Effectiveness of Magnesium Supplementation on Sleep Quality and Related Health Outcomes for Adults with Poor Sleep Quality: A Randomized Double-Blind Placebo-Controlled Crossover Trial

doi:10.21203/rs.3.rs-3958974/v1

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Effectiveness of Magnesium Supplementation on Sleep Quality and Related Health Outcomes for Adults with Poor Sleep Quality: A Randomized Double-Blind Placebo-Controlled Crossover Trial

https://doi.org/10.21203/rs.3.rs-3958974/v1

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Objectives: Conduct a randomized double-blind placebo-controlled crossover trial on adults with nonclinical insomnia symptoms to examine the effectiveness of magnesium supplementation on sleep quality and mood.

Methods: Participants (N = 31 adults, M age = 45.49) were randomized to either the Magnesium (1 g/d) or Placebo Condition for 2 weeks. Following a two-week washout, participants engaged in the alternative condition. Standardized self-reports (i.e., Insomnia Severity Index, Pittsburgh Sleep Quality Index, Berlin Questionnaire, Pittsburgh Sleep Quality Index, Restorative Sleep Questionnaire, Pain and Sleep Questionnaire, Flinders Fatigue Scale, Trait Anxiety Inventory, Perceived Stress Scale, Profile of Mood States) were completed at Baseline and Post Conditions along with daily objective measures of sleep/activity (i.e., Oura Ring). ISRCTN registry is ISRCTN70584524.

Results: Magnesium supplementation resulted in significant improvements compared to Placebo for sleep quality, mood, and activity outcomes (e.g., sleep duration, deep sleep, sleep efficiency, readiness, activity balance, and HRV Readiness), p’s < .05. Nonsignificant improvements for the magnesium condition compared to the placebo condition were evidenced for the Restorative Sleep Questionnaire, Anxiety, Perceived Stress, and Flinder’s Fatigue Scale, p’s > .05. No adverse events were reported and adherence was 100%.

Conclusion: Magnesium may be an effective nonpharmacological intervention to promote sleep and mental health. Longer term clinical trials conducted in a variety of populations and settings are encouraged.

Sleep Quality

Magnesium

Insomnia Symptoms

Mood

About one-third of the general population experience insomnia symptoms, which are associated with increased risk for physical and mental health issues. Because the common interventions of over-the-counter and prescription drugs often have side effects, limited efficacy, and may result in dependency [1], research is needed examining the effectiveness of alternative interventions to improve sleep quality and related health outcomes for adults with poor sleep quality.

Magnesium supplementation is purported to improve sleep; however, as both an over-the-counter sleep aid, limited randomized controlled trial evidence exists to support this assertion [2-3. Because plasma magnesium levels are lower in sleep deprived people,⁴ magnesium supplementation may improve sleep quality. Observational studies found magnesium helps in maintaining a normal circadian rhythm, reducing daytime sleepiness, and improving sleep quality [4-6].

Magnesium is alluring because it is natural, inexpensive, and available as an over-the-counter sleep aid; however, its effectiveness and safety must be investigated. Furthermore, limitations of the magnesium and sleep research include a focus on clinical sleep disorder populations, combining of magnesium with other complexes, and a lack of randomized controlled trials with both subjective and objective sleep measures[6-7]. In short, research on the effectiveness of magnesium supplementation for improving sleep quality in adults with nonclinical insomnia symptoms is required using both objective and subjective assessments within a controlled trial design.

The purpose of this randomized placebo-controlled double-blind crossover pilot trial was to examine the effectiveness of nano magnesium chloride supplementation on sleep quality, daytime activity, and mood with adults with nonclinical insomnia symptoms using both subjective and objective measures. The primary outcome was sleep quality. The secondary outcomes were daytime activity, mood, anxiety, pain effected by sleep, and perceived stress.

Participants

Participants were 31 nonobese adults (M age = 46.01, SD = 8.47; range = 27 to 55 years; M BMI = 25.23 6.66) who reported nonclinical insomnia symptoms based on the Insomnia Severity Index (M = 13.10, SD = 4.10) [7].

Exclusion Criteria

Participants were excluded if they had severe insomnia (based on the Insomnia Severity Index ≥ 22) or absence of insomnia ( < 8); (2) history of a disorder affecting sleep quality; (3) events that could cause severe stress within 2 weeks of baseline; (4) use of medication that could influence sleep patterns, within 1 month of baseline; (5) current use of hormone therapy; (6) binge drinking; (7) smoking; (8) high caffeine intake; (9) work schedule that causes irregular sleep patterns; (10) history of travel to a different time zone within 1 month of study; (11) low or high body mass index (BMI ≤ 18 kg/m2 or ≥30 kg/m2); (12) pregnant, trying to conceive, or breastfeeding; (13) taking sleep supplements or medication, (14) unwilling to abstain from other magnesium product use for two weeks leading up to trial initiation and during the trial, and (14) individuals deemed incompatible with the study protocol.

Procedures

Based on the prescreen questionnaire, eligible participants signed an Institutional Review Board approved informed consent prior to enrolling in the study. Participants completed psychometrically validated self-report questionnaires at Day 0 (Pre) and post each condition. Participants also completed a Daily Diary to assess subjective sleep quality/quantity, adherence, and adverse events, and wore an Oura Ring to objectively determine sleep and daytime activity. Participants maintained their current lifestyle behaviors and did not engage in any new forms of structured exercise or begin a new diet or health intervention during the trial. The adherence rate was 100%.

Study design: This study was approval by Sterling Institutional Review Board (10721-HAHausenblas) in compliance with the Declaration of Helsinki standards for ethical principles regarding human participant research and registered with ISRCTN registry is ISRCTN70584524. The Consolidated Standards of Reporting Trials (CONSORT) was used to report this trial.

This study was conducted in a double-blind, parallel treatment, stratified random, placebo-controlled manner. The independent variable was the UF Magnesium nutritional supplementation. The dependent variables were sleep quality and quantity. Sample size power calculation indicated that 30 participants were needed in each group to achieve a power of 80% and alpha < .05 (https://clincalc.com/stats/samplesize.aspx).

Intervention: Using a randomized double-blind placebo-controlled crossover pilot trial, the participants were randomized to either the Magnesium or Placebo Control condition for 2 weeks. Following a one-week washout period, the participants engaged in the alternate condition. The magnesium (i.e., Upgraded Formulas) was a nano magnesium chloride that is 100% natural, keto, organic, and vegan. It is free from artificial flavors, fillers, colors, and stabilizers. Participants were instructed to take 4 capsules 120 minutes or less before bed with 12 oz of water. The Placebo was sucrose.

Blinding: To ensure that all subjects and researchers were unaware of the treatment assignments, the supplement/placebo bottles were labelled as either A or B by an independent party. The supplement/placebo pills were identical in color, odor, and size. The research team was blinded to the content of the bottles. At the conclusion of the study, immediately following the last assessment, the research team was unblinded. The participants were then unblinded and informed of their assigned condition.

Supplement Information and Adherence: Participants were instructed to take the capsules about 30 minutes prior to nighttime sleep. The participants provided the number of pills remaining in their bottles as an adherence measure as well as indicated their adherence. The participants also received a daily text reminder to take their supplement.

Measures

The following psychometrically validated self-report measures were completed at Baseline and Post Conditions:

Insomnia Severity Index: The Insomnia Severity Index is a 7-item self-report questionnaire assessing the nature, severity, and impact of insomnia[7]. The dimensions evaluated are: severity of sleep onset, sleep maintenance, and early morning awakening problems, sleep dissatisfaction, interference of sleep difficulties with daytime functioning, noticeability of sleep problems by others, and distress caused by the sleep difficulties. A 5-point Likert scale is used to rate each item (e.g., 0 = no problem; 4 = very severe problem), yielding a total score ranging from 0 to 28. The total score is interpreted as follows: absence of insomnia (0–7); sub-threshold insomnia (8–14); moderate insomnia (15–21); and severe insomnia (22–28).

Pittsburgh Sleep Quality Index. The Pittsburgh Sleep Quality Index is a standardized, self-administered questionnaire that evaluates retrospective sleep quality and disturbances within the past month [8]. The translated PSQI consists of the same items as the original instrument; it comprises 19 items forming seven subscales: (1) sleep quality (1 item), (2) sleep latency (2 items), (3) sleep duration (1 item), (4) sleep efficiency (3 items), (5) sleep disturbance (9 items), (6) sleep medication (1 item), and (7) daily dysfunction (2 items). The PSQI-M was evaluated following the original scoring system. Each component has a score that ranges from 0 to 3. The scores of seven components will be summed to yield a PSQI global score ranging from 0 to 21. Respondents with a global score of greater than 5 are classified as ‘poor sleepers’, while those with a score of 5 or less are classified as ‘good sleepers’.

Restorative Sleep Questionnaire: The Restorative Sleep Questionnaire (RSQ) is a validated 11-item questionnaire that assesses restorative sleep by asking respondents to rate on a 5-point scale feelings of tiredness, mood, and energy [10]. The RSQ has good psychometric properties and is able to distinguish between healthy controls, patients with primary insomnia, and insomnia patients with isolated nonrestorative sleep complaints.

Profile of Mood States (POMS) Questionnaire: The POMS-40 was used to assess the mood states of tension, anger, vigor, fatigue, depression, and confusion [11]. A composite score was computed by summing each of the individual scores for tension, depression, anxiety, fatigue, and confusion, with vigor scores subtracted to indicate patients' total mood disturbance. Each item of the POMS items was scored on a 5-point Likert scale ranging from 0 (not at all) to 4 (extremely) with lower scores indicated an improved mood. This scale has good to excellent reliability and validity [11].

Flinders Fatigue Scale: The Finders Fatigue Scale is a 7-item scale that measures various characteristics of fatigue (e.g., frequency, severity) experienced over the past 2 weeks [12]. The items tap into commonly reported themes of how problematic fatigue is, the consequences of fatigue, frequency, severity, and insomnia patients' perception of fatigue's association with sleep. Six items are presented in Likert format, with responses ranging from 0 (not at all) to 4 (extremely). Item 5 measures the time of day when fatigue is experienced and uses a multiple-item checklist. Respondents can indicate more than one response for item 5, and it is scored as the sum of all times of the day indicated by the respondent. One item explicitly asks for respondents' impression of whether they attribute their fatigue to their sleep. Total fatigue is calculated as the sum of all individual items. Total fatigue scores range from 0 to 31, with higher scores indicating greater fatigue. A clear description of the term “fatigue” is provided in the initial instructions to the scale.

Perceived Stress Scale: The Perceived Stress Scale-4 measures the degree to which individuals appraise situations in their lives as stressful [13]. Specifically, the scale evaluates the degree to which individuals believe their life has been unpredictable, uncontrollable, and overloaded during the previous month. The items are general in nature rather than focusing on specific events or experiences. The scale consisted of four items, and each item was scored on a 5-point Likert scale ranging from 0 (“never”) to 4 (“very often”) with higher scores indicating more perceived stress. This scale has excellent psychometric properties (Du et al., 2023).

Pain and Sleep Questionnaire: The Pain and Sleep Questionnaire measures the impact of pain on sleep in chronic pain patients is the Pain and Sleep Questionnaire (PSQ) (14). The PSQ is an eight-item questionnaire developed to assess the impact of pain on quality of sleep. Six of the eight items are scored on a 100 mm VAS (ranging from 0 [‘never’] to 100 [‘always’]) and asks respondents to rate how often they have trouble falling asleep (PSQ1); how often they need pain medication to fall asleep (PSQ2); how often they need sleeping medication to fall asleep (PSQ3); how often they are awakened by pain during the night (PSQ4) and in the morning (PSQ5); and how often their partner is awakened (PSQ6). The seventh item is also scored using a VAS; however, it uses different anchor points (0 [‘very poor’], 100 [‘excellent’]) and asks individuals to rate the overall quality of their sleep. The final item asks individuals to indicate, using a number that can range from 1 to 24, the average number of hours of sleep they get each night. Typically, a single index is created from summing the scores on the first five items and using this composite score as an overall measure of the impact of pain on quality of sleep (referred to as the Pain and Sleep Index).

Trait Anxiety Inventory: The Trait Anxiety Inventory (20-items) was used to measure general feelings of anxiety including general states of calmness, confidence, and security [15]. Higher scores indicate more severe anxiety levels. Each item was assessed on a 4-point Likert-type scale (from 0 to 3 points).

Daily measures were:

Oura Ring. The Oura Ring is a novel, multisensory device that quantifies daily physical activity, night-time sleep duration, and estimates sleep stages, including REM (https://ouraring.com/). The ring also measures motion and body temperature. The Oura Ring uses physiological signals (a combination of motion, heart rate, heart rate variability, and pulse wave variability amplitude) in combination with sophisticated machine learning based methods to calculate deep, light and rapid-eye-movement (REM) sleep in addition to sleep/wake states. Rings are waterproof, made in ceramic, and come with a dedicated mobile App. They come in different sizes (US standard ring sizes 6–13) and weigh about 15 g with a battery life of about 3 days. The ring automatically connects via Bluetooth and transfers data to a mobile platform via the dedicated App. The Oura Ring has high validity in the assessment of nocturnal heart rate, heart rate variability, movement and sleep outcomes in healthy adults in natural environment [21]. Participants will keep the Oura Ring at the completion of the study.

Daily diary: The daily diary assessed adverse events and adherence.

Statistical Analysis: Data were analyzed for normality by examining skewness and kurtosis scores and using Shapiro-Wilk test and Q-Q plot. Outliers were characterized as data points that exceeded three interquartile ranges beyond 25th and 75th percentiles. However, no extreme outliers were observed. Descriptive statistics were expressed in Mean (SD). Paired sample t-tests (delta scores) were used to analyze time and condition differences for the self-report measures (p’s ≤ .05). For the Oura Ring data 2 (Condition: Magnesium x Placebo) x 3 (Time: Week 1, Week, 2,) repeated measures analysis of variance (ANOVA) were used to analyze the Oura Ring data. Multiple comparisons were corrected using Sidak Adjustment. Pos hoc tests were paired-sample t-tests where applicable. The data were analyzed using EXCEL and Statistical Product and Service Solutions (SPSS) version 28.

Self-reported Outcomes

For sleep quality, significant improvements following the Magnesium Condition compared to the Placebo Condition were evidenced for the Pittsburgh Sleep Quality Index. For the Insomnia Severity Index and Restorative Sleep Questionnaire, nonsignificant improvements were evidenced for the Magnesium Condition compared to the Placebo Condition (See Table 1).

Significant improvements for the Tension, Anger, and Depression Subscales and the POMS Total for the Magnesium Condition compared to the Placebo Condition were found. The Magnesium Condition had larger improvements in general feelings of perceived stress, (i.e., degree to which situations are appraised as stressful), anxiety, daytime fatigue (i.e., extent that person felt fatigued (tired, weary, exhausted), and the impact of pain on sleep compared to the Placebo Condition, albeit nonsignificant.

Objective Sleep and Activity Outcomes

For sleep duration, significant main effects for Condition (F(1,192) = 28170.00, p < .001) and Interaction (F(2,384) = 4.35, p =.01) were evidenced, but no significant main effect for Time (F (2,384) = 0.54, p = .59) was found. The Magnesium Condition had a longer sleep duration compared to the Placebo Condition at Week 1 (see Table 2).

For time awake during the night, significant main effects for Condition (F(1,192) = 28170, p < .001) and Interaction (F(2,384) = 4.35, p =.01), but not for Time (F (2,384) = 0.54, p = .59) were evidenced. Time awake during the night was less for the Magnesium Condition compared to the Placebo Condition.

For light sleep, significant main effects for Condition (F(1,192) = 9843.16, p < .001) and an Interaction (F(2,384) = 7.69, p =.001), but no significant main effect for Time (F (2,384) = 1.58, p = .21) was found. Light sleep increased for the Placebo Condition and decreased for the Magnesium Condition.

For REM sleep, significant main effects for Condition (F(1,192) = 5270.23, p < .001), but not for Time (F (2,384) = 0.18, p = .84) or Interaction (F(2,384) = .42, p =.65).

For sleep latency, only a significant main effects for Condition F(1,192) = 1091.27, p < .001 was evidenced. Sleep latency improved for the Magnesium Condition compared to Placebo Condition, albeit nonsignificant.

For sleep efficiency, significant main effects for Condition (F(1,192) = 28170, p < .001) and Interaction (F(2,384) = 4.35, p =.01), but no significant Time main effect (F (2,384) = 0.54, p = .59) were found. Sleep Efficiency represents the percentage of time spent asleep compared to time spent awake while in bed. Magnesium Condition Sleep Efficiency was significantly better than the Placebo Condition.

Readiness Score consists of eight contributors (body temperature, sleep, heart rate variability, sleep balance, previous day activity, activity balance, resting heart rate, & recover index) that blend with one another to provide you with an indication of how ready you are to take on the day. Significant main effect for Condition (F(1,366) = 121695.48, p < .001) and Interaction (F(2,732) = 7.04, p = .001) were found indicating the Readiness improved significantly for the Magnesium Condition compared to the Placebo Condition (see Figure 1).

For activity balance a significant main effect for Time (F (2,732) = 5.00, p = .007) and Condition (F(1,366) = 68073.29, p < .001) as well as a significant Interaction (F(2,732) = 10.35, p < .001) were found. Activity Balance measures how your activity level over the past 14 days (with the past 2-5 being weighted slightly more) is affecting your readiness to perform. When your activity balance is optimal, it means that you've been active, but kept from training at your maximum capacity. Significant improvements were found in Readiness Score Activity Balance for the Magnesium Condition compared to the Placebo Condition.

For readiness score sleep balance, significant Condition (F(1,366) = 71328, p < .001), Time (F (2,732) = 7.44, p = .001) and Interactions (F(2,732) = 7.91, p = .007) were evidenced. Readiness Score Sleep Balance compares how well you’ve been sleeping in the past 14 days against your long-term average, with the past few nights of sleep weighing more heavily on your score. In other words, if you slept poorly last night, this would impact your Sleep Balance more in comparison to a poor night of sleep that occurred one week ago. The Magnesium Condition had a significant improvement compared to a significant decrease for the Placebo condition.

For the Heart Rate Variability (HRV) Readiness Score, significant Condition (F(1,366) = 22065.39, p < .001) Time (F (2,732) = 6.59, p = .001), and Interaction (F(2,732) = 7.34, p = .001) were evidenced. Readiness score is a measurement of recovery status. Magnesium Condition had a significant improvement and less of a decrease compared to Placebo.

The purpose of this randomized placebo-controlled double-blind trial was to examine the effectiveness of magnesium supplementation on sleep quality and mood for adults with nonclinical insomnia symptoms (i.e., occasional sleeplessness) using both subjective and objective measures. The results of this study demonstrated that supplementation with magnesium is safe and resulted in significant improvements in several sleep quality, activity, and mood outcomes compared to placebo. Study findings, limitations, and future research directions are discussed below.

For self-reported sleep quality, the Magnesium Condition had significantly improved sleep quality (Pittsburgh Sleep Quality Index). Nonsignificant improvements (i.e., trending in the right direction) were evidenced for the Magnesium Condition compared to the Placebo Condition for insomnia symptoms and restorative sleep (i.e., refreshing quality of sleep). Future research in diverse and larger samples are encouraged to elucidate the effects of these positive trending results. As well, significant improvements for the Tension, Anger, and Depression Subscales and the POMS Total for the Magnesium Condition compared to the Placebo Condition were found. The Magnesium Condition had larger improvements in general feelings of perceived stress, (i.e., degree to which situations are appraised as stressful), anxiety, daytime fatigue (i.e., extent that person felt fatigued (tired, weary, exhausted), and the impact of pain on sleep compared to the Placebo Condition, albeit nonsignificant.

For the objective sleep results, deep sleep improved over time for the Magnesium Condition, and worsened for the Placebo Condition. Deep sleep is associated with changes in the body rather than the brain, and it is the most restorative and rejuvenating sleep stage. During deep sleep breathing is slow, heartbeat is regular, and muscles are relaxed; and it is the period where the body heals itself (e.g., replaces cells, builds muscle tissue, and heals wounds). Deep sleep encompasses between 0 to 35% of total sleep, and the average adult spends 15 to 20% of their total sleep time in deep sleep.

Regarding cognition, deep sleep contributes to thinking, creativity, and memory consolidation and restoration, specifically procedural and declarative memory. This deep sleep stage allows the brain to rest and recover, which assists with improving cognitive function, concentration, and alertness. And during deep sleep the brain processes and integrates new information, which can improve memory retention and learning. We found that magnesium supplementation improved deep sleep, which provides an explanation for previous findings that magnesium supplementation improved cognitive abilities compared to placebo [15-17].

For activity outcomes, the participants had significant improvements in daytime activity measures. First, daily physical activity, (i.e., Activity Daily Movement) which is an assessment of walking/steps per day, increased for the Magnesium Condition compared to a decrease for the Placebo Condition. Second, the Magnesium Condition had significant improvements in Readiness compared to the Placebo Condition. The Readiness Score consists of eight contributors (body temperature, sleep, heart rate variability, sleep balance, previous day activity, activity balance, resting heart rate, and recover index) that blend with one another to provide an indication of how ready people are “to take on the day”. In other words, it is an indicator of how “ready” the body is to engage in activity; and it is based on the previous day’s resting heart rate, heart rate variability balance, body temperature, and previous night’s sleep quality.

Finally, the Magnesium Condition had significant improvements in Readiness Activity Balance compared to the Placebo Condition. Readiness Activity Balance is the level to which the participant reached maximum activity capacity without overtraining. A higher score is associated with a balance of low, moderate, and high intensity activities. These activity results support previous research findings of a bidirectional relationship between improved sleep quality and increased daytime activity [18-19]. Insufficient sleep is linked to reduced energy, productivity, and physical activity as well as increased feeling of fatigue²⁰.

The strengths of the study include a double-blind placebo-controlled trial with both self-report and objective assessments in people’s natural sleep environment. Future studies with larger sample size and longer assessment periods in both clinical and nonclinical sleep populations are encouraged so that more definitive conclusions can be made regarding the potential for this specific magnesium supplement to positively impact sleep and activity health. In summary, the results of this study demonstrate that supplementation with magnesium is safe and resulted in significant improvements in sleep quality, activity, and mood.

HRV = heart rate variability, POMS = Profile of Mood States, PSQ = Pain and Sleep Questionnaire, RSQ = Restorative Sleep Questionnaire

Availability of data and materials: Data and/or statistical analyses are available upon request on a case-by-case basis for noncommercial scientific inquiry and/or educational use as long as Institutional Review Board restrictions and research agreement terms are not violated.

Acknowledgments: The authors thank Jacksonville University for providing support to complete this study. All individuals have consented to approval.

Compliance with ethical standards: The authors have no potential conflicts of interest. The study involves human participants and ethical approval and informed consent was obtained (Sterling IRB approval 10721-HAHausenblas).

Non-financial interests: none to declare.

Informed consent: Informed consent was obtained from all individual participants included in the study.

Funding: Trial was funded in part by Upgraded Formulas®

Ethical approval: “All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.”

Disclosure of potential conflicts of interest: The authors declare no conflicts of interest

Clinical Trials Registry: ISRCTN70584524.

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Table 1

Insomnia Severity Index, Pittsburgh Sleep Quality Index, Profile of Mood States (POMS), Trait Anxiety, Perceived Stress Scale, Flinder’s Fatigue Scale, and Sleep and Pain Questionnaire Mean and Standard Deviation (SD) Change Scores and Pair-Sample t-tests on Delta Scores

	Magnesium Condition Mean (SD)	Placebo Condition Mean (SD)	t-test (df = 30)
Insomnia Severity Index	3.99 (5.20)	3.32 (4.69)	t = -0.34, p = 0.74
Pittsburgh Sleep Quality Index*	-2.68 (3.23)	-1.74 (2.53)	t = -1.96, p = 0.05
Restorative Sleep Questionnaire	87.17 (98.49)	92.2 (121.14)	t = -0.21, p = 0.84
POMS: Tension (anxiety, uneasy)*	3.04 (4.25)	1.42 (4.04)	t = -1.96, p = 0.05
POMS: Anger (hostility, furious)*	1.86 (3.03)	0.50 (2.80)	t = -3.02, p = 0.01
POMS: Fatigue (inertia, exhaustion)	-2.74 (3.45)	-1.71 (3.78)	t = -1.45, p = 0.16
POMS: Depression (dejection, hopeless)*	-2.08 (3.16)	-0.61 (2.72)	t = -2.67, p = 0.01
POMS: Esteem (confidence)	1.55 (3.00)	0.73 (2.54)	t = 1.6, p = 0.12
POMS: Vigor (activity, energetic)	1.08 (3.63)	1.06 (2.59)	t = 0.02, p = 0.99
POMS Confusion (bewildered, muddled)	-1.43 (2.58)	-1.06 (2.31)	t = -0.68, p = 0.50
POMS Total*	-7.55 (11.21)	-3.61 (9.31)	t = -1.93, p = 0.05
Anxiety	-5.44 (10.90)	-4.39 (8.40)	t = -0.5, p = 0.62
Perceived Stress Scale	-2.09 (2.60)	-1.59 (2.83)	t = -1.03, p = 0.31
Flinder's Fatigue Scale	-5.14 (5.47)	-3.91 (5.40)	t = -1.28, p = 0.21
Pain and Sleep Questionnaire	-14.69 (33.52)	-17.01 (32.3)	t = 1.23, p = 0.23

*=Magnesium condition was significantly improved compared to Placebo condition.

Table 2 Oura Ring Mean and Standard Deviation (SD) Sleep and Activity Scores by Condition and Time

*=significant worsening from Baseline

+ indicates a significant difference between Baseline and Week 1

# indicates a significant difference between Baseline and Week 2

^ indicates a significant difference from Week 1 to Week 2

No competing interests reported.

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Effectiveness of Magnesium Supplementation on Sleep Quality and Related Health Outcomes for Adults with Poor Sleep Quality: A Randomized Double-Blind Placebo-Controlled Crossover Trial

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