***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: Insomnia is a major health problem , with significant psychological , health , and economic consequences . Studies have demonstrated that cognitive-behavioural therapy can effectively treat insomnia ; however , treatment availability is limited by many factors , including a lack of trained clinicians . One potential way to overcome these barriers is to use the Internet to deliver treatment . Toward this aim , we developed a self-guided , interactive , tailored Internet intervention for adults with insomnia ( SHUTi : Sleep Healthy Using The Internet )  . The current paper provides a detailed description of SHUTi and examines users ' perceptions of the intervention 's usefulness and effectiveness . The study was part of a larger r and omised controlled trial ( RCT ) to test the efficacy of SHUTi , but findings in this paper are based only on the 21 participants who completed the post- assessment after using SHUTi . The overwhelming majority rated SHUTi as convenient , underst and able , and useful . Nearly all ( 95 % ) indicated that the program had at least somewhat improved their sleep , sleep efficiency , and overall quality of life . Ninety percent perceived the intervention as effective and predicted it would be effective in producing a long-term cure . Although these results were based on a small sample , they provide encouraging evidence of the potential for Internet interventions to be accepted by patients BACKGROUND Chronic sleep-onset insomnia is a prevalent health complaint in adults . Although behavioral and pharmacological therapies have been shown to be effective for insomnia , no placebo-controlled trials have evaluated their separate and combined effects for sleep-onset insomnia . The objective of this study was to evaluate the clinical efficacy of behavioral and pharmacological therapy , singly and in combination , for chronic sleep-onset insomnia . METHODS This was a r and omized , placebo-controlled clinical trial that involved 63 young and middle-aged adults with chronic sleep-onset insomnia . Interventions included cognitive behavior therapy ( CBT ) , pharmacotherapy , or combination therapy compared with placebo . The main outcome measures were sleep-onset latency as measured by sleep diaries ; secondary measures included sleep diary measures of sleep efficiency and total sleep time , objective measures of sleep variables ( Nightcap sleep monitor recorder ) , and measures of daytime functioning . RESULTS In most measures , CBT was the most sleep effective intervention ; it produced the greatest changes in sleep-onset latency and sleep efficiency , yielded the largest number of normal sleepers after treatment , and maintained therapeutic gains at long-term follow-up . The combined treatment provided no advantage over CBT alone , whereas pharmacotherapy produced only moderate improvements during drug administration and returned measures toward baseline after drug use discontinuation . CONCLUSIONS These findings suggest that young and middle-age patients with sleep-onset insomnia can derive significantly greater benefit from CBT than pharmacotherapy and that CBT should be considered a first-line intervention for chronic insomnia . Increased recognition of the efficacy of CBT and more widespread recommendations for its use could improve the quality of life of a large numbers of patients with insomnia Background Many people with COPD report difficulties falling asleep or staying asleep , insufficient sleep duration , or nonrestorative sleep . Cognitive behavioral therapy for insomnia ( CBT-I ) has proved effective not only in people with primary insomnia but also in people with insomnia comorbid with psychiatric and medical illness ( eg , depression , cancer , and chronic pain ) . However , CBT-I has rarely been tested in those with COPD who have disease-related features that interfere with sleep and may lessen the effectiveness of such therapies . The purpose of this study was to determine the feasibility of applying a CBT-I intervention for people with COPD and to assess the impact of CBT-I on insomnia severity and sleep-related outcomes , fatigue , mood , and daytime functioning . Methods The study had two phases . In Phase 1 , a 6-weekly session CBT-I intervention protocol in participants with COPD was assessed to examine feasibility and acceptability . Phase 2 was a small trial utilizing a prospect i ve two-group pre- and post-test design with r and om assignment to the six-session CBT-I or a six-session wellness education ( WE ) program to determine the effects of each intervention , with both interventions being provided by a nurse behavioral sleep medicine specialist . Results Fourteen participants ( five in Phase 1 and nine in Phase 2 ) completed six sessions of CBT-I and nine participants completed six sessions of WE . Participants indicated that both interventions were acceptable . Significant positive treatment-related effects of the CBT-I intervention were noted for insomnia severity ( P = 0.000 ) , global sleep quality ( P = 0.002 ) , wake after sleep onset ( P = 0.03 ) , sleep efficiency ( P = 0.02 ) , fatigue ( P = 0.005 ) , and beliefs and attitudes about sleep ( P = 0.000 ) . Significant positive effects were noted for depressed mood after WE ( P = 0.005 ) . Conclusion Results suggest that using CBT-I in COPD is feasible and the outcomes compare favorably with those obtained in older adults with insomnia in the context of other chronic illnesses The frequencies of five common sleep complaints -- trouble falling asleep , waking up , awaking too early , needing to nap and not feeling rested -- were assessed in over 9,000 participants aged 65 years and older in the National Institute on Aging 's multicentered study entitled " Established Population s for Epidemiologic Studies of the Elderly " ( EPESE ) . Less than 20 % of the participants in each community rarely or never had any complaints , whereas over half reported at least one of these complaints as occurring most of the time . Between 23 % and 34 % had symptoms of insomnia , and between 7 % and 15 % percent rarely or never felt rested after waking up in the morning . In multivariate analyses , sleep complaints were associated with an increasing number of respiratory symptoms , physical disabilities , nonprescription medications , depressive symptoms and poorer self-perceived health . Sleep disturbances , particularly among older persons , oftentimes may be secondary to coexisting diseases . Determining the prevalence of specific sleep disorders , independent of health status , will require the development of more sophisticated and objective measures of sleep disturbances OBJECTIVE To assess the association between sleep problems and chronic disease in older adults . METHODS Self-reported st and ardized question naire data from 1506 community-dwelling men and women aged 55 - 84 years in the continental United States who completed a 20-min telephone interview when contacted from lists of r and omly selected telephone numbers . RESULTS A majority of the participants ( 83 % ) reported one or more of 11 medical conditions and nearly one in four elderly respondents ( age 65 - 84 years ) had major comorbidity ( i.e. four or more conditions ) . Depression , heart disease , bodily pain and memory problems were associated with more prevalent symptoms of insomnia . Other conditions such as obesity , arthritis , diabetes , lung diseases , stroke and osteoporosis were associated with other sleep-related problems such as breathing pauses , snoring , daytime sleepiness , restless legs or insufficient sleep ( < 6 h nightly ) . CONCLUSIONS Poll findings are consistent with epidemiological studies of sleep , aging and chronic disease . These results suggest that the sleep complaints common in older adults are often secondary to their comorbidities and not to aging per se . These types of studies may be useful in promoting sleep awareness among health professionals and among older adults , especially those with heart disease , depression , chronic bodily pain or major comorbidity Abstract Background Optimizing the measurement of Continuous Positive Airway Pressure ( CPAP ) compliance and treatment efficacy is paramount for patients with obstructive sleep apnea syndrome ( OSAS ) . Compliance knowledge is currently based on data coming from CPAP machines ; however algorithms and measured parameters vary from one machine to another . This study was conducted to clinical ly evaluate a novel device , NOWAPI ® , design ed to assess compliance remotely in conjunction with any CPAP machine . NOWAPI ® was tested against polygraphy , the gold st and ard for the measurement of CPAP treatment duration and residual apnea-hypopnea index ( AHI ) . Methods Single group assignment , open label , non-r and omized . Sleep laboratory setting . 22 adult patients with OSAS treated by CPAP were included . Recordings were performed during one night while the patient was treated with his/her usual CPAP and interface . NOWAPI ® data were collected electronically and compared to data acquisition and visual scoring using an EMBLETTA ® GOLD polygraph . Statistics were only descriptive . Results Recordings were performed with six different CPAP machines and three different interfaces ( full facemask , nasal pillow , nasal mask ) . The median [ Q1 ; Q3 ] absolute difference in CPAP treatment duration between NOWAPI ® and polygraphy was of 1.0 min [ 0.0 ; 12.0 ] , corresponding to a relative difference of 0.21 % [ 0.0 ; 2.2 ] ( Per Protocol data set , n = 20 ) . NOWAPI ® tended to underestimate residual AHI in a magnitude of two events per hour as compared to polygraphy . The device was well tolerated and the patient satisfaction was good . Conclusions This clinical study confirmed prior bench tests , showing that NOWAPI ® estimate of CPAP treatment duration was clinical ly acceptable and in agreement with polygraphy . Although a limited number of OSAS patients treated by CPAP were included , relevant findings for the device improvement were identified . Trial Registration Clinical Trials.gov identifier : NCT01441622 . The study was funded by Air Liquide BACKGROUND In 1997 , a US expert panel developed explicit criteria on potentially inappropriate drugs for the general elderly population . OBJECTIVE To investigate the proportion of inappropriate medications among home-dwelling , elderly patients in Helsinki , Finl and , between November 1 , 1998 , and March 31 , 1999 . METHODS A cross-sectional mail survey was sent to a r and om sample of 3921 elderly urban residents aged 75 , 80 , 85 , 90 , and 95 years . Of these , 3219 were home dwellers . MAIN OUTCOMES MEASURES Prevalence of potentially inappropriate drugs and prevalence of drugs considered inappropriate related to 15 common medical conditions according to recommendations given by the expert panel in 1997 . RESULTS The response rate was 78 % . Of the respondents , 12.5 % , 1.3 % , and 0.2 % were taking at least 1 , 2 , or 3 inappropriate drugs , respectively . The most prevalent inappropriate drugs were  dipyridamole  ( 3.6 % ) ,  long-acting benzodiazepines  ( 2.6 % ) ,  amitriptyline hydrochloride  ( 1.6 % ) ,  ergot mesyloids  ( 1.6 % ) ,  muscle relaxants  ( 1.2 % ) , and  meprobamate  ( 1.1 % ) . Use of medications considered inappropriate with certain medical conditions was higher : 27.2 % of patients with chronic obstructive pulmonary disease were taking  beta-blockers  and 19.3 % used  sedatives .  Of diabetic individuals taking oral hypoglycemics or insulin , 32.5 % were taking a concomitant beta-blocker  . Of those with a peripheral vascular disease , 37.9 % were taking beta-blockers . However , two thirds of all these patient groups had concomitant coronary heart disease . CONCLUSIONS Compared with previous surveys , the use of inappropriate medications in our home-dwelling , elderly population is conspicuously low . In contrast , use of certain drugs considered inappropriate with different medical conditions was relatively high . However , the inappropriateness of the latter treatments may be question ed in individual patients This study asks whether insomniacs undergoing behavioral training  need to do so while totally free of hypnotics . Twenty-six insomniacs participated in the study , which included extensive monitoring of sleep both in the laboratory and at home . All subjects received six sessions of training in sleep hygiene and relaxation . About half the subjects were also given a hypnotic for occasional use ; the others were asked to abstain from all hypnotics . Follow-up was performed immediately after treatment and again 10 months later . When compared with a waiting list , 6 hours of behavioral therapy improved insomniacs ' sleep latency and sleep efficiency immediately after treatment , whether or not hypnotics were given concomitantly . Immediately following the 6 hours of therapy , those who had combined pharmacotherapy and behavior therapy improved about the same as those who had received behavior therapy alone . However , on the 10-month follow-up , those who had learned sleep hygiene and relaxation without the help of occasional hypnotics had more sleep and a better sleep efficiency than those who had been allowed an occasional hypnotic . We conclude that when teaching sleep hygiene and behavioral therapy to insomniacs , it might be advantageous to disallow the concomitant use of hypnotics as needed Cognitive Behavioral Therapy ( CBT ) is effective in reducing insomnia complaints , but the effects of self-help CBT have been inconsistent . The aim of this study was to determine the effectiveness of self-help for  insomnia  delivered in either electronic or paper- and -pencil format compared to a waiting-list . Participants kept a diary and filled out question naires before they were r and omized into electronic ( n = 216 ) , paper- and -pencil ( n = 205 ) , or waiting-list ( n = 202 ) groups . The intervention consisted of 6 weeks of unsupported self-help CBT , and post-tests were 4 
    Output:
    
Results : Our review revealed any technological systems that could purportedly rehabilitate elderly patients with insomnia .
Conclusions : The potential for ICT to support insomnia care at home can improve the quality of life for families and reduce health care costs and premature institutional care