***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: In three parallel groups , brief and intermittent administration and withdrawal of triazolam , 0.5 mg , temazepam , 30 mg , and placebo were assessed in a 12‐night sleep laboratory study of 18 subjects with insomnia . With this intermittent schedule both drugs improved sleep , with about a one‐third reduction in total wake time ; this reduction was significant for temazepam but not for triazolam . Even though the periods of drug administration were quite brief , withdrawal of triazolam consistently produced rebound insomnia , with increases in total wake time above baseline of 61 % and 51 % , respectively , for the first night of each withdrawal period . With temazepam this effect was more variable , with total wake time increased only with the second withdrawal period ( 39 % ) . Thus these findings indicate that even under conditions of brief , intermittent use and withdrawal , triazolam and , to a lesser degree , temazepam produce rebound insomnia after abrupt withdrawal , thereby predisposing to drug‐taking behavior and increasing the potential for drug dependence BACKGROUND In view of the high co-occurrence of depression and insomnia , a novel way to reduce the risk of escalating depression might be to offer an insomnia intervention . We aim ed to assess whether an online self-help insomnia program could reduce depression symptoms . METHODS We did this r and omised controlled trial at the Australian National University in Canberra , Australia . Internet users ( aged 18 - 64 years ) with insomnia and depression symptoms , but who did not meet criteria for major depressive disorder , were r and omly assigned ( 1:1 ) , via computer-generated r and omisation , to receive SHUTi , a 6 week , modular , online insomnia program based on cognitive behavioural therapy for insomnia , or HealthWatch , an interactive , attention-matched , internet-based placebo control program . R and omisation was stratified by age and sex . Telephone-based interviewers , statisticians , and chief investigators were masked to group allocation . The primary outcome was depression symptoms at 6 months , as measured with the Patient Health Question naire ( PHQ-9 ) . The primary analysis was by intention to treat . This trial is registered with the Australian New Zeal and Clinical Trials Registry , number ACTRN12611000121965 . FINDINGS Between April 30 , 2013 , and June 9 , 2014 , we r and omly assigned 1149 participants to receive SHUTi ( n=574 ) or HealthWatch ( n=575 ) , of whom 581 ( 51 % ) participants completed the study program assessment s at 6 weeks and 504 ( 44 % ) participants completed 6 months ' follow-up . SHUTi significantly lowered depression symptoms on the PHQ-9 at 6 weeks and 6 months compared with HealthWatch ( F[degrees of freedom 2,640·1]=37·2 , p<0·0001 ) . Major depressive disorder was diagnosed in 22 ( 4 % ) participants at 6 months ( n=9 in the SHUTi group and n=13 in the HealthWatch group ) , with no superior effect of SHUTi versus HealthWatch ( Fisher 's exact test=0·52 ; p=0·32 ) . No adverse events were reported . INTERPRETATION Online cognitive behaviour therapy for insomnia treatment is a practical and effective way to reduce depression symptoms and could be capable of reducing depression at the population level by use of a fully automatised system with the potential for wide dissemination . FUNDING Australian National Health and Medical Research Council Forty-five adults with primary insomnia received cognitive-behavioral therapy ( CBT ) implemented in a group therapy format , in individual face-to-face therapy or through brief individual telephone consultations . The results indicate that CBT was effective in improving sleep parameters with all 3 methods of treatment implementation , and there was no significant difference across methods of implementation . All 3 treatment modalities produced improvements in sleep that were maintained for 6 months after treatment completion . These results suggest that group therapy and telephone consultations represent cost-effective alternatives to individual therapy for the management of insomnia OBJECTIVE The aim of this study was to investigate the potential of mindfulness-based stress reduction ( MBSR ) as a treatment for  chronic primary insomnia .  DESIGN A r and omized controlled trial was conducted . SETTING The study was conducted at a university health center . PATIENTS Thirty adults with primary chronic insomnia based on criteria of the Diagnostic and Statistical Manual of Mental Disorders , Text Revision , 4th Edition were r and omized 2:1 to MBSR or pharmacotherapy ( PCT ) . INTERVENTIONS Mindfulness-based stress reduction , a program of mindfulness meditation training consisting of eight weekly 2.5 hour classes and a daylong retreat , was provided , with ongoing home meditation practice expectations during three-month follow-up ; PCT , consisting of three milligrams of eszopiclone ( LUNESTA ) nightly for eight weeks , followed by three months of use as needed . A 10-minute sleep hygiene presentation was included in both interventions . MAIN OUTCOMES The Insomnia Severity Index ( ISI ) , Pittsburgh Sleep Quality Index ( PSQI ) , sleep diaries , and wrist actigraphy were collected pretreatment , posttreatment ( eight weeks ) , and at five months ( self-reports only ) . RESULTS Between baseline and eight weeks , sleep onset latency ( SOL ) measured by actigraphy decreased 8.9 minutes in the MBSR arm ( P < .05 ) . Large , significant improvements were found on the ISI , PSQI , and diary-measured total sleep time , SOL , and sleep efficiency ( P < .01 , all ) from baseline to five-month follow-up in the MBSR arm . Changes of comparable magnitude were found in the PCT arm . Twenty-seven of 30 patients completed their assigned treatment . This study provides initial evidence for the efficacy of MBSR as a viable treatment for chronic insomnia as measured by sleep diary , actigraphy , well-vali date d sleep scales , and measures of remission and clinical recovery Overwhelming evidence shows the quality of reporting of r and omised controlled trials ( RCTs ) is not optimal . Without transparent reporting , readers can not judge the reliability and validity of trial findings nor extract information for systematic review s. Recent method ological analyses indicate that inadequate reporting and design are associated with biased estimates of treatment effects . Such systematic error is seriously damaging to RCTs , which are considered the gold st and ard for evaluating interventions because of their ability to minimise or avoid bias . A group of scientists and editors developed the CONSORT ( Consoli date d St and ards of Reporting Trials ) statement to improve the quality of reporting of RCTs . It was first published in 1996 and up date d in 2001 . The statement consists of a checklist and flow diagram that authors can use for reporting an RCT . Many leading medical journals and major international editorial groups have endorsed the CONSORT statement . The statement facilitates critical appraisal and interpretation of RCTs . During the 2001 CONSORT revision , it became clear that explanation and elaboration of the principles underlying the CONSORT statement would help investigators and others to write or appraise trial reports . A CONSORT explanation and elaboration article was published in 2001 alongside the 2001 version of the CONSORT statement . After an expert meeting in January 2007 , the CONSORT statement has been further revised and is published as the CONSORT 2010 Statement . This up date improves the wording and clarity of the previous checklist and incorporates recommendations related to topics that have only recently received recognition , such as selective outcome reporting bias . This explanatory and elaboration document-intended to enhance the use , underst and ing , and dissemination of the CONSORT statement-has also been extensively revised . It presents the meaning and rationale for each new and up date d checklist item providing examples of good reporting and , where possible , references to relevant empirical studies . Several examples of flow diagrams are included . The CONSORT 2010 Statement , this revised explanatory and elaboration document , and the associated website ( www.consort-statement.org ) should be helpful re sources to improve reporting of r and omised trials CONTEXT Insomnia is a common condition in older adults and is associated with a number of adverse medical , social , and psychological consequences . Previous research has suggested beneficial outcomes of both psychological and pharmacological treatments , but blinded placebo-controlled trials comparing the effects of these treatments are lacking . OBJECTIVE To examine short- and long-term clinical efficacy of cognitive behavioral therapy ( CBT ) and pharmacological treatment in older adults experiencing chronic primary insomnia . DESIGN , SETTING , AND PARTICIPANTS A r and omized , double-blinded , placebo-controlled trial of 46 adults ( mean age , 60.8 y ; 22 women ) with chronic primary insomnia conducted between January 2004 and December 2005 in a single Norwegian university-based outpatient clinic for adults and elderly patients . INTERVENTION CBT ( sleep hygiene , sleep restriction , stimulus control , cognitive therapy , and relaxation ; n = 18 ) , sleep medication ( 7.5-mg zopiclone each night ; n = 16 ) , or placebo medication ( n = 12 ) . All treatment duration was 6 weeks , and the 2 active treatments were followed up at 6 months . MAIN OUTCOME MEASURES Ambulant clinical polysomnographic data and sleep diaries were used to determine total wake time , total sleep time , sleep efficiency , and slow-wave sleep ( only assessed using polysomnography ) on all 3 assessment points . RESULTS CBT result ed in improved short- and long-term outcomes compared with zopiclone on 3 out of 4 outcome measures . For most outcomes , zopiclone did not differ from placebo . Participants receiving CBT improved their sleep efficiency from 81.4 % at pretreatment to 90.1 % at 6-month follow-up compared with a decrease from 82.3 % to 81.9 % in the zopiclone group . Participants in the CBT group spent much more time in slow-wave sleep ( stages 3 and 4 ) compared with those in other groups , and spent less time awake during the night . Total sleep time was similar in all 3 groups ; at 6 months , patients receiving CBT had better sleep efficiency using polysomnography than those taking zopiclone . CONCLUSION These results suggest that interventions based on CBT are superior to zopiclone treatment both in short- and long-term management of insomnia in older adults . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00295386 Adolescence is a time of change that can be both exciting and stressful . In this review , we focus on the central role that disturbed sleep and daytime sleepiness occupies in interactions involving substance abuse and negative health , social , and emotional outcomes . As a means of improving sleep and lowering risk for recidivism of substance abuse , we developed and implemented a six-session group treatment to treat  sleep disturbances in adolescents who have received treatment for substance abuse . The components of the treatment are stimulus control instructions , use of bright light to regularize sleep , sleep hygiene education , cognitive therapy , and Mindfulness-Based Stress Reduction . Preliminary evidence indicates that participants who completed four or more sessions in the treatment program showed improved sleep and that improving sleep may lead to a reduction in substance abuse problems at the 12-month follow-up PURPOSE To determine the feasibility and pilot a sleep education program in New Zeal and high school students . METHODS A parallel , two-arm r and omized controlled pilot trial was conducted . High school students ( 13 to 16 years ) were r and omly allocated to either a classroom-based sleep education program intervention ( n = 15 ) or to a usual curriculum control group ( n = 14 ) . The sleep education program involved four 50-minute classroom-based education sessions with interactive groups . Students completed a 7-day sleep diary , a sleep question naire ( including sleep hygiene , knowledge and problems ) at baseline , post-intervention ( 4 weeks ) and 10 weeks follow-up . RESULTS An overall treatment effect was observed for weekend sleep duration ( F 1,24 = 5.21 , p = 0.03 ) . Participants in the intervention group slept longer during weekend nights at 5 weeks ( 1:37 h : min , p = 0.01 ) and 10 weeks : ( 1:32 h : min , p = 0.03 ) compared to those in the control group . No differences were found between groups for sleep duration on weekday nights . No significant differences were observed between groups for any of the secondary outcomes ( sleep hygiene , sleep problems , or sleep knowledge ) . CONCLUSIONS A sleep education program appears to increase weekend sleep duration in the short term . Although this program was feasible , most schools are under time and re source pressure , thus alternative methods of delivery should be assessed for feasibility and efficacy . Larger trials of longer duration are needed to confirm these findings and determine the sustained effect of sleep education on sleep behavior and its impact on health and psychosocial outcomes . COMMENTARY A commentary on this article appears in this issue on page 793 PURPOSE To estimate prevalence and chronicity of insomnia and the impact of chronic insomnia on  health and functioning of adolescents . METHODS Data were collected from 4175 youths 11 - 17 at baseline and 3134 a year later sample d from managed care groups in a large metropolitan area .  Insomnia was assessed by youth-reported DSM-IV symptom criteria . Outcomes are three measures of somatic health , three measures of mental health , two measures of substance use , three measures of interpersonal problems , and three of daily activities . RESULTS Over one 
    Output:
    
Gains were generally maintained over time .