Global trends and neurobiological frontiers of manual therapy in sleep disorders: integrating bibliometrics with clinical evidence

BackgroundSleep disorders not only impair nocturnal rest but also significantly compromise daytime functioning, emotional regulation, and overall mental well-being. Beyond conventional pharmacological treatments, manual therapy has emerged as a promising non-pharmacological intervention. Specifically, emerging evidence suggests its benefits may extend to alleviating psychological distress and enhancing mood. This study employs a bibliometric approach to systematically investigate the current status, research hotspots, and future trends of manual therapy for sleep disorders, with an emphasis on its psycho-physiological outcomes.MethodsPublications related to manual therapy for sleep disorders were retrieved from the Web of Science Core Collection (WoSCC). Bibliometric visualizations and analyses were conducted using VOSviewer and CiteSpace. Furthermore, clinical trial records from PubMed were extracted to assess the translational and clinical advancements in this field.ResultsThe analysis included 594 publications originating from 321 institutions across 63 countries. The overall trend demonstrates a consistent annual increase in both publication volume and citation impact, reflecting escalating academic interest. Keyword and literature co-occurrence analyses indicate that exploring neurobiological mechanisms and circadian rhythm regulation are the predominant research frontiers.ConclusionBibliometric evidence indicates that research on manual therapy for sleep disorders is evolving toward multidimensional and interdisciplinary integration. Manual therapy increasingly emerges as a key complementary treatment, exerting therapeutic effects via the regulation of 5-hydroxytryptamine (5-HT) and the Hypothalamic-Pituitary-Adrenal axis (HPA axis). Its safety and efficacy represent distinct advantages; however, future clinical translation necessitates multi-center validation and standardized sham-controlled protocols.

More Daylight Exposure Could Lower Dementia Risk

Time spent in daylight could lower the risk of dementia and offer extra benefits for people at particularly high risk, new research suggests. The findings, published in General Psychiatry, could provide a low-cost way to support brain health.

Having less than 0.7 hours of bright daytime light per day was a stronger predictor of dementia than six traditional risk factors. Moderately bright natural light exposure—equivalent to an overcast day outdoors—was linked with a 16% reduction in the risk of dementia.

“Daytime light exposure may serve as a novel indicator of dementia risk,” said researcher Hongliang Feng, PhD, from Guangzhou Medical University in China. Natural cycles of darkness at night followed by bright light during the day are fundamental to entrain circadian rhythms. These regulate physiology, behavior, and cognition, with circadian disruptions common among people with dementia.

Noting that modern lifestyles limit daytime exposure to natural light, the researchers investigated exposure to day- and nighttime light using actigraphy devices that track body movements with built-in light sensors.

The study included 87,577 UK Biobank participants who wore accelerometers on their wrists to measure physical activity and natural light exposure for seven days. Over a median follow-up of 8.1 years, 741 of these people (0.85%) developed dementia.

Higher daytime light, both in terms of average exposure and the duration in bright light, was significantly associated with a lower dementia risk. Daytime light exposure above 1000 lux—a moderately bright light level equal to an overcast day outdoors—was associated with a hazard ratio of 0.84 for dementia. Longer exposure to brighter light of at least 0.70 hours with at least 5000 lux was linked with a further risk reduction, and a hazard ratio of 0.83.

In exploratory analyses, circadian rest-activity rhythms (CRAC) and brain structures mediated up to a third of this association, supporting the idea that improvements in circadian rhythms may have contributed to these results. Dementia protection from light exposure was stronger in people with high levels of nighttime light exposure, those with a “night owl” evening chronotype, or who carried the APOE ε4 allele, with a risk reduction of up to 41%.

Having more than 0.7 hours per day of bright daytime light of at least 5000 lux outperformed the established dementia risk predictors, including alcohol consumption, obesity, air pollution, hearing loss, use of vitamin D supplements, and traumatic brain injury.

However, nighttime light showed no significant association with dementia risk.

The findings point to the importance of higher daytime light exposure in reducing the chances of dementia and offer a simple, cost-free way to reduce this risk.

“Practical implementation pathways could include optimizing indoor lighting at home, community‐based outdoor activity promotion programs, and workplace lighting modifications designed to increase daytime light exposure, such as ensuring adequate illumination and access to natural light,” the researchers suggested.

They added: “Our findings underscore a more pronounced protective association of daytime light exposure in individuals with higher average nighttime light exposure, an evening chronotype, or APOE ε4 carrier status.

“In other words, these findings suggest a targeted approach to mitigate dementia risk by increasing daytime light levels for these populations.”

The post More Daylight Exposure Could Lower Dementia Risk appeared first on Inside Precision Medicine.

Sleep Habits Can Influence Effects of Alzheimer’s Disease Risk Genes

Research led by Edith Cowan University in Australia suggests the impact of genetic mutations that impact Alzheimer’s disease risk are influenced by a person’s sleep habits.

As reported in the journal Alzheimer’s & Dementia, the researchers confirmed links with aquaporin-4 gene (AQP4) variants and changes in brain volume, atrophy and cognition linked to Alzheimer’s disease.

The investigators also showed how long people sleep, how long it takes them to fall asleep, how often their sleep is disturbed, and how good or poor their sleep is overall contributed to the effect of these mutations.

“Our study shows that individuals carrying certain AQP4 variants showed faster grey matter loss when they reported shorter sleep,” said study co-author Ayeisha Milligan Armstrong, PhD, a researcher at Edith Cowan University, in a press statement.

“It’s not just which genes you carry—it’s how those genes interact with the world around you. The same variant can look protective or detrimental depending on how someone is sleeping. That’s important, because sleep is one of the few modifiable factors people can actually act on.”

Researchers now think the brain gets rid of amyloid‑beta using a kind of plumbing system that washes waste away along the outside of blood vessels. In this system, fluid moves through the spaces around blood vessels, helped by tiny water channels called aquaporin‑4, encoded by AQP4, which sit on the parts of astrocyte cells that wrap tightly around those vessels.

“Given that AQP4 has been identified as an important mediator of brain amyloid beta clearance, variation within the AQP4 gene has been investigated in relation to neurodegenerative diseases and their associated phenotypes,” write the authors.

“A bi-directional relationship has been observed between suboptimal sleep and increasing brain amyloid beta accumulation…Importantly, a previous study utilizing data from the Australian Imaging, Biomarker and Lifestyle cohort reported that the relationship between sleep and cross-sectional brain amyloid beta burden was moderated by genetic variants in AQP4.”

To investigate this link further, the researchers studied 351 cognitively normal people already showing ongoing build‑up of brain amyloid‑beta on positron emission tomography (PET) imaging. They genotyped the group for 13 mutations in the AQP4 gene and also assessed sleep duration and quality, brain volume, amyloid burden and cognition scores.

Several AQP4 variants interacted with sleep measures to predict gray‑matter atrophy, brain ventricular volume, white‑matter volume, and cognitive decline. For example, people carrying certain variants who also had shorter sleep duration were more likely to have faster grey‑matter loss, and other variants magnified the impact of poorer global sleep quality on ventricular enlargement in the brain.

One variant showed a direct association with better global cognitive performance and two other variants seemed to be linked to less cognitive decline as sleep disturbances increased.

“We’ve known for a while that poor sleep and Alzheimer’s risk are linked,” said first author Tenielle Porter, PhD, also a researcher at Edith Cowan University.

“What this shows is that rather than assuming everyone at risk follows the same pathway, a more targeted and personalized approach to Alzheimer’s prevention may be needed. But we’re not at the point of recommending genetic testing; our findings need replication in larger and more diverse cohorts.”

The post Sleep Habits Can Influence Effects of Alzheimer’s Disease Risk Genes appeared first on Inside Precision Medicine.

<![CDATA[Pediatric experts link insomnia and mental health, favor CBT over sedatives, and warn against cannabis for sleep.]]>

Physical factor therapies for insomnia: a narrative review of mechanisms, clinical evidence, and phenotype-guided applications

Although pharmacological treatments for insomnia remain widely prescribed, their long-term use is constrained by risks of tolerance, dependence, and residual daytime effects. This has prompted growing interest in non-pharmacological interventions that target insomnia’s underlying mechanisms. This narrative review examines five physical factor therapies for insomnia: auditory stimulation, phototherapy, thermotherapy, electrical stimulation, and magnetic stimulation. They are classified according to their primary sites of action into peripheral sensory modulation, central neuromodulation, or systemic autonomic regulation. In each context, research findings about circadian entrainment, thermoregulatory promotion of falling asleep, attenuation of cortical hyperarousal, and restoration of autonomic balance are discussed. Clinical evidence from randomized controlled trials and meta-analyses is critically appraised, with emphasis on therapeutic efficacy, safety, and limitations. Overall, physical factor therapies may constitute promising adjunctive options for selected insomnia phenotypes, but current evidence remains heterogeneous and preliminary for several modalities. Recent advances in portable and home-based technologies support their feasibility, although long-term effectiveness, adherence, and cost-effectiveness remain to be established. Future research should prioritize larger sham-controlled trials, objective sleep and circadian outcomes, standardized protocols, biomarker-guided stratification, and closed-loop intervention systems.

Cognitive-attitudinal factors predict CBT-I enrollment willingness in Chinese sleep clinic patients: a knowledge-attitudes-practices survey

BackgroundDespite strong evidence for cognitive behavioral therapy for insomnia (CBT-I), uptake remains constrained by poorly understood cognitive, attitudinal, and practical barriers. This study examined determinants of willingness to enroll in sleep improvement programs among adults at risk of sleep disorders—including insomnia, obstructive sleep apnea, and comorbid psychological distress—attending a tertiary sleep clinic in China.MethodsA cross-sectional knowledge-attitudes-practices survey was conducted among 2,661 adults attending the sleep and behavioral medicine outpatient clinic at Ganzhou Hospital-Nanfang Hospital, Southern Medical University, Ganzhou, Jiangxi, China, between February 2022 and June 2025. Willingness to enroll in a structured sleep improvement program was assessed alongside sleep health knowledge, perceived need, CBT-I versus medication effectiveness beliefs, telehealth acceptability, clinical severity (Insomnia Severity Index, Epworth Sleepiness Scale, STOP-Bang), psychological symptoms (PHQ-2, GAD-2), perceived barriers, and sociodemographic characteristics. Multivariable logistic regression identified independent predictors of willingness to enrollment, with secondary analyses evaluating model discrimination and testing prespecified interactions.ResultsAmong 2,661 participants (median age 45 years, 56.5% female, median ISI = 13), 1,386 (52.1%) expressed willingness to enroll. Univariable comparisons showed no significant differences between willing and not-willing groups across demographics, clinical characteristics, or barriers (all p>0.05). However, multivariable modeling revealed that when considered simultaneously, cognitive-attitudinal factors emerged as significant independent predictors, suggesting complex interactions rather than simple bivariate associations. In multivariable models, perceived need (OR = 1.20, 95% CI: 1.16–1.25, p<0.001), beliefs that CBT-I is more effective and durable than sleep medication (OR = 1.12, 95% CI: 1.08–1.16, p<0.001), sleep health and treatment knowledge (assessed by a six-item knowledge score) (OR = 1.09, 95% CI: 1.05–1.13, p<0.001), and anxiety symptoms (OR = 1.07, p=0.005) positively predicted willingness. Paradoxically, depression symptoms (OR = 0.94, p<0.001) and insomnia severity (OR = 0.93, p<0.001) inversely predicted willingness. Model discrimination was modest (AUC = 0.543, 95% CI: 0.504–0.590). Time (mean 3.54) and cost (3.44) were most severe barriers but showed no independent association with willingness (p>0.05).ConclusionCognitive-attitudinal factors (perceived need, CBT-I beliefs, knowledge) independently predicted enrollment willingness, whereas demographics and practical barriers did not. Depression and insomnia severity paradoxically reduced willingness, creating an inverse care law. However, poor model discrimination and measurement of stated willingness rather than actual enrollment limit conclusions. Prospective validation and motivational enhancement strategies for patients with depression are needed.