Factor Analysis and Problem Solving applied to Sleep By Keith Torkelson MS, BS
Back Link - Introduced in: SleepAbility
II
HAB_Product_19010702_SleepAbility-II
https://ktork46.blogspot.com/2019/05/sleepability-study-2019-ii-considering.html
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Requirement |
Specification |
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Unit |
Living Arrangements & Sleep Studies |
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Lesson |
Preparing for a Doctor’s Appointment |
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Audience |
Those taking psychotropic medications |
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Author(s) |
Keith “Buster” Torkelson & Avey C. |
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Blog(s) |
HealthMan & CloZAPine |
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BHAB |
Behavioral Health Advisory Board – Present on Sleep |
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Computer(s) |
Asus Vivobook “ LIV” |
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Connectivity |
Wi-Fi and Hotspot |
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Family |
Ahnika MD PhD our niece is Keith’s Medication Advocate |
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Filename |
Assess_Factor_Analysis_Applied_Sleep_19052601_Working V2025 |
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Measures(s) |
Use this material to generate 2 measures tool |
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Measures Tools |
What I am doing? 11 Items Psychiatric Stability Screener 10 Items |
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Method |
Desktop Publishing |
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Publish |
Wednesday 9/2/25 - Ready for Direct Share |
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Purpose(s) |
Prepare for a Doctor’s Appointment – Maintaining the Treatment Plan |
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AI |
Food for training AI systems |
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Compelling Evidence |
For all of 2025 thus far our Treatment Plan has been working as measured by Sleep |
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Theme |
Partnership with Psychiatrist |
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Title |
Factor Analysis and Problem Solving applied to Sleep By Keith Torkelson MS, BS |
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Topic(s) |
To Sleep, Medication, Treatment, Prosuming, etc. |
Introduction to Sleep Factor
Analysis
Sleep factor analysis involves identifying and understanding the diverse internal and external factors
that influence an individual's sleep quality. These factors include
demographics, lifestyle habits (like diet and exercise), psychological
conditions (such as stress), environmental elements (light, room temperature), medical conditions, and medications.
The goal of analysis is to understand these complex interactions to improve
sleep health through strategies like optimizing environmental conditions,
managing stress, or addressing underlying
health issues.
Hypothesis
Ha or H1 Sleep
and the lack thereof is a common denominator about impaired brain health
Null Hypothesis
H₀ Chronically going without health
promoting sleep will not impair brain health
Presenting Problem
Psychiatrist wants to take me off
a medication that is working.
It is vital to have an open conversation with your psychiatrist about your concerns before stopping any medication. Your doctor may have valid reasons for the change, and by expressing your positive experience, you can find a solution together. If you are not satisfied with their explanation, you are within your rights to seek a second opinion from another professional.
What to do when your doctor wants
to take you off a medication that is working?
If your doctor wants to take you off a medication that is working well, the best first step is to have an open, non-confrontational conversation to understand their reasoning. It is your right to ask questions and participate in decisions about your care.
Before your appointment
To have a productive and successful appointment, you should gather necessary information, document your symptoms, and prepare a list of questions in advance. This preparation will help you use your limited time with the provider efficiently and ensure your most important concerns are addressed.
Track your progress.
To effectively track your progress on a current medication, you should keep a health diary or
journal by recording your medication intake, symptoms, how you feel, and any
lifestyle factors like diet or exercise. You
can use a physical notebook, digital tools like symptom tracking apps
such as Symple, or word processing documents. Regularly documenting details
helps identify patterns, track progress towards health goals, and provides
valuable data to share with your healthcare provider to adjust your treatment plan as needed.
Scored by and for Keith Torkelson
What I am doing? 11 Items
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Progress |
2025
0902 TU-RT SW-Solo |
Note |
|
Dietary Habits |
0.75 |
Above average |
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Exercise |
0.50 |
Walking only |
|
How You Feel? |
0.75 |
I feel glad yet guarded about
my medication |
|
Life Style Factors |
0.75 |
Satisfactory |
|
Medication Intake |
1.00 |
CloZAPine, Ambien, Lorazepam
are working well - Adherent |
|
Physical Activity |
0.50 |
Would like to get to the gym |
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Sleep Patterns |
1.00 |
Medication is effective |
|
Social Connectedness |
0.80 |
Above average |
|
Stress Management |
0.90 |
Coping including writing and
publishing |
|
Little Substance Use |
0.90 |
Alcohol in remission since 2012 |
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Symptoms |
1.00 |
Addresses all factors of
insomnia |
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CALC |
=7.50/11 |
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What I am doing score
11 Items (HSF) = |
80.5% |
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HSF = High Scores are Favorable | RT = Real Time | SW = Share (d) With
How You Feel?
How do you communicate emotions? You can communicate emotions by using “I” statements to describe how you feel, being mindful of your tone and body language, and using active listening to engage with others. Being honest and clear about your emotions fosters better understanding and connection. Jan 16, 2025
Lifestyle Factors
Lifestyle factors are the behaviors and habits an individual practices daily that significantly impact their health and well-being, encompassing diet, physical activity, sleep, stress management, substance use, and social connections. These modifiable choices, such as eating a healthy diet, exercising regularly, getting adequate sleep, avoiding smoking and excessive alcohol, managing stress, and maintaining social relationships, can either promote good health and prevent disease or contribute to chronic illnesses.
Dietary Habits:
Food intake (e.g., fruits, vegetables, processed foods, sugary drinks)
Nutrient intake (e.g., vitamins, minerals, fiber)
Physical Activity:
Exercise frequency and intensity
Sedentary behavior (e.g., sitting for long periods)
Substance Use:
Smoking, alcohol consumption, and drug use.
Sleep Patterns:
Sleep duration and quality.
Stress Management:
Coping mechanisms (e.g., exercise, meditation, yoga)
Stress levels
Other Factors:
Social connections:
Environmental factors (e.g., air quality, water quality)
Mental health (e.g., depression, anxiety)
Reduce Risk
Lifestyle factors can have a significant impact on chronic diseases such as heart disease, stroke, cancer, diabetes, and obesity. Making positive changes to these factors can improve health outcomes and reduce the risk of these diseases.
Include details about:
What symptoms have improved?
Improved symptoms refer to a reduction or amelioration of previously experienced symptoms.
Types of Improvement:
Partial improvement
Partial improvement occurs when a patient's symptoms lessen in severity or frequency but do not completely disappear. The concept is particularly relevant in medicine, especially when treating chronic conditions or mental health disorders, where achieving full remission can be difficult.
Complete improvement:
"Complete improvement: When symptoms disappear entirely" is medically known as complete remission. While this is often a goal of treatment, it does not always mean a person is permanently "cured," as some conditions can return.
Remission:
Complete remission indicates that a disease's signs and symptoms have disappeared in response to treatment. A doctor can find no measurable evidence of the disease through clinical exams, lab tests, and imaging.
A Cure:
A cure means the disease is permanently gone, with no chance of recurrence. The term "remission" is typically used instead of "cure," especially for conditions like cancer, because microscopic disease cells can sometimes linger and cause a relapse.
Factors Contributing to Improved Symptoms:
Treatment:
Medications, therapies, or interventions prescribed by a healthcare professional.
Lifestyle changes:
Diet, exercise, stress management, and sleep habits.
Time:
Some symptoms may improve naturally over time.
Patient factors:
Individual variations in response to treatment and coping mechanisms.
Evaluation of Improvement:
Patient report:
Subjective assessment of symptom severity and frequency.
Objective measures:
Physical exams, laboratory tests, or other assessments that quantify improvement.
Follow-up appointments:
Regular check-ins with a healthcare professional to monitor progress and adjust treatment if necessary.
Importance of Improved Symptoms:
Reduced discomfort and suffering
Alleviation of symptoms can improve quality of life.
Enhanced functioning:
Improved symptoms can enable individuals to engage in daily activities more easily.
Improved prognosis:
In some cases, symptom improvement may indicate a positive treatment outcome or disease remission.
Note:
It's crucial to consult a healthcare professional for proper diagnosis and treatment of any symptoms. Self-treatment or ignoring symptoms can be harmful.
Any side effects and how you manage them.
How your daily life has benefited
from the medication.
This AI on Google Search does not have a body, a daily life, or personal experiences, and therefore, cannot take medication or benefit from it. Responses are generated based on a vast amount of text and data, including information about how medication benefits humans.
Write down your concerns.
Before the appointment, make a list of your questions. This will help you stay on track and ensure you address your most important issues.
Bring a trusted person.
A friend or family member can help you take notes, remember key
details, and provide support.
What does it mean to be
psychiatrically stable?
Mental stability refers to a state of mental well-being where a person
is able to…
Scored by and for Keith Torkelson
Psychiatric Stability Screener 10 Items
|
## |
Aspect |
2025
0902 TU-RT SW-Solo |
|
01 |
Regulate their emotions |
0.75 |
|
02 |
They can manage their thoughts,
feelings, and behaviors in a healthy way |
0.75 |
|
03 |
Cope with stress |
0.75 |
|
04 |
They have the ability to handle
challenges and setbacks without significant distress |
0.75 |
|
05 |
Maintain healthy relationships |
0.75 |
|
06 |
They can build and sustain positive
connections with others |
0.75 |
|
07 |
Fulfill their responsibilities |
0.75 |
|
08 |
They are able to meet their
obligations at work, school, or in their personal life |
0.75 |
|
09 |
Have a sense of purpose |
0.75 |
|
10 |
They feel grounded and have a
sense of direction in their life |
0.75 |
|
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CALC |
=7.50/10 |
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Psychiatric Stability
Screener Score 10 Items (HSF) = |
75% |
HSF = High Scores are Favorable |
RT = Real Time | SW = Share (d) With
Ability to Manage
Mental stability is not a fixed state, but rather a continuum. People may experience fluctuations in
their mental health, but overall, they are able to maintain a sense of balance and well-being. It is important
to note that mental stability does not necessarily mean the absence of mental
health challenges, but rather the
ability to manage them effectively.
Begin Sleep Factor Analysis
Special Topic – Insight From
Factor Analysis - Assessments
Table – Detecting Factors Related
to Sleep
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Code |
Meaning |
Note |
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LSEQ |
Leeds Sleep Evaluation Questionnaire (10 Items) |
Selected UCI tool instead Included Here and Not Scored |
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SEQ |
Self-completion Sleep Evaluation Questionnaire |
FYI |
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GTS |
Ease of Getting To Sleep |
Mostly Good |
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QOS |
The perceived Quality Of Sleep |
Mostly VG |
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AFS |
The ease of Awakening From Sleep |
Mostly VG |
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BFW |
Integrity of early morning Behavior Following Wakefulness |
Mostly Good |
Last Reviewed: 20190704-TH: High Scores are Favorable
FYI - Primary Reference
Factor analysis of a sleep
evaluation questionnaire - Psychological Medicine
Chronology
Ease of Getting To Sleep (GTS)
>
The perceived
Quality Of Sleep (QOS) >
The
ease of Awakening From Sleep (AFS) >
Integrity of early morning Behavior Following Wakefulness (BFW)
FYI - [PDF] - Leeds Sleep
Evaluation Questionnaire – Theseus (10 Items)
By RM Ngang - 2011 - Related
articles
[PDF] - The Leeds Sleep
Evaluation Questionnaire – ResearchGate
[SECURITY CHECK REQUIRED for all
researchgate links]
[COPY AND PASTE LINK INTO BROWSER]
PDF | The Leeds Sleep Evaluation Questionnaire comprises ten self-rating 100-mm-line analogue questions concerned with aspects of sleep and early morning...
Article· Literature Review (PDF Available) in Psychopharmacology 71(2):173-9 · February 1980 with 2,602 Reads - Source: PubMed
Abstract
The Leeds Sleep Evaluation Questionnaire comprises ten self-rating 100-mm-line analogue questions concerned with aspects of sleep and early morning behaviour. The questionnaire has been used to monitor subjectively perceived changes in sleep during psychopharmacological investigations involving a variety of psychoactive agents, including sedative-hypnotics, antidepressants, anxiolytics, CNS stimulants, and antihistamines.
Medications
Dose-related improvements in the self-reported ratings of getting to sleep and perceived quality of sleep were generally associated with reductions in the self-reported levels of alertness and behavioral integrity the morning following the nocturnal administration of sedative hypnotic and anti-anxiety agents. Psychostimulants, on the other hand, impaired subjective ratings of sleep and produced increases in early morning assessments of alertness. Certain antidepressant and antihistaminic agents produced effects similar to the sedative-hypnotics, while others did not affect self-reported aspects of sleep and early morning behaviour.
Extracts
Hypnotic drugs
Hypnotic drugs, also known as sleeping pills or somnifacients, are a class of medications that induce sleep and treat insomnia by slowing down the body's functions and acting on the GABA system. They include several classes, such as benzodiazepines (e.g., temazepam), nonbenzodiazepines or Z-drugs (e.g., zolpidem), melatonin receptor agonists (e.g., ramelteon), orexin receptor antagonists (e.g., suvorexant), and some antihistamines (like diphenhydramine), and can have risks including dependency and side effects.
Sleep the Normal State
Sleep is a normal, essential biological process where the brain and body undergo repair, energy restoration, and memory consolidation, cycling through distinct non-REM (NREM) and rapid eye movement (REM) stages. It involves the thalamus quieting the external world to facilitate brain maintenance and the hypothalamus initiating the process. The stages progress from light sleep to deep sleep, with REM sleep being a more active stage crucial for dreaming and cognitive function.
Capturing the Sleep Experience
Capturing the sleep experience involves using a combination of subjective and objective methods to gain a more complete picture of your rest. Subjective techniques, like journaling, record personal perceptions, while objective tools, including wearables and medical studies, measure physiological data.
Analogue rating scale
An analogue rating scale, also known as a Visual Analogue Scale (VAS), is a psychometric measurement tool used for subjective characteristics like pain intensity. It typically consists of a 100-millimeter line with two anchor points, such as "no pain" and "worst possible pain". Respondents indicate their level of sensation by marking a point on the line, and the score is the distance in millimeters from one end of the line.
Digital rating scale
Digital scales generally offer higher
accuracy and precision, capable of measuring minute changes in weight.
Analog scales, while still accurate for many purposes, often cannot detect very
small weight differences as effectively as their digital counterparts. Both
types of scales come in portable models.
Types of Rating Scales
- Graphic Rating Scale
- Numerical Rating Scale
- Descriptive Rating Scale
- Comparative Rating Scale
Visual Analog Scale
The visual analogue scale or visual analog scale (VAS) is a psychometric response scale which can be used in questionnaires. It is a measurement instrument for subjective characteristics or attitudes that cannot be directly measured.
Psychopharmacology
Psychopharmacology is the scientific study of how medications affect the brain and behavior to treat mental health conditions like depression, anxiety, schizophrenia, and bipolar disorder. It involves understanding how medications alter neurotransmitter activity, the pharmacokinetics (what the body does to the drug), and pharmacodynamics (what the drug does to the body) to determine the optimal treatment regimens. A psychopharmacologist applies this knowledge to prescribe and monitor medications, often in conjunction with psychotherapy, to improve patient outcomes.
Sample of “Sleeper” Medications
FYI - Additional Medications
Ambien
Ambien is the brand name for the sedative-hypnotic drug zolpidem, which is used for the short-term treatment of insomnia. It is available as a generic drug (zolpidem), and in different formulations such as immediate-release (Ambien) and extended-release (Ambien CR). Ambien is a controlled substance due to its potential for dependence and misuse.
Why does my psychiatrist want to
take me off Ambien if it is working so well?
An effective way to reduce the possibility of Ambien withdrawal is to taper off the drug. Your physician will likely suggest a tapered dose regimen that can wean you off the medication. For example, you may initially be instructed to take a smaller dose. Apr 13, 2023
Doses of Ambien
Information provided here is for general knowledge and should not be considered medical advice. Always consult with a healthcare provider for any health concerns or before starting any treatment.
Formulations
Ambien is a medication prescribed for the short-term treatment of insomnia. It contains zolpidem, which is a sedative-hypnotic. There are different formulations of zolpidem, including immediate-release tablets (Ambien) and extended-release tablets (Ambien CR).
Older Adults
Research indicates that there are differences in how men and women process zolpidem, which may influence prescribing practices. For individuals over 65 or those who are debilitated, a lower dose is generally recommended.
Extended Release
Ambien CR is designed to help individuals both fall asleep and remain asleep. Extended-release tablets should be swallowed whole and not crushed, divided, or chewed.
Impaired Performance
It is important to take Ambien just before going to bed and only when you have a period of 7 to 8 hours available for sleep before needing to be active. Consuming Ambien with or immediately after a meal might slow its absorption. Higher amounts of zolpidem are associated with an increased risk of impaired performance the following day, which can affect activities like driving.
Ambien - Dependence
Ambien is intended for short-term use in managing insomnia. Using it
for extended periods can increase the likelihood
of dependence. If a dose is missed, it should be skipped, and the
regular schedule should be followed; doses should not be doubled.
FYI - https://www.drugs.com/dosage/ambien.html
Ambien - Dosage in Adults
Use the lowest effective dose for the patient. The recommended initial dose is 5 mg for women and either 5 or 10 mg for men, taken only once per night immediately before bedtime with at least 7–8 hours remaining before the planned time of awakening. If the 5 mg dose is not effective, the dose can be increased to 10 mg. In some patients, the higher morning blood levels following use of the 10 mg dose increase the risk of next-day impairment of driving and other activities that require full alertness. The total dose of AMBIEN should not exceed 10 mg once daily immediately before bedtime. AMBIEN should be taken as a single dose and should not be re-administered during the same night.
Lorazepam
Lorazepam dosages typically range from 0.5 mg to 2 mg, depending on the condition being treated. 5 mg of lorazepam is a high dose that's typically only used in hospital settings. Jun 26, 2025. Controlled substance: Can cause paranoid or suicidal ideation and impair memory, judgment, and coordination. Combining with other substances, particularly alcohol, can slow breathing and possibly lead to death.
I won’t be taking it if I wasn’t
dependent on it
The user's statement, "I won't be taking it if I wasn't dependent on it," highlights the difference between physical dependence and addiction, especially with medication. These terms are often used interchangeably, but they are different medical concepts.
Dependence vs. addiction
The speaker likely refers to physical dependence, which can happen with certain medications over time, even when taken as prescribed. Dependence means the body has adjusted to the drug, leading to withdrawal symptoms if the dose is lowered or stopped suddenly.
Addiction
Substance dependence, also known as drug dependence, is a biopsychological situation whereby an individual's functionality is dependent on the necessitated re-consumption of a psychoactive substance…
Risk for Drug Abuse
Factors such as peer pressure, physical and sexual abuse, early exposure to drugs, stress, and parental guidance can greatly affect a person's likelihood of drug use and addiction. Development. Genetic and environmental factors interact with critical developmental stages in a person's life to affect addiction risk. Jun 6, 2018
CloZAPine Dependence
Is Clozapine addictive? Stopping or reducing clozapine causes withdrawal symptoms and sometimes a relapse of symptoms of psychosis; therefore, it may be difficult to cease. However, it is not considered a risk for recreational drug abuse.
Aside - Ditto Paper
Factor analysis of a sleep
evaluation questionnaire. - NCBI
https://www.ncbi.nlm.nih.gov/pubmed/26096
By AC Parrott & Hindmarch I. -
1978 - Cited by 227 - Related articles
Psychol Med. 1978 May;8(2):325-9.
Abstract – Sleep Cycle
A self-completion sleep evaluation questionnaire (SEQ), consisting of 10 cm line analogue rating scale questions, was constructed to investigate subjects' responses to aspects of sleep and early morning behaviour. The questions were grouped into 4 chronological areas: the ease of getting to sleep (GTS), the perceived quality of sleep (QOS), the ease of awakening from sleep (AFS), and the integrity of early morning behaviour following wakefulness (BFW).
Factors
Five hundred and one SEQs were completed during several investigations into the comparative effectiveness of hypnotic drugs. The classical factor analysis produced 4 factors which corresponded to the 4 aspects of sleep and early morning behaviour listed above. The GTS and QOS factors were positively correlated (+0.57), as were the AFS and BFW factors (+0.48). The 2 sleeping state factors (GTS and QOS) were orthogonal to the 2 waking state factors (AFS and BFW).
FYI - Factor analysis of a sleep
evaluation questionnaire - Psychological Medicine
by AC Parrott - 1978 - Cited by
227 - Related articles
Jul 9, 2009
Factor analysis of a sleep
evaluation questionnaire. A self-completion sleep evaluation questionnaire
(SEQ).
Research Using Temazepam (Restoril) in Depth
From Parrot - Has References
FYI - Hindmarch, I. (1975).
A 1, 4-benzodiazepine, temazepam (K 3917), its effect on some
psychological parameters of sleep and behaviour. Arzneimittel-Forschung (Drug
Research) 25(11), 1836–1839. Google Scholar
Hindmarch, I. (1976).
A sub-chronic study of the subjective quality of sleep and
psychological measures of performance on the morning following night time
medication with temazepam. Arzneimittel-Forschung (Drug Research) 26(11),
2113–2116. Google Scholar | PubMed
What is it called when a doctor
tries you out on a new medication: A trial or an experiment?
Clinical trials are research studies that test a medical, surgical, or behavioral intervention in people. These trials are the primary way that researchers determine if a new form of treatment or prevention, such as a new drug, diet, or medical device (for example, a pacemaker), is safe and effective in people. Mar 22, 2023
Trials with Restoril
Clinical trials for Restoril (temazepam) have established its effectiveness as a short-term treatment for insomnia and informed safety regulations regarding its use. The findings have led to FDA warnings about the risk of dependence, withdrawal, and serious side effects, especially when combined with other central nervous system (CNS) depressants.
Live Experience - Medications
In 2006-2007 Doctor Ravinder P
Singh tried CloZAPine with me. In 2012
Dr. Daniels took me off CloZAPine because she had something better. I
ended up on the Psych Ward after not
sleeping for 72 hours. Bum Soo
Lee MD treated me on the Psych Ward and rather than prescribe me CloZAPine he
gave me Restoril. Restoril was eventually
replaced with Lorazepam. On and off I
have been on Lorazepam since circa 2013.
In Leisure Court Skilled Nursing the doctor prescribe me 4.0 mg per day. I was also prescribed Ambien. Yet they withheld CloZAPine. After moving to Harvest Retirement Dr Rimal Bera and I agreed to
cut my Lorazepam from 4.0 mg per day down to 1.0 mg per day.
How come I can’t sleep without
medication?
You may be dependent on sleep medication because of underlying issues like stress, anxiety, depression, a medical condition, or poor sleep habits, rather than a problem with sleep itself. While medication might offer temporary relief, it doesn't fix these root causes. To stop relying on medication, you need to address the real cause, often through behavioral changes or other therapies recommended by a doctor, such as managing stress, improving sleep hygiene, and considering cognitive behavioral therapy for insomnia (CBT-I).
Will I ever be able to sleep
again without sleep medication?
Yes, it's possible to sleep without medication by addressing the underlying causes of your insomnia through lifestyle changes, practicing good sleep hygiene, and potentially using therapies like Cognitive Behavioral Therapy for Insomnia (CBT-I). You should speak with a doctor to rule out any underlying health conditions or to safely stop taking your current sleep medication, as abrupt cessation can lead to withdrawal symptoms.
How come without medication I
don’t sleep anymore?
You may not be sleeping anymore due to factors like stress and anxiety, poor sleep habits (inconsistent schedules, screen use before bed), lifestyle choices (caffeine, alcohol), medical conditions (pain, breathing issues, mental health conditions), certain medications, or environmental factors like an uncomfortable sleep space. To improve your sleep, try adopting a consistent schedule, creating a relaxing bedtime routine, ensuring your bedroom is cool, dark, and quiet, and limiting stimulants like caffeine and screens before bed. If these changes don't help, consulting a healthcare provider is recommended to rule out underlying issues.
Factor analysis of a Sleep
Factor analysis applied to sleep data identifies underlying factors or patterns within complex sleep measurements and subjective experiences. For example, studies have used factor analysis to group questionnaire items into factors like "sleep wanting," "sleep onset preference," and "sleep efficiency", or to extract factors from polysomnography data such as "sleep fragmentation" and "delta-wave sleep". This statistical technique helps in understanding the dimensions of sleep health and can reveal common variations in sleep habits across different populations.
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