{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T08:26:26Z","timestamp":1788942386171,"version":"build-2803163510"},"reference-count":92,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2021,1,28]],"date-time":"2021-01-28T00:00:00Z","timestamp":1611792000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000024","name":"Canadian Institutes of Health Research","doi-asserted-by":"publisher","award":["CIHR MOP-391913-IRH-CCAA-11829-FRN PJT-156149"],"award-info":[{"award-number":["CIHR MOP-391913-IRH-CCAA-11829-FRN PJT-156149"]}],"id":[{"id":"10.13039\/501100000024","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Clocks &amp; Sleep"],"abstract":"<jats:p>Insomnia is a common problem in Canada and has been associated with increased use of health care services and economic burden. This paper examines the prevalence and risk factors for insomnia in two Cree First Nation communities in Saskatchewan, Canada. Five hundred and eighty-eight adults participated in a baseline survey conducted as part of the First Nations Sleep Health Collaborative Project. The prevalence of insomnia was 19.2% among participants with an Insomnia Severity Index score of \u226515. Following the definition of nighttime insomnia symptoms, however, the prevalence of insomnia was much higher, at 32.6%. Multivariate logistic regression modeling revealed that age, physical health, depression diagnosis, chronic pain, prescription medication use for any health condition, and waking up during the night due to terrifying dreams, nightmares, or flashbacks related to traumatic events were risk factors for insomnia among participants from two Saskatchewan Cree First Nation communities.<\/jats:p>","DOI":"10.3390\/clockssleep3010007","type":"journal-article","created":{"date-parts":[[2021,1,28]],"date-time":"2021-01-28T05:23:05Z","timestamp":1611811385000},"page":"98-114","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Prevalence of Insomnia in Two Saskatchewan First Nation Communities"],"prefix":"10.3390","volume":"3","author":[{"given":"James A","family":"Dosman","sequence":"first","affiliation":[{"name":"Canadian Centre for Health and Safety in Agriculture, University of Saskatchewan, 104 Clinic Place, Saskatoon, SK S7N 2Z4, Canada"},{"name":"Department of Medicine, University of Saskatchewan, Royal University Hospital, 103 Hospital Drive, Saskatoon, SK S7N 0W8, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6960-5583","authenticated-orcid":false,"given":"Chandima P","family":"Karunanayake","sequence":"additional","affiliation":[{"name":"Canadian Centre for Health and Safety in Agriculture, University of Saskatchewan, 104 Clinic Place, Saskatoon, SK S7N 2Z4, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5188-5855","authenticated-orcid":false,"given":"Mark","family":"Fenton","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Saskatchewan, Royal University Hospital, 103 Hospital Drive, Saskatoon, SK S7N 0W8, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vivian R","family":"Ramsden","sequence":"additional","affiliation":[{"name":"West Winds Primary Health Centre, Department of Academic Family Medicine, University of Saskatchewan, 3311 Fairlight Drive, Saskatoon, SK S7M 3Y5, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Skomro","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Saskatchewan, Royal University Hospital, 103 Hospital Drive, Saskatoon, SK S7N 0W8, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shelley","family":"Kirychuk","sequence":"additional","affiliation":[{"name":"Canadian Centre for Health and Safety in Agriculture, University of Saskatchewan, 104 Clinic Place, Saskatoon, SK S7N 2Z4, Canada"},{"name":"Department of Medicine, University of Saskatchewan, Royal University Hospital, 103 Hospital Drive, Saskatoon, SK S7N 0W8, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Donna C","family":"Rennie","sequence":"additional","affiliation":[{"name":"College of Nursing, University of Saskatchewan, 104 Clinic Place, Saskatoon, SK S7N 2Z4, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeremy","family":"Seeseequasis","sequence":"additional","affiliation":[{"name":"Community A, PO Box 96, Duck Lake, SK S0K 1J0, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clifford","family":"Bird","sequence":"additional","affiliation":[{"name":"Community B, PO Box 250, Montreal Lake, SK S0J 1Y0, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathleen","family":"McMullin","sequence":"additional","affiliation":[{"name":"Canadian Centre for Health and Safety in Agriculture, University of Saskatchewan, 104 Clinic Place, Saskatoon, SK S7N 2Z4, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brooke P","family":"Russell","sequence":"additional","affiliation":[{"name":"Canadian Centre for Health and Safety in Agriculture, University of Saskatchewan, 104 Clinic Place, Saskatoon, SK S7N 2Z4, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Niels","family":"Koehncke","sequence":"additional","affiliation":[{"name":"Canadian Centre for Health and Safety in Agriculture, University of Saskatchewan, 104 Clinic Place, Saskatoon, SK S7N 2Z4, Canada"},{"name":"Department of Medicine, University of Saskatchewan, Royal University Hospital, 103 Hospital Drive, Saskatoon, SK S7N 0W8, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Smith-Windsor","sequence":"additional","affiliation":[{"name":"Victoria Hospital, Prince Albert, SK S6V 4N9, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1712-0303","authenticated-orcid":false,"given":"Malcolm","family":"King","sequence":"additional","affiliation":[{"name":"Department of Community Health &amp; Epidemiology, College of Medicine, University of Saskatchewan, 107 Wiggins Road, Saskatoon, SK S7N 5E5, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sylvia","family":"Abonyi","sequence":"additional","affiliation":[{"name":"Department of Community Health &amp; Epidemiology, College of Medicine, University of Saskatchewan, 107 Wiggins Road, Saskatoon, SK S7N 5E5, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Punam","family":"Pahwa","sequence":"additional","affiliation":[{"name":"Canadian Centre for Health and Safety in Agriculture, University of Saskatchewan, 104 Clinic Place, Saskatoon, SK S7N 2Z4, Canada"},{"name":"Department of Community Health &amp; Epidemiology, College of Medicine, University of Saskatchewan, 107 Wiggins Road, Saskatoon, SK S7N 5E5, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,1,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"281","DOI":"10.1016\/j.jsmc.2013.05.002","article-title":"Epidemiology of insomnia: Prevalence, course, risk factors, and public health burden","volume":"8","author":"Morin","year":"2013","journal-title":"Sleep Med. Clin."},{"key":"ref_2","first-page":"55","article-title":"The economic burden of insomnia: Direct and indirect costs for individuals with insomnia syndrome, insomnia symptoms, and good sleepers","volume":"32","author":"Daley","year":"2009","journal-title":"Sleep"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"427","DOI":"10.1016\/j.sleep.2008.04.005","article-title":"Insomnia and Its Relationship to Health-Care Utilization, Work Absenteeism, Productivity and Accidents","volume":"10","author":"Daley","year":"2009","journal-title":"Sleep Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"S438","DOI":"10.1097\/00002826-198406001-00404","article-title":"Epidemiology of Insomnia","volume":"7","author":"Mondini","year":"1984","journal-title":"Clin. Neuropharmacol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"665","DOI":"10.1093\/sleep\/24.6.665","article-title":"Insomnia and health problems in Canadians","volume":"24","author":"Sutton","year":"2001","journal-title":"Sleep"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1053\/smrv.2002.0186","article-title":"Epidemiology of insomnia: What we know and what we still need to learn","volume":"6","author":"Ohayon","year":"2002","journal-title":"Sleep Med. Rev."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"764","DOI":"10.1590\/S0004-282X2004000500004","article-title":"Analysis of the prevalence of insomnia in the adult population of S\u00e3o Jos\u00e9 Do Rio Preto, Brazil","volume":"62","author":"Tognola","year":"2004","journal-title":"Arq. Neuropsiquiatr."},{"key":"ref_8","first-page":"9","article-title":"Insomnia","volume":"17","author":"Tjepkema","year":"2005","journal-title":"Health Rep."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1027","DOI":"10.1093\/sleep\/32.8.1027","article-title":"Incidence and risk factors of insomnia in a population-based sample","volume":"32","author":"LeBlanc","year":"2009","journal-title":"Sleep"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"859","DOI":"10.5665\/SLEEP.1114","article-title":"Prevalence and polysomnographic correlates of insomnia comorbid with medical disorders","volume":"34","author":"Budhiraja","year":"2011","journal-title":"Sleep"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"540","DOI":"10.1177\/070674371105600905","article-title":"Prevalence of insomnia and its treatment in Canada","volume":"56","author":"Morin","year":"2011","journal-title":"Can. J. Psychiatry"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1173","DOI":"10.5665\/sleep.2012","article-title":"Sleep problems: An emerging global epidemic? Findings from the INDEPTHWHO-SAGE study among more than 40,000 older adults from 8 countries across Africa and Asia","volume":"35","author":"Stranges","year":"2012","journal-title":"Sleep"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"6306942","DOI":"10.1155\/2019\/6306942","article-title":"Insomnia among Town Residents in Ethiopia: A Community-Based Cross-Sectional Survey","volume":"2019","author":"Ali","year":"2019","journal-title":"Sleep Disord."},{"key":"ref_14","first-page":"216","article-title":"The diagnosis and management of insomnia in clinical practice: A practical evidence-based approach","volume":"162","author":"Holbrook","year":"2000","journal-title":"CMAJ"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"S7","DOI":"10.5664\/jcsm.26929","article-title":"Insomnia: Definition, prevalence, etiology, and consequences","volume":"3","author":"Roth","year":"2007","journal-title":"J. Clin. Sleep Med."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"La, Y.K., Choi, Y.H., Chu, M.K., Nam, J.M., Choi, Y.C., and Kim, W.J. (2020). Gender differences influence over insomnia in Korean population: A cross-sectional study. PLoS ONE, 15.","DOI":"10.1371\/journal.pone.0227190"},{"key":"ref_17","unstructured":"Morin, C.M. (1993). Insomnia: Psychological Assessment and Management, Guilford Press."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"297","DOI":"10.1016\/S1389-9457(00)00065-4","article-title":"Validation of the Insomnia Severity Index as an outcome measure for insomnia research","volume":"2","author":"Bastien","year":"2001","journal-title":"Sleep Med."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"601","DOI":"10.1093\/sleep\/34.5.601","article-title":"The insomnia severity index: Psychometric indicators to detect insomnia cases and evaluate treatment response","volume":"34","author":"Morin","year":"2011","journal-title":"Sleep"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"43690","DOI":"10.1038\/srep43690","article-title":"Gender and Regional Differences in Sleep Quality and Insomnia: A General Population-based Study in Hunan Province of China","volume":"7","author":"Tang","year":"2017","journal-title":"Sci. Rep."},{"key":"ref_21","first-page":"16","article-title":"Prevalence of insomnia for Canadians aged 6 to 79","volume":"29","author":"Chaput","year":"2018","journal-title":"Health Rep."},{"key":"ref_22","first-page":"759","article-title":"L\u2019insomnie Pr\u00e9valence et traitement chez les patients consultant en m\u00e9decine g\u00e9n\u00e9rale Insomnia. Prevalence and treatment of patients in general practice","volume":"47","author":"Blais","year":"2001","journal-title":"Can. Fam. Physician"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1007\/s11920-018-0940-9","article-title":"Sex Differences in Insomnia: From Epidemiology and Etiology to Intervention","volume":"20","author":"Suh","year":"2018","journal-title":"Curr. Psychiatry Rep."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1093\/sleep\/29.1.85","article-title":"Sex differences in insomnia: A meta-analysis","volume":"29","author":"Zhang","year":"2006","journal-title":"Sleep"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1111\/j.1440-1819.2010.02154.x","article-title":"Correlations among insomnia symptoms, sleep medication use and depressive symptoms","volume":"65","author":"Komada","year":"2011","journal-title":"Psychiatry Clin. Neurosci."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1099","DOI":"10.1001\/archinte.158.10.1099","article-title":"Clinical correlates of insomnia in patients with chronic illness","volume":"158","author":"Katz","year":"1998","journal-title":"Arch. Intern. Med."},{"key":"ref_27","first-page":"11","article-title":"Examining the association between insomnia and bowel disorders in Canada: Is there a trend?","volume":"2","author":"Hon","year":"2010","journal-title":"Univ. Br. Columbia Med. J."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Koyanagi, A., Garin, N., Olaya, B., Ayuso-Mateos, J.L., Chatterji, S., Leonardi, M., Koskinen, S., Tobiasz-Adamczyk, B., and Haro, J.M. (2014). Chronic Conditions and Sleep Problems among Adults Aged 50 years or over in Nine Countries: A Multi- Country Study. PLoS ONE, 9.","DOI":"10.1371\/journal.pone.0114742"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"389","DOI":"10.1016\/j.jsmc.2013.04.004","article-title":"Insomnia and Obstructive Sleep Apnea","volume":"8","author":"Ong","year":"2013","journal-title":"Sleep Med. Clin."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"104","DOI":"10.1007\/s11325-005-0026-x","article-title":"Insomnia complaints in patients evaluated for obstructive sleep apnea","volume":"9","author":"Krell","year":"2005","journal-title":"Sleep Breath"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1563","DOI":"10.1016\/j.mayocp.2018.05.032","article-title":"Association of Chronic Insomnia with Mortality and Adverse Renal Outcomes","volume":"93","author":"Lu","year":"2018","journal-title":"Mayo Clin. Proc."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"359","DOI":"10.1016\/j.semnephrol.2015.06.007","article-title":"Insomnia in Patients with Chronic Kidney Disease","volume":"35","author":"Lindner","year":"2015","journal-title":"Semin. Nephrol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"369","DOI":"10.2147\/RMHP.S234552","article-title":"The Association between Subclinical Hypothyroidism and Sleep Quality: A Population-Based Study","volume":"12","author":"Song","year":"2019","journal-title":"Risk Manag. Health Policy"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1016\/j.jpsychores.2007.03.004","article-title":"Psychological and health-related quality of life factors associated with insomnia in a population based sample","volume":"63","author":"Savard","year":"2007","journal-title":"J. Psychosom. Res."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"4306463","DOI":"10.1155\/2019\/4306463","article-title":"A Narrative Review of the Literature on Insufficient Sleep, Insomnia, and Health Correlates in American Indian\/Alaska Native Populations","volume":"2019","author":"Lombardero","year":"2019","journal-title":"J. Environ. Public Health"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1795","DOI":"10.5665\/sleep.6156","article-title":"Prevalence, correlates, and predictors of insomnia in the US Army prior to deployment","volume":"39","author":"Taylor","year":"2016","journal-title":"Sleep"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"108066","DOI":"10.1016\/j.diabres.2020.108066","article-title":"Closing the indigenous health gap in Canada: Results from the TransFORmation of IndiGEnous PrimAry HEAlthcare delivery (FORGE AHEAD) program","volume":"162","author":"Hayward","year":"2020","journal-title":"Diabetes Res. Clin. Pract."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1016\/S0140-6736(09)60827-8","article-title":"Indigenous health part 2: The underlying causes of the health gap","volume":"374","author":"King","year":"2009","journal-title":"Lancet"},{"key":"ref_39","unstructured":"Allan, B., and Smylie, J. (2015). First Peoples, Second Class Treatment: The Role of Racism in the Health and Well-Being of Indigenous Peoples in Canada, Wellesley Institute. Available online: http:\/\/www.wellesleyinstitute.com\/wp-content\/uploads\/2015\/02\/Summary-First-Peoples-Second-Class-Treatment-Final.pdf."},{"key":"ref_40","unstructured":"Edjoc, R., Hu, J., Jacobsen, L., Khatibsemnani, N., Layes, A., Martinello, N., Mitra, D., Morrison, H., Orpana, H., and Osorio, N. (2021, January 12). Key Health Inequalities in Canada: A National Portrait, Available online: https:\/\/www.canada.ca\/content\/dam\/phac-aspc\/documents\/services\/publications\/science-research\/key-health-inequalities-canada-national-portrait-executive-summary\/hir-executive-summary-eng.pdf."},{"key":"ref_41","unstructured":"Waldram, J.B., Herring, A., and Young, T.K. (2006). Aboriginal Health in Canada: Historical, Cultural, and Epidemiological Perspectives, University of Toronto Press. [2nd ed.]."},{"key":"ref_42","unstructured":"Cunningham, M. (2009). Chapter V: Health. United Nations, Permanent Forum on Indigenous Issues, State of the World\u2019s Indigenous Peoples, United Nations."},{"key":"ref_43","first-page":"120","article-title":"Decolonizing anti-racism","volume":"32","author":"Lawrence","year":"2005","journal-title":"Soc. Justice J. Crime World Order"},{"key":"ref_44","unstructured":"Dunlop, C.I. (2016). Bullying Experiences among First Nations Youth: Identifying Effects on Mental Health and Potential Protective Factors. [Electronic Dissertation, The University of Western Ontario]. Available online: https:\/\/ir.lib.uwo.ca\/etd\/3717\/."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"38","DOI":"10.7202\/1071792ar","article-title":"Bullying behaviour and victimization among aboriginal students within Northwestern Ontario","volume":"9","author":"Brownlee","year":"2014","journal-title":"First Peoples Child Fam. Rev."},{"key":"ref_46","unstructured":"(2020, September 18). Aboriginal Affaires and Northern Development Canada (AANDC), Terminology. Available online: https:\/\/www.aadnc-aandc.gc.ca\/eng\/1358879361384\/1358879407462."},{"key":"ref_47","unstructured":"University of British Columbia (2020, September 18). First Nations Studies Program, Aboriginal Identity & Terminology. Available online: http:\/\/indigenousfoundations.arts.ubc.ca\/aboriginal_identity__terminology\/."},{"key":"ref_48","unstructured":"Greenwood, M., de Leeuw, S., Lindsay, N.M., and Reading, C. (2015). Determinants of Indigenous Peoples\u2019 Health in Canada: Beyond the Social, Canadian Scholars\u2019 Press."},{"key":"ref_49","unstructured":"(2019, August 31). Canadian Institutes of Health Research, Natural Sciences and Engineering Research Council of Canada, and Social Sciences and Humanities Research Council of Canada, Tri-Council Policy Statement: Ethical Conduct for Research Involving Humans- TCPS 2. Available online: https:\/\/ethics.gc.ca\/eng\/documents\/tcps2-2018-en-interactive-final.pdf."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1016\/j.sleh.2015.10.004","article-title":"National Sleep Foundation\u2019s updated sleep duration recommendations: Final report","volume":"1","author":"Hirshkowitz","year":"2015","journal-title":"Sleep Health"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1016\/0165-1781(89)90047-4","article-title":"The Pittsburgh Sleep Quality Index: A new instrument for psychiatric practice and research","volume":"28","author":"Buysse","year":"1989","journal-title":"Psychiatry Res."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"737","DOI":"10.1016\/S0022-3999(02)00330-6","article-title":"Test-retest reliability and validity of the Pittsburgh Sleep Quality Index in primary insomnia","volume":"53","author":"Backhaus","year":"2002","journal-title":"J. Psychosom. Res."},{"key":"ref_53","doi-asserted-by":"crossref","unstructured":"Hosmer, D.W., Lemeshow, S., and Sturdivant, R.X. (2013). Applied Logistic Regression, John Wiley & Sons, Inc.. [3rd ed.].","DOI":"10.1002\/9781118548387"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1177\/204946370800200102","article-title":"Insomnia Co-Occurring with Chronic Pain: Clinical Features, Interaction, Assessments and Possible Interventions","volume":"2","author":"Tang","year":"2008","journal-title":"Rev. Pain."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1111\/j.1532-5415.1997.tb00970.x","article-title":"Sleep disturbance, psychosocial correlates, and cardiovascular disease in 5201 older adults: The Cardiovascular Health Study","volume":"45","author":"Newman","year":"1997","journal-title":"J. Am. Geriatr. Soc."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"860","DOI":"10.1097\/01.JGP.0000206164.56404.ba","article-title":"Sleep: A marker of physical and mental health in the elderly","volume":"14","author":"Reid","year":"2006","journal-title":"Am. J. Geriatr. Psychiatry"},{"key":"ref_57","first-page":"889","article-title":"Prevalence of sleep problems and quality of life in an older population","volume":"25","author":"Schubert","year":"2002","journal-title":"Sleep"},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"299","DOI":"10.1111\/jgs.12649","article-title":"Sleep disturbances and risk of falls in older community-dwelling men: The outcomes of Sleep Disorders in Older Men (MrOS Sleep) Study","volume":"62","author":"Stone","year":"2014","journal-title":"J. Am. Geriatr. Soc."},{"key":"ref_59","unstructured":"Statistics Canada (2020, September 30). Aboriginal Peoples in Canada: Key Results from the 2016 Census. Available online: https:\/\/www150.statcan.gc.ca\/n1\/daily-quotidien\/171025\/dq171025a-eng.htm?indid=14430-2&indgeo=0."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1093\/sleep\/30.2.213","article-title":"Comorbidity of chronic insomnia with medical problems","volume":"30","author":"Taylor","year":"2007","journal-title":"Sleep"},{"key":"ref_61","first-page":"S6","article-title":"Comorbid insomnia: Current diagnosis and future challenges","volume":"15","author":"Roth","year":"2009","journal-title":"Am. J. Manag. Care"},{"key":"ref_62","first-page":"S24","article-title":"Current and new thinking in the management of comorbid insomnia","volume":"15","author":"Neubauer","year":"2009","journal-title":"Am. J. Manag. Care"},{"key":"ref_63","unstructured":"The National Sleep Foundation (2020, August 21). How Medications May Affect Sleep. Available online: https:\/\/www.sleepfoundation.org\/articles\/how-medications-may-affect-sleep."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"860","DOI":"10.1111\/j.1532-5415.1995.tb05527.x","article-title":"Occult caffeine as a source of sleep problems in an older population","volume":"43","author":"Brown","year":"1995","journal-title":"J. Am. Geriatr. Soc."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"341","DOI":"10.1056\/NEJM199701303360506","article-title":"Management of insomnia","volume":"336","author":"Kupfer","year":"1997","journal-title":"N. Engl. J. Med."},{"key":"ref_66","unstructured":"(1994). Drugs for Psychiatric Disorders. Med. Lett. Drugs Ther., 36, 89\u201396."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"292","DOI":"10.4088\/PCC.08m00749bro","article-title":"The effect of eszopiclone in patients with insomnia and coexisting rheumatoid arthritis: A pilot study","volume":"11","author":"Roth","year":"2009","journal-title":"Prim. Care Companion J. Clin. Psychiatry"},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1053\/smrv.2000.0146","article-title":"Secondary insomnia: Diagnostic challenges and intervention opportunities","volume":"5","author":"McCrae","year":"2001","journal-title":"Sleep Med. Rev."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"531","DOI":"10.1016\/j.jsmc.2016.08.004","article-title":"Assessing and Managing Sleep Disturbance in Patients with Chronic Pain","volume":"11","author":"Cheatle","year":"2016","journal-title":"Sleep Med. Clin."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"737","DOI":"10.1007\/s00586-010-1661-x","article-title":"Prevalence of sleep disturbance in patients with low back pain","volume":"20","author":"Alsaadi","year":"2011","journal-title":"Eur. Spine J."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"1313","DOI":"10.1016\/j.sleep.2015.07.022","article-title":"The effect of sleep deprivation on pain perception in healthy subjects: A meta-analysis","volume":"16","author":"Schrimpf","year":"2015","journal-title":"Sleep Med."},{"key":"ref_72","unstructured":"Health Canada (2020, June 30). Canadian Pain Task Force Report: June 2019. Available online: https:\/\/www.canada.ca\/content\/dam\/hc-sc\/documents\/corporate\/about-health-canada\/public-engagement\/external-advisory-bodies\/canadian-pain-task-force\/report-2019\/canadian-pain-task-force-June-2019-report-en.pdf."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1016\/j.sleep.2005.08.008","article-title":"Epidemiology of insomnia: Prevalence, self-help treatments and consultations initiated, and determinants of help-seeking behaviors","volume":"7","author":"Morin","year":"2006","journal-title":"Sleep Med."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"455","DOI":"10.1016\/j.sleep.2011.11.015","article-title":"Long-term outcomes and predictors of chronic insomnia: A prospective study in Hong Kong Chinese adults","volume":"13","author":"Zhang","year":"2012","journal-title":"Sleep Med."},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"352","DOI":"10.1097\/HRP.0000000000000198","article-title":"Pain and Depression: A Systematic Review","volume":"26","author":"IsHak","year":"2018","journal-title":"Harv. Rev. Psychiatry"},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"697","DOI":"10.1176\/ajp.146.1.128-a","article-title":"Sleep disturbance as the hallmark of posttraumatic stress disorder","volume":"146","author":"Ross","year":"1989","journal-title":"Am. J. Psychiatry"},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"173","DOI":"10.3928\/00485713-20160125-01","article-title":"Sleep Disturbances in Posttraumatic Stress Disorder: Updated Review and Implications for Treatment","volume":"46","author":"Koffel","year":"2016","journal-title":"Psychiatr. Ann."},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"427","DOI":"10.1016\/j.chest.2018.04.007","article-title":"Sleep Disorders in Patients with Posttraumatic Stress Disorder","volume":"154","author":"Riaz","year":"2018","journal-title":"Chest"},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"567","DOI":"10.2165\/00023210-200620070-00003","article-title":"Sleep disturbances in patients with post-traumatic stress disorder: Epidemiology, impact and approaches to management","volume":"20","author":"Maher","year":"2006","journal-title":"CNS Drugs"},{"key":"ref_80","unstructured":"Statistics Canada (2018, April 26). Census in Brief: The Housing Conditions of Aboriginal People in Canada, Available online: http:\/\/www12.statcan.gc.ca\/census-recensement\/2016\/as-sa\/98-200-x\/2016021\/98-200-x2016021-eng.pdf."},{"key":"ref_81","first-page":"9","article-title":"Housing conditions and respiratory hospitalizations among FirstNations people in Canada","volume":"28","author":"Garner","year":"2017","journal-title":"Health Rep."},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"141","DOI":"10.3402\/ijch.v70i2.17806","article-title":"Housing conditions in 2 Canadian First Nations Communities","volume":"70","author":"Larcombe","year":"2011","journal-title":"Int. J. Circumpolar Health"},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1136\/oem.2003.011379","article-title":"Insomnia is more common among subjects living in damp buildings","volume":"62","author":"Janson","year":"2005","journal-title":"Occup. Environ. Med."},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"357","DOI":"10.1016\/j.envres.2014.11.023","article-title":"Exposure to visible mould or dampness at home and sleep problems in children: Results from the LISAplus study","volume":"137","author":"Tiesler","year":"2015","journal-title":"Environ. Res."},{"key":"ref_85","unstructured":"Reading, C.L., and Wien, F. (2009). Health Inequalities and Social Determinates of Aboriginal Peoples\u2019 Health, National Collaborating Centre for Aboriginal Health, University of Northern British Colombia. Available online: https:\/\/www.ccnsa-nccah.ca\/docs\/determinants\/RPT-HealthInequalities-Reading-Wien-EN.pdf."},{"key":"ref_86","unstructured":"First Nations Health Council (2020, November 02). Social Determinants of Health Discussion Guide. Available online: http:\/\/fnhc.ca\/wp-content\/uploads\/FNHC-Social-Determinants-of-Health-Discussion-Guide.pdf."},{"key":"ref_87","doi-asserted-by":"crossref","first-page":"378","DOI":"10.1089\/heq.2019.0041","article-title":"Social determinants of health inequities in Indigenous Canadians through a life course approach to colonialism and the residential school system","volume":"3","author":"Kim","year":"2019","journal-title":"Health Equity"},{"key":"ref_88","unstructured":"Truth and Reconciliation Commission of Canada (2015). Canada\u2019s Residential Schools: The History, Part 2 1939 to 2000, McGill-Queen\u2019s University Press. Available online: http:\/\/www.trc.ca\/assets\/pdf\/Volume_1_History_Part_2_English_Web.pdf."},{"key":"ref_89","unstructured":"APA (American Psychiatric Association) (1994). Diagnostic and Statistical Manual of Mental Disorders, The American Psychiatric Association. [4th ed.]."},{"key":"ref_90","unstructured":"American Academy of Sleep Medicine (1990). International Classification of Sleep Disorders: Diagnostic and Coding Manual (ICSD), American Sleep Disorders Association. (revised 2005)."},{"key":"ref_91","unstructured":"World Health Organization (1994). International Statistical Classification of Diseases and Related Health Problems (ICD), World Health Organization. [2nd ed.]. Tenth revision."},{"key":"ref_92","doi-asserted-by":"crossref","first-page":"952","DOI":"10.1016\/j.sleep.2009.07.008","article-title":"Epidemiological and clinical relevance of insomnia diagnosis algorithms according to the DSM-IV and the International Classification of Sleep Disorders (ICSD)","volume":"10","author":"Ohayon","year":"2009","journal-title":"Sleep Med."}],"container-title":["Clocks &amp; Sleep"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2624-5175\/3\/1\/7\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T05:16:23Z","timestamp":1760159783000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2624-5175\/3\/1\/7"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,1,28]]},"references-count":92,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2021,3]]}},"alternative-id":["clockssleep3010007"],"URL":"https:\/\/doi.org\/10.3390\/clockssleep3010007","relation":{},"ISSN":["2624-5175"],"issn-type":[{"value":"2624-5175","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,1,28]]}}}