanket surface, with the longitudinal
 
with minor movements producing a stroking-like effect.
There are limitations to the current study design, which
include a lack of a control group, the long duration of the study,
some missing data, and the inability to provide a placebo weighted
blanket. The participants represented their own control (pre-
and post-test measures) in our cross-over design and a control
group would only have been necessary if the goal was to compare
different types of blankets. However, in some tests, we had
reduced numbers of participants (e.g. in the PSG), particularly
due to technical issues with this equipment-intensive technique.
As we calculated that we needed at least 26 participants for

participants, which allowed for some issues and participant drop-
out (which occurred mainly at the week 4 post-test stage).Giving
a weighted blanket to control participants without insomnia
would have been less meaningful, unless we were interested in
looking at a possible negative impact of the blanket. However, the
strengths of our design include the use of combined objective and
subjective assessments using different, independent methods,
and the use of a pre- and post-test baseline.
PSG is the golden standard to study sleep, but it can be
cumbersome, disturbing and is limited to a few nights, hence not
representative of the subject’s habitual night sleep. The PSG did
         

reporting a subjective positive impact of the blanket. Regarding

responsiveness of the brain to stimuli, where a decreased amount
suggests a ‘loss of contact’ with the external environment, hence
         
movement (U-sleep) analysis was based on recordings from the
   
PSG. Hence, we used the ‘next to last hour’ measure to assess
sleep, since the last hour is often characterized by a shallow
sleep. The participants showed a decrease of movements this
next to last hour, which represented a quieter, more restful sleep.
Therefore the combination with actigraphy made for a more
comprehensive evaluation of the effects of using the weighted
blanket over time. The actigraphy showed a number of objective
improvements in sleep, including a decrease in movements and
an increase in the length of sleep bouts.
Overall, these measures suggest the additional pressure
stimulation from the weighted blanket provided a calming effect
on the participants, by decreasing agitation and increasing the
quality of their sleep. This was demonstrated through a decrease
in movements during sleep with the weighted blanket, which
were increased in the pre- and post-test periods, and also the
subjective increased in sleep quality (measured by the VAS)
and KSS (which is a validated instrumental scale). Although
these subjective measures are possibly less clinically relevant,
it is important to consider the psychological effects of using the
weighted blanket (cf. [20]), for example, having a positive attitude.
Weighted blankets and deep pressure touch may work well for
insomniacs, both through psychological means (e.g. calming and
‘cocooning’, releasing anxiety [27]) and physiological means (e.g.
tactile input that decreases activity of the sympathetic nervous
system [28]).As increased sympathetic arousal likely affects
sleep quality negatively, reducing it may aid sleep.
CONCLUSION
The weighted chain blanket used in the present study had
a positive impact on sleep, both objectively and subjectively,
where a number of physiological and behavioral measures were
improved during weighted blanket use. When the participants
used the weighted blanket, they had a calmer night’s sleep,
with a decrease in movements. Subjectively, they believed that
using the blanket provided them with a more comfortable,
better quality, and more secure sleep. In conclusion, a weighted
blanket may aid in reducing insomnia through increased tactile
and proprioceptive inputs, may provide an innovative, non-
pharmacological approach and complementary tool to improve
sleep quality.
CONFLICT OF INTEREST
The study was supported by a grant from Somna AB. GB is
the Medical Director of SDS Clinic, where the study was overseen.
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Ackerley R, Badre G, Olausson H (2015) Positive Effects of a Weighted Blanket on Insomnia. J Sleep Med Disord 2(3): 1022.
Cite this article
... In addition, sleep difficulties were found to be associated with a large economic cost at both the societal and the individual level [9,10]. The societal costs of sleep-related difficulties, both direct and indirect, have been estimated to approach 1.55% of gross domestic product in some countries [11]. ...
... Dementia is a diagnosis associated with a known degenerative process to the areas that modulate sleep [39], thus maybe being influenced by the WB. There are also reports that elderly people who suffer from dementia may find relief from deep pressure touch [9,40]. An alternative reason for longer use time among people with dementia and people with ID could be a speculation about the living arrangements for some people in these two groups. ...
... Assumptions have been made that the different types of WB make noises and can be perceived as warmer or colder which can be disturbing when having diagnoses involving sensory difficulties. The heavier blankets were kept longer than the lighter ones, which is consistent with findings of previous studies [9,21]. The topic of WB weight has been discussed in literature, and often 10% of the person's bodyweight is recommended as the optimal weight of the blanket [9,19,21,39,43]. ...
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Background: Weighted blankets (WBs) have been suggested as a treatment option for insomnia and are commonly prescribed despite lack of evidence of efficacy. Aim: To investigate prescription pattern, return rate and cost of WBs. Material and methods: This observational cohort register-based study in western Sweden included every individual who, in a 2.5-year period, was prescribed and received at least one WB (n = 4092). A cost evaluation was made by mapping prescription processes for WBs and sleep medication. Results: Individuals diagnosed with dementia, anxiety, autism or intellectual disability (ID) retained the WB longer than others. Individuals younger than six and older than 65 years had shorter use time. The cost evaluation showed that the prescription process for WBs was longer and resulted in a higher cost than for sleep medication. Conclusions: Some individuals had longer use time, indicating a possible benefit from using a WB. Due to low risk of harm but high economic cost, a revision of the WBs prescription process could be recommended to identify those who might benefit from WB. Significance: Our result points towards a need for revision of the prescription process, to implement standardized sleep assessments, and create a more efficient prescription process to lower the cost.
... Sleep problems for these residents was defined based on Diagnosis of Insomnia (ICD 10-SE) (The National Board of Health and Welfare, 2010). The study period of 28 days was based on previous studies where the influence on sleep by the weighted blanket was shown after 2-4 weeks (Ackerley et al., 2015;Hvolby & Bilenberg, 2011). If the older person was cold with the weighted blanket, an ordinary blanket was also placed over the older person and then the weighted blanket. ...
... The nursing staff experienced that healthy sleep was attained because the weighted blanket helped the residents fall asleep faster and to sleep more undisturbed through the night. Similar influences of the weighted blanket have been reported from previous studies (Ackerley et al., 2015;Bundy & Lane, 2020;Ekholm et al., 2020;Reynolds et al., 2015). Previous studies were not performed on the older population per se, but on more mixed target groups. ...
... Previous studies were not performed on the older population per se, but on more mixed target groups. Adjusting sleep with weighted blankets has been described as a tactile non-pharmacological complement to improve sleep quality (Ackerley et al., 2015). In this study, the nursing staff experienced a reduction in pharmacological treatment and that this reduction was related to implementing the weighted blanket. ...
Article
Purpose The most common treatment for resident’s health problems is pharmacological. Little research has been done on how an intervention with a non-pharmacological method, such as a weighted blanket, Through the nursing staff view, we can learn how weighted blankets influence resident’s health in nursing homes. The aim of this study was to explore nursing staff’s experiences of how an intervention with weighted blankets influenced resident’s expressions of health. Methods The study had a descriptive qualitative design with semi-structured interviews with 20 nursing staff working in nursing homes, and an inductive content analysis was applied. Results The nursing staff expressed that the weighted blanket positively influenced resident’s health in the areas of sleep, physical activity, and psychological behaviour. The weighted blanket made them fall asleep faster, sleep was uninterrupted andthey felt more rested in the morning. The nursing staff observed an increased level of activity as the resident became more energetic . The nursing staff also experienced reduced negative psychological behaviours like anxiety and worrying.
... Sleep problems for these residents was defined based on Diagnosis of Insomnia (ICD 10-SE) (The National Board of Health and Welfare, 2010). The study period of 28 days was based on previous studies where the influence on sleep by the weighted blanket was shown after 2-4 weeks (Ackerley et al., 2015;Hvolby & Bilenberg, 2011). If the older person was cold with the weighted blanket, an ordinary blanket was also placed over the older person and then the weighted blanket. ...
... The nursing staff experienced that healthy sleep was attained because the weighted blanket helped the residents fall asleep faster and to sleep more undisturbed through the night. Similar influences of the weighted blanket have been reported from previous studies (Ackerley et al., 2015;Bundy & Lane, 2020;Ekholm et al., 2020;Reynolds et al., 2015). Previous studies were not performed on the older population per se, but on more mixed target groups. ...
... Previous studies were not performed on the older population per se, but on more mixed target groups. Adjusting sleep with weighted blankets has been described as a tactile non-pharmacological complement to improve sleep quality (Ackerley et al., 2015). In this study, the nursing staff experienced a reduction in pharmacological treatment and that this reduction was related to implementing the weighted blanket. ...
Article
Full-text available
Purpose The most common treatment for resident’s health problems is pharmacological. Little research has been done on how an intervention with a non-pharmacological method, such as a weighted blanket, Through the nursing staff view, we can learn how weighted blankets influence resident’s health in nursing homes. The aim of this study was to explore nursing staff’s experiences of how an intervention with weighted blankets influenced resident’s expressions of health. Methods The study had a descriptive qualitative design with semi-structured interviews with 20 nursing staff working in nursing homes, and an inductive content analysis was applied. Results The nursing staff expressed that the weighted blanket positively influenced resident’s health in the areas of sleep, physical activity, and psychological behaviour. The weighted blanket made them fall asleep faster, sleep was uninterrupted andthey felt more rested in the morning. The nursing staff observed an increased level of activity as the resident became more energetic . The nursing staff also experienced reduced negative psychological behaviours like anxiety and worrying. Conclusion This study indicated that the weighted blanket changed the health expression of resident in several crucial areas. Deep pressure treatment indicates an alternative health-improved treatment for resident in nursing homes.
... Hygiene covers were not used due to the risk of suffocation. The intervention period was conducted over 28 days, which was based on previous studies where the effect of the weighted blanket was shown after 2-4 weeks [40,41]. If the older people were cold, an ordinary blanket was placed over the older people and then the weighted blanket. ...
... It also became more manageable for older people to fall asleep in the evening. Previous studies have also described this overall improved effect on sleep using the weighted blanket [40,70,71] Insomnia in older people is associated with cognitive impairment [15]. A weighted blanket can also affect depressive symptoms, which are alleviated in connection with sleep problems and vice versa [17]. ...
Article
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Background: An increasingly aging population is a global phenomenon. While considered a positive step forward, vulnerability to age-related health problems increases along with the ageing population. The aim of the study was to investigate weighted blankets' effect on health regarding quality of life (QoL), sleep, nutrition, cognition, activities of daily living ADL and medication in older people living in nursing homes. Methods: In total, 110 older people were involved in an intervention with weighted blankets, and 68 older people completed the intervention. Measures before and after were performed regarding quality of life; QoL-AD, EQ-VAS, sleep; MISS, nutrition; MNA, cognition; S -MMSE (ADL) and medication. Comparative statistical analyses were applied. Results: After intervention with weighted blankets, health in general, such as QoL, improved. Sleep also improved significantly, especially with respect to waking up during the night. Nutrition was enhanced, health as a cognitive ability improved, and medication in the psychoanaleptic group decreased. The effect size varied between small and large. Conclusions: A weighted blanket seems to be an effective and safe intervention for older people in nursing homes, as several improvements were made regarding the health of older people.
... Weighted blankets elicit similar affective effects as deep pressure including feelings of calm 24,41,65 and reductions in anxiety 22, 110 . In addition, weighted blankets improve insomnia in healthy adults 2 and psychiatric patients 41 . In addition to sensory gating and modulation of affect, 4,76,122,127,151 weighted blankets could plausibly reduce pain by decreasing anxiety 4, 76,122,127,151 or improving sleep. ...
... Sample size determination was based on previous studies of weighted blankets for anxiety 24 and sleep 2 and was calculated using G*power version 3.1.9.7. Based on the effect size estimated from data for changes in sleep quality of Cohen's d = 0.75 2 , two independent groups, a = 0.05, and power = 0.80, we determined the current study would require 48 participants in each group. ...
Article
Pleasant sensation is an underexplored avenue for modulation of chronic pain. Deeper pressure is perceived as pleasant and calming, and can improve sleep. Although pressure can reduce acute pain, its effect on chronic pain is poorly characterized. The current remote, double-blind, randomized controlled trial tested the hypothesis that wearing a heavy weighted blanket – providing widespread pressure to the body – relative to a light weighted blanket would reduce ratings of chronic pain, mediated by improvements in anxiety and sleep. Ninety-four adults with chronic pain were randomized to wear a 15-lb. (heavy) or 5-lb. (light) weighted blanket during a brief trial and overnight for one week. Measures of anxiety and chronic pain were collected pre- and post-intervention, and ratings of pain intensity, anxiety, and sleep were collected daily. After controlling for expectations and trait anxiety, the heavy weighted blanket produced significantly greater reductions in broad perceptions of chronic pain than the light weighted blanket (Cohen's f = .19, CI [-1.97, -.91]). This effect was stronger in individuals with high trait anxiety (p = .02). However, weighted blankets did not alter pain intensity ratings. Pain reductions were not mediated by anxiety or sleep. Given that the heavy weighted blanket was associated with greater modulation of affective versus sensory aspects of chronic pain, we propose that the observed reductions are due to interoceptive and social/affective effects of deeper pressure. Overall, we demonstrate that widespread pressure from a weighted blanket can reduce the severity of chronic pain, offering an accessible, home-based tool for chronic. The study purpose, targeted condition, study design, and primary and secondary outcomes were pre-registered in ClinicalTrials.gov (NCT04447885: “Weighted Blankets and Chronic Pain”). Perspective: This randomized-controlled trial showed that a 15-lb weighted blanket produced significantly greater reductions in broad perceptions of chronic pain relative to a 5-lb weighted blanket, particularly in highly anxious individuals. These findings are relevant to patients and providers seeking home-based, nondrug therapies for chronic pain relief.
... In general, relaxation has positive effects on our physical and mental health [5,6]. Different techniques have been found to reduce the level of arousal and enhance sleep in terms of shorter sleep onset latency and subjective sleep quality, including muscle relaxation [5], cognitive techniques [6], newer forms of mindfulness [7], and deep pressure stimulation from weighted blankets [8,9]. The advances in technology have led to a variety of new products that are advertised as sleep enhancing. ...
Article
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Insomnia is a common sleep disorder characterized by difficulties initiating sleep, maintaining sleep and/or early-morning awakenings. Hyperarousal is a common causal and maintaining factor in insomnia models. Different techniques to decrease arousal have shown to be effective. Calm breathing can be one approach to enhance sleep. The Somnox sleep robot looks like a bean-shaped cushion to hug, and it gives physical and auditive guidance to calm down the users' breathing. There is currently no impartial empirical evidence of the sleep robot's effects on insomnia. This study is a randomized waitlist-controlled trial with a recruitment target of a minimum of 44 adults with insomnia and sleep disturbing arousal. Participants will complete pre-, mid- and post-intervention assessments, in addition to a 1-month follow-up. The primary outcome measure is the Insomnia Severity Index. Secondary sleep outcome measures are the Pre-Sleep Arousal Scale, a sleep diary and actigraphy. A secondary comorbid symptoms outcome measure is the Hospital Anxiety and Depression Scale. The main research question is whether treated participants have greater improvements regarding symptoms of insomnia post-intervention, compared with the waitlist control group. The analytic approach will be mixed-effects models. The current study will increase the knowledge on breath guidance as a way to reduce hyperarousal and enhance sleep. The sleep robot is a novel method and a potential treatment option for people with insomnia, when the recommended first-line treatments of Cognitive Behavioral Therapy and pharmaceuticals are inaccessible or undesirable. The ethics of healthcare robotics is discussed.
... There are several weighted blankets available adding extra weight through the use of chain links built into the interior of the blanket together with padding for comfort [69]. Other weighted blankets use plastic balls to add weight [70]. ...
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Background Attention deficit hyperactivity disorder (ADHD) and Autism Spectrum Disorder (ASD) are often accompanied by sleep problems influencing social, emotional and cognitive functioning in everyday activities. Aim The aim of this study was to investigate whether the use of a weighted blanket has a positive impact on sleep and everyday activities in individuals with ADHD and/or ASD. Material and methods The study included 85 individuals diagnosed with ADHD and/or ASD, 48 children aged ≤17 (57%) and 37 adults ≥18 years (44%), who were prescribed with a weighted blanket. The participants responded via a telephone interview. Results Findings demonstrated that a weighted blanket improved abilities related to falling asleep, sleeping the whole night, and relaxing during the day. Using a weighted blanket improved morning/evening daily routine, including preparing/going to sleep and waking up in the morning. Conclusions Weighted blankets showed positive impact on falling asleep, sleeping the whole night, and relaxing during the day, and they were used frequently by children and adults with ADHD and/or ASD. Findings indicate that a weighted blanket improved morning/evening routine, however this research area needs further investigation using both subjective and objective parameters.
... Besides having different responses towards the same perceived thermal condition due to physiological difference of the two genders, gender-specific psychological difference could also be the cause of distinct choice of bedding system. A high coverage percentage may provide females with a sense of comfort, as research has linked the use of weighted blanket to improved sleep quality, potentially due to the increase of serotonin, a neurotransmitter that lowers anxiety and produces a calming effects [45,46]. Male students, on the other hand, would adjust the thermal resistance accordingly for a desired thermal condition for sleep onset. ...
Article
Thermal environment can greatly influence one's sleep quality, yet research into thermal satisfaction and sleep quality is lacking. This study investigates the thermal environment, thermal sensation, satisfaction and sleep quality of university students residing in dormitory in Hong Kong in winter. Based on subjective questionnaire and environmental measurement, it was found that under the same thermal condition, females selected a bedding system with higher total thermal resistance than males. Self-assessed overall sleep quality was associated with mid-sleep/early awakenings, refreshment and duration of sleep, and sleep quality was largely influenced by thermal comfort and satisfaction. Thermally satisfied subjects and those with neutral thermal sensation had significantly better sleep quality. Thermal satisfaction and sleep quality toward hot and cold environments were also different. Existing sleeping thermal comfort models failed to predict accurately the thermal sensation in sleeping state, suggesting a need for the development of better prediction model for sleeping person.
Article
Background Emergence delirium (ED) is a significant problem in the post anesthesia care unit (PACU), resulting in dislodgement of medical devices, patient and staff injury, prolonged recovery, and parent dissatisfaction. Parental requests for the use of weighted blankets in the hospital setting have increased. However, while weighted blankets have shown potential as treatment for anxiety in adults and children, no studies have demonstrated their safe use with children in the hospital setting. Purpose To explore the safety of weighted blanket use with children in the PACU as an intervention for ED, a feasibility study was conducted. Design and Methodology: A convenience sample of 93 participants, aged three to 10 years were recruited. Watcha scores, vital signs, length of wear time, and reason for blanket removal were recorded for all patients. Results Eighty-five patients completed the study. Four participants experienced vital signs outside the defined safety parameters, with only one experiencing an adverse event (1.2%). This was consistent with the historic adverse event rate of 1% for the study site. Staff did not report issues with the use or cleaning of the blankets. Of interest, there was significant correlation between ED and suspected pain. Conclusion The study demonstrated weighted blanket use is safe and feasible with children in the hospital setting, Additional studies are needed to determine the effectiveness of weighted blankets as an intervention for ED and the impact pain may have on the severity and prevalence of ED.
Article
Objective: The purpose of this qualitative study was to explore working men’s perspectives about sleep health and the intersecting influences of gender and work, describing participant’s views on current and potential programming and organizational support to promote sleep health. Methods: Twenty men employed in male-dominated industries in the north-central region of Alberta, Canada, participated in 4 consultation group discussions addressing motivators, facilitators and barriers to sleep health. Results: Participants reported sleeping an average of 6.36 (SD ±1.1) hours per night, and the majority worked more than 40 hours per week. Data were analyzed using an inductive approach. The findings provided important insights. In normalizing sleep deprivation and prioritizing the need to “just keep going” on six or less hours of sleep, the men subscribed to masculine ideals related to workplace perseverance, stamina and resilience. Workplace cultures and practices were implicated including normative dimensions of overtime and high productivity and output, amid masculine cultures constraining emotions and conversations about sleep, the sum of which muted avenues for discussing, let alone promoting sleep. Challenges to good sleep were primarily constructed around time constraints, and worry about meeting work and home responsibilities. Men’s preferences for workplace support included providing and incentivizing the use of sleep health resources, designing work for sleep health (e.g., shift schedules, overtime policies) and getting advice from experienced coworkers and experts external to the workplace organization. Conclusion: These findings hold potential for informing future gender-sensitive programming and organizational practices to support sleep health among working men.
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Objective: To assess the effectiveness of a weighted-blanket intervention in treating severe sleep problems in children with autism spectrum disorder (ASD). Methods: This phase III trial was a randomized, placebo-controlled crossover design. Participants were aged between 5 years and 16 years 10 months, with a confirmed ASD diagnosis and severe sleep problems, refractory to community-based interventions. The interventions were either a commercially available weighted blanket or otherwise identical usual weight blanket (control), introduced at bedtime; each was used for a 2-week period before crossover to the other blanket. Primary outcome was total sleep time (TST) recorded by actigraphy over each 2-week period. Secondary outcomes included actigraphically recorded sleep-onset latency, sleep efficiency, assessments of child behavior, family functioning, and adverse events. Sleep was also measured by using parent-report diaries. Results: Seventy-three children were randomized and analysis conducted on 67 children who completed the study. Using objective measures, the weighted blanket, compared with the control blanket, did not increase TST as measured by actigraphy and adjusted for baseline TST. There were no group differences in any other objective or subjective measure of sleep, including behavioral outcomes. On subjective preference measures, parents and children favored the weighted blanket. Conclusions: The use of a weighted blanket did not help children with ASD sleep for a longer period of time, fall asleep significantly faster, or wake less often. However, the weighted blanket was favored by children and parents, and blankets were well tolerated over this period.
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Poor sleep imparts a significant personal and societal burden. Therefore, it is important to have accurate estimates of its causes, prevalence and costs to inform health policy. A recent evaluation of the sleep habits of Australians demonstrates that frequent (daily or near daily) sleep difficulties (initiating and maintaining sleep, and experiencing inadequate sleep), daytime fatigue, sleepiness and irritability are highly prevalent (20%-35%). These difficulties are generally more prevalent among females, with the exception of snoring and related difficulties. While about half of these problems are likely to be attributable to specific sleep disorders, the balance appears attributable to poor sleep habits or choices to limit sleep opportunity. Study of the economic impact of sleep disorders demonstrates financial costs to Australia of $5.1 billion per year. This comprises $270 million for health care costs for the conditions themselves, $540 million for care of associated medical conditions attributable to sleep disorders, and about $4.3 billion largely attributable to associated productivity losses and non-medical costs resulting from sleep loss-related accidents. Loss of life quality added a substantial further non-financial cost. While large, these costs were for sleep disorders alone. Additional costs relating to inadequate sleep from poor sleep habits in people without sleep disorders were not considered. Based on the high prevalence of such problems and the known impacts of sleep loss in all its forms on health, productivity and safety, it is likely that these poor sleep habits would add substantially to the costs from sleep disorders alone.
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This paper presents the results of a concurrent, nested, mixed methods exploratory study on the safety and effectiveness of the use of a 30 lb weighted blanket with a convenience sample of 32 adults. Safety is investigated measuring blood pressure, pulse rate, and pulse oximetry, and effectiveness by electrodermal activity (EDA), the State Trait Anxiety Inventory-10 and an exit survey. The results reveal that the use of the 30 lb weighted blanket, in the lying down position, is safe as evidenced by the vital sign metrics. Data obtained on effectiveness reveal 33% demonstrated lowering in EDA when using the weighted blanket, 63% reported lower anxiety after use, and 78% preferred the weighted blanket as a calming modality. The results of this study will be used to form the basis for subsequent research on the therapeutic influence of the weighted blanket with adults during an acute inpatient mental health admission.
Book
Clinical practice related to sleep problems and sleep disorders has been expanding rapidly in the last few years, but scientific research is not keeping pace. Sleep apnea, insomnia, and restless legs syndrome are three examples of very common disorders for which we have little biological information. This new book cuts across a variety of medical disciplines such as neurology, pulmonology, pediatrics, internal medicine, psychiatry, psychology, otolaryngology, and nursing, as well as other medical practices with an interest in the management of sleep pathology. This area of research is not limited to very young and old patients-sleep disorders reach across all ages and ethnicities. Sleep Disorders and Sleep Deprivation presents a structured analysis that explores the following: Improving awareness among the general public and health care professionals. Increasing investment in interdisciplinary somnology and sleep medicine research training and mentoring activities. Validating and developing new and existing technologies for diagnosis and treatment. This book will be of interest to those looking to learn more about the enormous public health burden of sleep disorders and sleep deprivation and the strikingly limited capacity of the health care enterprise to identify and treat the majority of individuals suffering from sleep problems. © 2006 by the National Academy of Sciences. All rights reserved.
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The application of deep touch pressure (DTP) has been suggested to provide positive effects on anxiety modulation. However, empirical and theoretical evidence linked to the clinical effects of DTP are relatively rare. This study conducts a quantitative analysis of behavioral assessments and performs physiological measurements, including those of electrodermal activity and heart rate variability, to understand the modulation of the autonomic nervous system (ANS), and the orchestration of sympathetic (SNS) and parasympathetic nervous systems (PsNS). The results suggest that the activation of PsNS plays a critical role in ANS modulation. This study provides physiological evidence to support the positive clinical effects of DTP for reducing anxiety in dental environments.
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Chronic insomnia is defined by difficulties in falling asleep, maintaining sleep, and early morning awakening, and is coupled with daytime consequences such as fatigue, attention deficits, and mood instability. These symptoms persist over a period of at least 3 months (Diagnostic and Statistical Manual 5 criteria). Chronic insomnia can be a symptom of many medical, neurological, and mental disorders. As a disorder, it incurs substantial health-care and occupational costs, and poses substantial risks for the development of cardiovascular and mental disorders, including cognitive deficits. Family and twin studies confirm that chronic insomnia can have a genetic component (heritability coefficients between 42% and 57%), whereas the investigation of autonomous and central nervous system parameters has identified hyperarousal as a final common pathway of the pathophysiology, implicating an imbalance of sleep-wake regulation consisting of either overactivity of the arousal systems, hypoactivity of the sleep-inducing systems, or both. Insomnia treatments include benzodiazepines, benzodiazepine-receptor agonists, and cognitive behavioural therapy. Treatments currently under investigation include transcranial magnetic or electrical brain stimulation, and novel methods to deliver psychological interventions. Copyright © 2015 Elsevier Ltd. All rights reserved.
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Previous studies have shown that individuals with autism spectrum disorders and attention- deficit/hyperactivity disorder (ADHD) experience sensory over-responsivity (SOR) in which a heightened response is evoked by stimuli in the environment. These individuals also display symptoms of anxiety such as irritability, avoidance, and sweating. Deep touch pressure, a technique in which firm touch is applied to the body either by the self or by a machine, has been shown to improve functioning and reduce symptoms of anxiety in these populations. A patient presenting with bipolar I disorder and comorbid anxiety, ADHD, and dyslexia was taught deep touch pressure strategies to alleviate severe symptoms of sensory over-responsivity and anxiety. The patient reported that the techniques were helpful as they allowed her to cope with potentially overwhelming situations in her environment. Clinician-rated functioning also improved over the course of treatment. This case study suggests that deep touch pressure may be useful in patients with bipolar disorder who have SOR and anxiety as comorbid conditions. (Journal of Psychiatric Practice 2014; 20:71-77).
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Occupational therapists working in the school system setting report using weighted vests as a technique to improve attention and sensory processing for students who have an autism spectrum disorder. Some critics, however, contend that this technique is used without evidence of effectiveness. This study examines the overall research available on the use of weighted vest with children on the autism spectrum to see what, if any, consensus concerning effectiveness exist regarding this practice.
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In this pilot study, we determined the effectiveness of a weighted vest on attention to task for second-grade general education students with difficulty attending. We used an intervention and a control group and an ABA design to compare participants' percentage of time on task with and without a vest. Ten participants from nine elementary schools in a suburban Texas school district were randomly assigned to an intervention or a control group. Control group participants wore a nonweighted vest. Participants, classroom teachers, and research assistants who coded the data were blind as to the group to which the participants were assigned. A repeated measures analysis of variance indicated no significant differences between groups or between baseline, intervention, and withdrawal conditions. Our results indicated that the weighted vests were not effective in increasing time on task. These results should be generalized cautiously owing to the small sample size and participant selection process.
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To assess the prevalence of insomnia symptoms, their associated factors and daytime symptoms in the general population of Sweden. This is a cross-sectional postal survey performed in the general population of Sweden aged between 19 and 75 years (6 million inhabitants). A total of 1209 out of 1705 randomly selected participants from the National Register of the Total Population completed the questionnaire. The participation rate was 71.3%. Participants filled out a paper-pencil questionnaire composed of 157 items covering sociodemographic characteristics, sleeping habits and environment, sleep quality and sleep symptoms, and health status. We found 32.1% (95% confidence interval: 29.5-34.8%) of the sample reported having difficulty initiating (DIS) or maintaining sleep (DMS) or non-restorative sleep accompanied with sufficient sleep (NRS) at least 4 nights per week: 6.3% of the sample had DIS, 14.5% had DMS and 18.0% had NRS. Results from logistic regressions showed that restless legs symptoms, breathing pauses during sleep and depressive or anxious mood were associated with DIS and DMS but not NRS. Living in an urban area (OR:2.0) and drinking alcohol daily (OR:4.6) were associated only with NRS. Daytime symptoms were reported by over 75% of subjects with insomnia symptoms. DIS, DMS and NRS were associated with daytime fatigue but not excessive sleepiness as measured by the Epworth scale. DIS was associated with the use of sleeping pills or natural sleeping aid compounds in multivariate models. Insomnia symptoms occurring at least 4 nights per week are frequent in Sweden, affecting about a third of the population. Subjects with NRS have a distinctly different profile than those with DIS or DMS, which suggests different etiological causes for this symptom.