***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: Disturbed sleep is a common problem , particularly among elderly people , and is usually treated with hypnotics . The side effects of longterm administration of hypnotic drugs are well known , but despite this there remains a substantial population of chronic users . These people can be helped to reduce their dependence on hypnotics through psychological techniques . A group of longterm users treated in this manner were shown to reduce their intake of hypnotics  significantly more than a group of users who did not receive any psychological treatment . Furthermore , the treated patients did not experience any deterioration in their sleep patterns , and their subjective refreshment from sleep improved significantly . For the patient with sleep problems , psychological techniques are preferable to the longterm use of hypnotics both as a weaning-off agent and as an alternative to drugs We tested the hypothesis that exercise would improve subjective sleep quality and activity in depressed elders . A 10-week r and omized controlled trial was utilized . Participants consisted of a volunteer sample , aged > 60 with a diagnosis of major or minor depression or dysthymia . A total of 32 subjects aged 60 - 84 years with a mean age of 71.3 + /- 1.2 years was used . Intervention consisted of a supervised weight-training program three times a week or an attention-control group . Main outcome measures were Pittsburgh Subjective Sleep Quality Index ( PSQI ) , Likert Scale of Subjective Sleep Quality and Quantity . Paffenbarger Activity Index . Geriatric Depression Scale ( GDS ) . Beck Depression Inventory ( BDI ) , Hamilton Rating Scale of Depression ( HRSD ) , and the Medical Outcomes Survey Short Form 36 ( SF-36 ) . Results showed that exercise significantly improved all subjective sleep- quality and depression measures . Depression measures were reduced by approximately twice that of controls . Habitual activity was not significantly increased by exercise .  Quality of life subscales significantly improved . In a forward stepwise multiple regression , percent improvement in GDS and percent increase in strength remained significant predictors of the improvement in total PSQI score ( r = 0.71 , p = 0.0002 ) . In conclusion , weight lifting exercise was effective in improving subjective sleep quality , depression , strength , and quality of life without significantly changing habitual activity Bright light has recently been shown to have phase-shifting effects on human circadian rhythms . In this study we applied this effect to 20 patients with delayed sleep phase syndrome ( DSPS ) who were unable to fall asleep at conventional clock times and had a problem staying alert in the morning . In a controlled treatment study , we found that 2 h of bright light exposure in the morning together with light restriction in the evening successfully phase advanced circadian rhythms of core body temperature and multiple sleep latencies in these patients . This finding corroborates the importance of light for entraining human circadian rhythms 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 re-assess relationships between mortality , hypnotic use , subjective insomnia , and sleep duration . DESIGN A prospect i ve study examining 5-year mortality among  hypnotic drug users and respondents with subjective insomnia identified in a longitudinal study of health , activity , and lifestyle ( Nottingham Longitudinal Study of Activity and Ageing ) . SETTING General community . PARTICIPANTS 1042 survey respondents , aged over 65 years , r and omly selected from the community and stratified at age 75 years . MAIN OUTCOME MEASURE Recorded mortality . RESULTS During the 5-year period , 352 respondents died . The mortality rate was significantly greater among those taking some form of medication for sleep ( n = 208 ) than for those not taking sleep medication ( n = 812 ; chi-square = 4.91 , df = 1 , P = 0.027 ) . When sleep medication users were categorized as either " hypnotic users " ( ie , users of medication with recognized hypnotic or sedative actions ) or " other users " ( including analgesics and other over-the-counter medicines ) , only " other users " showed significant excess mortality ( chi-square = 7.27 , df = 1 , P = 0.007 ) . Logistic regression showed that " other users " were 2.5 times more likely to die than " non-users " even when gender , health risk , and usual sleep duration were controlled . There were no significant relationships between mortality and subjective insomnia or reported duration of sleep . CONCLUSIONS Earlier reported relationships between excess mortality and use of medication for sleep are replicated in this study . Among elderly people , however , this relationship does not derive from the pharmacological characteristics of prescription hypnotics . Rather , it appears that reported self-medication to promote sleep , using a variety of non-sedative products , provides an epidemiological " marker " for a group within which levels of morbidity and mortality are particularly high . Excess mortality associated with very short or long sleep duration was not replicated in this study . Overall , these findings provide little epidemiological support for a wide-spread interaction between benzodiazepine hypnotic use and sleep disordered breathing in old age 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 Details of consumption of hypnotic drugs derived from a nationally representative sample of elderly people were analysed in terms of the prevalence , duration , and likely frequency of use . Of 1020 r and omly selected subjects aged 65 and over 16 % ( 166 ) reported using ( mainly benzodiazepine ) hypnotic drugs , and of these 89 % reported having taken such a drug the night before the interview . Most of these users ( 73 % ) had been taking  hypnotic drugs  for more than one year , with 25 % reporting drug use for more than 10 years . These results suggest that for most elderly users of hypnotic drugs , patterns of consumption encourage the development of cumulative effects and benzodiazepine dependence The effects of lunchtime bright light exposure in patients of a geriatric hospital were investigated . Ten in patients ( six women and four men ; mean age + /- SD : 81.2 + /- 8.8 years ) with sleep disturbances were studied for 9 weeks . Nurses performed daily ratings for sleep-wakefulness disturbances . Approximately 8000 lx bright light exposure was performed for 3 weeks in the light therapy room . Before and after exposure , ocular function was evaluated . Clinical ratings of sleep-wakefulness improved in eight patients . The score of difficulty in falling asleep and drowsiness in the morning declined during the light exposure . The score of drowsiness in the afternoon decreased during the post-light exposure . Post-exposure ocular disturbances were not found BACKGROUND Depression in elderly people may be contributed to by the multiple losses of aging . Exercise has the potential to positively impact many of these losses simultaneously . We tested the hypothesis that progressive resistance training ( PRT ) would reduce depression while improving physiologic capacity , quality of life , morale , function and self-efficacy without adverse events in an older , significantly depressed population . METHODS We conducted a 10-week r and omized controlled trial of volunteers aged 60 and above with major or minor depression or dysthymia . Subjects were r and omized for 10 weeks to either a supervised PRT program three times a week or an attention-control group . RESULTS A total of 32 subjects aged 60 - 84 , mean age 71.3 + /- 1.2 yr , were r and omized and completed the study . No significant adverse events occurred . Median compliance was 95 % . PRT significantly reduced all depression measures ( Beck Depression Inventory in exercisers 21.3 + /- 1.8 to 9.8 + /- 2.4 versus controls 18.4 + /- 1.7 to 13.8 + /- 2 , p = .002 ; Hamilton Rating Scale of Depression in exercisers 12.3 + /- 0.9 to 5.3 + /- 1.3 versus controls 11.4 + /- 1.0 to 8.9 + /- 1.3 , p = .008 ) . Quality of life subscales of bodily pain ( p = .001 ) , vitality ( p = .002 ) , social functioning ( p = .008 ) , and role emotional ( p = .02 ) were all significantly improved by exercise compared to controls . Strength increased a mean of 33 % + /- 4 % in exercisers and decreased 2 % + /- 2 % in controls ( p < .0001 ) . In a multiple stepwise regression model , intensity of training was a significant independent predictor of decrease in depression scores ( r2 = .617 , p = .0002 ) . CONCLUSIONS PRT is an effective antidepressant in depressed elders , while also improving strength , morale , and quality of life OBJECTIVE The prevalence , burden , and management of insomnia among primary care patients were evaluated . METHOD Consecutive patients aged 18 to 65 years in primary care clinics of a staff-model health maintenance organization ( N = 1,962 ) were screened with the 12-item General Health Question naire . A stratified r and om sample ( N = 373 ) completed face-to-face diagnostic assessment s including the Composite International Diagnostic Interview , a brief self-rated disability question naire ( Brief Disability Question naire ) , and the interviewer-rated Social Disability Schedule . A telephone follow-up survey was completed 3 months later . Use of psychotropic drugs , use of mental health services , and direct health care costs were assessed by using the health plan 's automated data systems . RESULTS Approximately 10 % of the primary care patients reported major current insomnia ( e.g. , taking at least 2 hours to fall asleep nearly every night ) . Current insomnia was associated with significantly greater functional impairment ( according to both Brief Disability Question naire and Social Disability Schedule ) , more days of disability due to health problems , and greater general medical service utilization . While insomnia was associated with depressive disorder and chronic medical illness , adjustment for these factors only partially accounted for the association of insomnia with disability and with health care utilization . Of the patients with current insomnia , 28 % received any psychotropic drug ; 14 % received benzodiazepines and 19 % received antidepressants . CONCLUSIONS Insomnia among primary care patients is associated with greater functional impairment , lost productivity , and excess health care utilization OBJECTIVE This study compared differential effects of behavioral therapy and triazolam in a clinical population with sleep-onset insomnia .  Triazolam was hypothesized to decrease sleep latency and frequency and duration of awakening , with some effects during the first night 's administration . But at follow-up , sleep measures were predicted to return to baseline levels . Behavioral treatment was hypothesized to effect sleep after 2 or more weeks of training which persisted at follow-up . METHOD Thirty patients with average sleep latencies of 81.48 minutes , who reported chronic insomnia for an average of 2.6 years , were r and omly assigned to one of two treatment groups : behavioral stimulus control/relaxation training and triazolam . RESULTS Both treatments decreased sleep latency but differentially . Triazolam was effective immediately but maintained only some gains at follow-up . Behavioral treatment decreased sleep latency beginning the second week , when subjects expected no improvement , with gains maintained at follow-up . Comparisons showed that triazolam group latencies returned toward baseline , while behavioral group gains were maintained at follow-up . CONCLUSIONS Triazolam treatment showed superior immediate treatment effects , while behavioral treatment showed superior treatment effects at follow-up , effects that accrued during the training period and differentially persisted at follow-up . One treatment strategy implied by these results would be to combine these two interventions concurrently . This would seem to use the immediate effects produced by the medication until the behavioral skills were learned , at which point medication would be terminated . This strategy could offer immediate 
    Output:
    
The data suggest a mild effect of  CBT  for sleep problems in older adults , best demonstrated for sleep maintenance insomnia .
It may be that the provisions of ' top-up ' or ' refresher ' sessions of CBT training to improve durability of effect are worthy of investigation .
Exercise , though not appropriate for all in this population , may enhance sleep .