***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 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background : Nearly 50 % of older adults have insomnia , with difficulty in getting to sleep , early awakening , or feeling unrefreshed on waking . With aging , several changes occur that can place one at risk for insomnia , including age-related changes in various circadian rhythms , environmental and lifestyle changes , and decreased nutrients intake , absorption , retention , and utilization . The natural N-methyl-D-aspartic acid ( NMDA ) antagonist and GABA agonist , Mg2 + , seems to play a key role in the regulation of sleep . The objective of this study was to determine the efficacy of magnesium supplementation to improve insomnia in elderly . Material s and Methods : A double-blind r and omized clinical trial was conducted in 46 elderly subjects , r and omly allocated into the magnesium or the placebo  group and received 500 mg magnesium or placebo daily for 8 weeks . Question naires of insomnia severity index ( ISI ) , physical activity , and sleep log were completed at baseline and after the intervention period . Anthropometric confounding factors , daily intake of magnesium , calcium , potassium , caffeine , calories form carbohydrates , and total calorie intake , were obtained using 24-h recall for 3 days . Blood sample s were taken at baseline and after the intervention period for analysis of serum magnesium , renin , melatonin , and cortisol . Statistical analyses were performed using SPSS19 and P values < 0.05 were considered as statistically significant . Results : No significant differences were observed in assessed variables between the two groups at the baseline . As compared to the placebo group , in the experimental group , dietary magnesium supplementation brought about statistically significant increases in sleep time ( P = 0.002 ) , sleep efficiency ( P = 0.03 ) , concentration of serum renin ( P < 0.001 ) , and melatonin ( P = 0.007 ) , and also result ed in significant decrease of ISI score ( P = 0.006 ) , sleep onset latency ( P = 0.02 ) and serum cortisol concentration ( P = 0.008 ) . Supplementation also result ed in marginally between-group significant reduction in early morning awakening ( P = 0.08 ) and serum magnesium concentration ( P = 0.06 ) . Although total sleep time ( P = 0.37 ) did not show any significant between-group differences . Conclusion : Supplementation of magnesium appears to improve subjective measures of insomnia such as ISI score , sleep efficiency , sleep time and sleep onset latency , early morning awakening , and likewise , insomnia objective measures such as concentration of serum renin , melatonin , and  serum cortisol , in elderly people Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more Background . Postoperative pain management remains a significant challenge for all healthcare providers . A r and omized controlled trial was conducted to examine the adjuvant effects of auricular acupressure on relieving postoperative pain and improving the passive range of motion in patients with total knee replacement ( TKR ) . Method . Sixty-two patients who had undergone a TKR were r and omly assigned to the acupressure group and the sham control group . The intervention was delivered three times a day for 3 days . A visual analog scale ( VAS ) and the Short-Form McGill Pain Question naire were used to assess pain intensity . Pain medication consumption was recorded , and the knee motion was measured using a goniometer . Results . The patients experienced a moderately severe level of pain postoperatively ( VAS 58.66 ± 20.35 ) while being on the routine PCA . No differences were found in pain scores between the groups at all points . However , analgesic drug usage in the acupressure group patients was significantly lower than in the sham control group ( P < 0.05 ) , controlling for BMI , age , and pain score . On the 3rd day after surgery , the passive knee motion in the acupressure group patients was significantly better than in the sham control group patients ( P < 0.05 ) , controlling for BMI . Conclusion . The application of auricular acupressure at specific therapeutic points significantly reduces the opioid analgesia requirement and improves the knee motion in patients with TKR STUDY OBJECTIVES ( 1 ) To describe the prevalence and prospect i ve course of insomnia in a representative young-adult sample and ( 2 ) to describe the cross-sectional and longitudinal associations between insomnia and depression . DESIGN Longitudinal cohort study . SETTING Community of Zurich , Switzerl and . PARTICIPANTS Representative stratified population sample . INTERVENTIONS None . MEASUREMENTS AND RESULTS The Zurich Study prospect ively assessed psychiatric , physical , and sleep symptoms in a community sample of young adults ( n=591 ) with 6 interviews spanning 20 years . We distinguished 4 duration -based subtypes of insomnia : 1-month insomnia associated with significant distress , 2- to 3-week insomnia , recurrent brief insomnia , and occasional brief insomnia . The annual prevalence of 1-month insomnia increased gradually over time , with a cumulative prevalence rate of 20 % and a greater than 2-fold risk among women . In 40 % of subjects , insomnia developed into more chronic forms over time . Insomnia either with or without comorbid depression was highly stable over time . Insomnia lasting 2 weeks or longer predicted major depressive episodes and major depressive disorder at subsequent interviews ; 17 % to 50 % of subjects with insomnia lasting 2 weeks or longer developed a major depressive episode in a later interview . " Pure " insomnia and " pure " depression were not longitudinally related to each other , whereas insomnia comorbid with depression was longitudinally related to both . CONCLUSIONS This longitudinal study confirms the persistent nature of insomnia and the increased risk of subsequent depression  among individuals with insomnia . The data support a spectrum of insomnia ( defined by duration and frequency ) comorbid with , rather than secondary to , depression STUDY OBJECTIVES To determine the prevalence and polysomnographic correlates of  insomnia in subjects with self-reported medical disorders . DESIGN Prospect i ve cross-sectional study . PARTICIPANTS Community-based sample of 3282 men and women aged 18 to 65 years old , with a subset who underwent polysomnography .  MEASUREMENTS Self-reported measures of sleep habits and current health , and  polysomnographic sleep variables .  RESULTS The prevalence of insomnia was 21.4 % . The adjusted odds of insomnia were 2.2 times as high in persons with any medical disorders as in those without medical disorders . Specifically , odds of insomnia were higher in people with heart disease ( OR = 1.6 [ 95 % CI : 1.2 - 23 ] , P = 0.004 ) , hypertension ( 1.5 [ 12 - 18 ] , P < 0.001 ) , diabetes ( 1.4 [ 105 - 20 ] , P = 0.04 ) , stomach ulcers ( 2.1 [ 1.6 - 2.7 ] , P < 0.001 ) , arthritis ( 1.8 [ 1.5 - 2.2 ] , P < 0.001 ) , migraine ( 1.8 [ 1.5 - 2.1 ] , P < 0.001 ) , asthma ( 1.6 [ 1.3 - 2.0 ] , P = 0.04 ) , COPD ( 1.9 [ 1.5 - 2.5 ] , P < 0.001 ) , neurological problems ( 2.0 [ 1.5 - 2.7 ] , P < 0.001 ) , and menstrual problems ( 1.7 [ 1.3 - 2.1 ] , P < 0.001 ) than in people without these disorders . Prevalence of insomnia increased with increasing number of medical disorders . However , polysomnographic sleep was not significantly different in persons with or without medical disorders for most disorders assessed . CONCLUSION This large population -based study suggests that insomnia is highly prevalent in diverse chronic medical disorders . However , polysomnographic evidence of disturbed sleep is present in only a subset of comorbid insomnia population Objective : The aim of this study is to examine the relationship between the changes in self-reported sleep symptoms and cardiac sympathovagal activity among women with postmenopausal insomnia ( PI ) who received auricular acupressure ( AA ) therapy .  Methods : A pretest/posttest study design was conducted at Taipei Veterans General Hospital , Taiwan , from August 2008 to July 2009 . Forty-five women ( mean ± SD age , 56.2 ± 5.4 years ) with PI ( 4.9 ± 3.5 years of insomnia ) received an AA therapy course on five auricular points every night before going to sleep for 4 weeks . Heart rate variability ( HRV ) , the Chinese version of the Pittsburgh Sleep Quality Index , and the Menopause Rating Scale were measured before and after AA treatment . Results : The total sleep duration and sleep efficiency were increased , and the sleep latency was shortened significantly ( P < 0.01 ) after AA therapy . The total Menopause Rating Scale and somatovegetative subscale scores were reduced significantly ( P < 0.05 ) after the intervention . A greater percentage change in Pittsburgh Sleep Quality Index was moderately correlated with both a lower percentage change in high-frequency power of HRV ( r = −0.660 , P < 0.001 ) and a greater percentage change in normalized low-frequency power ( nLF ) of HRV ( r = 0.599 , P < 0.001 ) . An elevation of high-frequency power and a reduction of nLF of HRV were observed in the responder group , whereas a raise in nLF of HRV was noted in the nonresponder group . Conclusions : This study suggests that AA intervention leads to more cardiac parasympathetic and less cardiac sympathetic activity , which contributes to the improvement of PI AIM Insomnia is a major problem which decreases life quality . Many causes are involved with it and anxiety is often associated . The underlying mechanism is not completely understood , even though different factors seem to be associated . Among them melatonin and its circadian rhythm is thought to have an important role . In addition , acupressure and acupuncture are known to ameliorate insomnia and anxiety , when a specific wrist point is stimulated ( HT 7 Shenmen ) . With these bases , the aim of the present study has been to evaluate the efficacy of an acupressure device , ' ' H7-insomnia control ' ' , positioned on HT 7 points , during the night , in terms of general health and anxiety levels , together with the evaluation of sleep quality and the urinary melatonin metabolite 6-hydroxymelatonin sulphate determination , in a number of insomniacs . METHODS Forty patients with insomnia were divided into two groups and r and omly received either the H7 or placebo treatments , in a double-blind protocol , for 20 nights . Before and after treatments every subject answered a series of question naires ( General Health Question naire 28 items ; State-Trait Anxiety Inventory ; Pittsburgh Sleep Quality Index ) and collected 24 h urines , divided into two sample s of 12 h each . Urinary melatonin metabolite was then determined using a RIA method . RESULTS Data obtained indicate that the device H7-insomnia control is efficacious to ameliorate quality of sleep and reduce anxiety levels in insomniacs , at a higher extent than in the placebo group . In addition , the 24 hours urinary melatonin metabolite rhythm , obtained at the end of treatment , was considered as being normal in a higher percentage of H7-treated patients , with respect to the placebo group . CONCLUSION It is plausible to hypothesize that the wrist acupressure device might be considered a valid tool , without adverse effects since it does not contain pharmaceutical products , that is able to naturally ameliorate sleep quality in insomniacs , acting through a not jet completely clarified mechanism , that may involve melatonin Sleep disturbance is one of the key diagnostic criteria for generalized anxiety disorder ( GAD ) . In this cross-sectional , prospect i ve , observational , and multicenter study , factors associated with the prevalence of insomnia and the impact of insomnia-associated factors on quality of life were evaluated . Using multivariate analyses , the factor most strongly associated with the presence of insomnia ( ISI ≥ 8) was the severity of the disorder ( Odds Ratio [ OR ] : 9.253 for severe GAD ; 95 % Confidence Interval [ CI ] : 1.914–44.730 ; p = 0.006 ) , pain interference and symptoms of depression ( OR : 1.018 ; 95 % CI 1.003–1.033 ; p = 0.016 and OR : 1.059 ; 95 % CI 1.019–1.101 ; p = 0.004 , respectively ) . Insomnia was not related to quality of life . Our results show insomnia to be a common health condition among patients with GAD , associated with the severity of anxiety and depressive symptoms and pain interference DESCRIPTION The American College of Physicians ( ACP ) developed this guideline to present the evidence and provide clinical recommendations on the management of chronic insomnia disorder in adults . METHO 
    Output:
    
Regarding safety , no significant difference was identified between APT and Western medications .
Conclusions APT appears to be an effective and safe treatment for comorbid insomnia .