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Sleep Initiation and Maintenance Disorders: HELP
Articles by Rebecca A. Bernert
Based on 7 articles published since 2009
(Why 7 articles?)

Between 2009 and 2019, Rebecca A. Bernert wrote the following 7 articles about Sleep Initiation and Maintenance Disorders.
+ Citations + Abstracts
1 Review Sleep disturbances as an evidence-based suicide risk factor. 2015

Bernert, Rebecca A / Kim, Joanne S / Iwata, Naomi G / Perlis, Michael L. ·Suicide Prevention Research Laboratory, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, Stanford, CA, USA, rbernert@stanford.edu. ·Curr Psychiatry Rep · Pubmed #25698339.

ABSTRACT: Increasing research indicates that sleep disturbances may confer increased risk for suicidal behaviors, including suicidal ideation, suicide attempts, and death by suicide. Despite increased investigation, a number of methodological problems present important limitations to the validity and generalizability of findings in this area, which warrant additional focus. To evaluate and delineate sleep disturbances as an evidence-based suicide risk factor, a systematic review of the extant literature was conducted with methodological considerations as a central focus. The following methodologic criteria were required for inclusion: the report (1) evaluated an index of sleep disturbance; (2) examined an outcome measure for suicidal behavior; (3) adjusted for presence of a depression diagnosis or depression severity, as a covariate; and (4) represented an original investigation as opposed to a chart review. Reports meeting inclusion criteria were further classified and reviewed according to: study design and timeframe; sample type and size; sleep disturbance, suicide risk, and depression covariate assessment measure(s); and presence of positive versus negative findings. Based on keyword search, the following search engines were used: PubMed and PsycINFO. Search criteria generated N = 82 articles representing original investigations focused on sleep disturbances and suicide outcomes. Of these, N = 18 met inclusion criteria for review based on systematic analysis. Of the reports identified, N = 18 evaluated insomnia or poor sleep quality symptoms, whereas N = 8 assessed nightmares in association with suicide risk. Despite considerable differences in study designs, samples, and assessment techniques, the comparison of such reports indicates preliminary, converging evidence for sleep disturbances as an empirical risk factor for suicidal behaviors, while highlighting important, future directions for increased investigation.

2 Article Objectively Assessed Sleep Variability as an Acute Warning Sign of Suicidal Ideation in a Longitudinal Evaluation of Young Adults at High Suicide Risk. 2017

Bernert, Rebecca A / Hom, Melanie A / Iwata, Naomi G / Joiner, Thomas E. ·Suicide Prevention Research Laboratory, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Rd, Stanford, CA 94304-5797. rbernert@stanford.edu. · Stanford Mood Disorders Center, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California, USA. · Department of Psychology, Florida State University, Tallahassee, Florida, USA. ·J Clin Psychiatry · Pubmed #28682534.

ABSTRACT: OBJECTIVE: Young adults attempt suicide at disproportionately high rates relative to other groups and demonstrate high rates of sleep disturbance. No study has yet prospectively evaluated disturbed sleep as an acute indicator of risk using an objective index of sleep. We investigated objective and subjective parameters of disturbed sleep as a warning sign of suicidal ideation among young adults over an acute period. METHODS: A longitudinal study across a 21-day observation period and 3 time points. Fifty of 4,847 participants (aged 18-23 years) were prescreened from a university undergraduate research pool (February 2007-June 2008) on the basis of suicide attempt history and recent suicidal ideation. Actigraphic and subjective sleep parameters were evaluated as acute predictors of suicidal ideation (Beck Scale for Suicide Ideation), with adjustment for baseline symptoms. Hierarchical regression analyses were employed to predict residual change scores. RESULTS: Ninety-six percent of participants (n = 48) endorsed a suicide attempt history. Mean actigraphy values revealed objectively disturbed sleep parameters; 78% (n = 39) and 36% (n = 18) endorsed clinically significant insomnia and nightmares, respectively. When results were controlled for baseline suicidal and depressive symptoms, actigraphic and subjective sleep parameters predicted suicidal ideation residual change scores at 7- and 21-day follow-ups (P < .001). Specifically, actigraphy-defined variability in sleep timing, insomnia, and nightmares predicted increases in suicidal ideation (P < .05). In a test of competing risk factors, sleep variability outperformed depressive symptoms in the longitudinal prediction of suicidal ideation across time points (P < .05). CONCLUSIONS: Objectively and subjectively measured sleep disturbances predicted acute suicidal ideation increases in this population, independent of depressed mood. Self-reported insomnia and nightmares and actigraphically assessed sleep variability emerged as acute warning signs of suicidal ideation. These findings highlight the potential utility of sleep as a proposed biomarker of suicide risk and a therapeutic target.

3 Article Sleep architecture parameters as a putative biomarker of suicidal ideation in treatment-resistant depression. 2017

Bernert, Rebecca A / Luckenbaugh, David A / Duncan, Wallace C / Iwata, Naomi G / Ballard, Elizabeth D / Zarate, Carlos A. ·Suicide Prevention Research Laboratory, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA. Electronic address: rbernert@stanford.edu. · Experimental Therapeutics and Pathophysiology Branch, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA. · Suicide Prevention Research Laboratory, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA. ·J Affect Disord · Pubmed #27810712.

ABSTRACT: BACKGROUND: Disturbed sleep may confer risk for suicidal behaviors. Polysomnographic (PSG) sleep parameters have not been systematically evaluated in association with suicidal ideation (SI) among individuals with treatment-resistant depression (TRD). METHODS: This secondary data analysis included 54 TRD individuals (N=30 with major depressive disorder (MDD) and N=24 with bipolar depression (BD)). PSG sleep parameters included Sleep Efficiency (SE), Total Sleep Time (TST), Wakefulness After Sleep Onset (WASO), REM percent/latency, and non-REM (NREM) Sleep Stages 1-4. The Hamilton Depression Rating Scale (HAM-D) was used to group participants according to presence or absence of SI. Sleep abnormalities were hypothesized among those with current SI. ANOVA analyses were conducted before (Model 1) and after adjusting for depression (Model 2) and diagnostic variables (Model 3). RESULTS: Significant differences in PSG parameters were observed in Model 1; those with SI had less NREM Stage 4 sleep (p<.05). After adjusting for central covariates, Models 2 and 3 revealed significantly less NREM Stage 4 sleep, lower SE (P<.05), and higher WASO (P<.05) among those with SI. BD participants with SI also had less NREM Stage 4 and more NREM Stage 1 sleep. LIMITATIONS: 1) a predominantly white sample; 2) exclusion of imminent suicide risk; 3) concomitant mood stabilizer use among BD patients; and 4) single-item SI assessment. CONCLUSIONS: Independent of depression severity, SI was associated with less NREM Stage 4 sleep, and higher nocturnal wakefulness across diagnostic groups. Sleep may warrant further investigation in the pathogenesis of suicide risk, particularly in TRD, where risk may be heightened.

4 Article Nocturnal Wakefulness Is Associated With Next-Day Suicidal Ideation in Major Depressive Disorder and Bipolar Disorder. 2016

Ballard, Elizabeth D / Vande Voort, Jennifer L / Bernert, Rebecca A / Luckenbaugh, David A / Richards, Erica M / Niciu, Mark J / Furey, Maura L / Duncan, Wallace C / Zarate, Carlos A. ·Bldg 10, CRC Room 7-5345, 10 Center Drive, MSC 1282, Bethesda, MD 20892. Elizabeth.Ballard@nih.gov. · Experimental Therapeutics & Pathophysiology Branch, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland, USA. · Suicide Prevention Research Laboratory, Stanford Mood Disorders Center, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California, USA. · Janssen Pharmaceuticals, Neuroscience Research and Development, La Jolla, California, USA. ·J Clin Psychiatry · Pubmed #27337418.

ABSTRACT: OBJECTIVE: Self-reported sleep disturbances may confer elevated risk for suicidal ideation, suicide attempts, and death. However, limited research has evaluated polysomnographically determined sleep disturbance as an acute physiologic risk factor for suicidal thoughts. This study sought to investigate the relationship between nocturnal wakefulness in association with next-day suicidal ideation using overnight polysomnography assessment from data collected between 2006 and 2013. METHODS: Sixty-five participants with DSM-IV-diagnosed major depressive disorder or bipolar depression underwent overnight polysomnography monitoring in a sleep laboratory. The Hamilton Depression Rating Scale (HDRS) was administered the morning after polysomnography recording to assess next-day suicidal ideation, severity of depressive symptoms, and subjective sleep disturbances. RESULTS: Using a generalized linear mixed model, a significant time-by-ideation interaction was found indicating greater nocturnal wakefulness at 4:00 am among participants with suicidal ideation (F4,136 = 3.65, P = .007). Increased time awake during the 4:00 am hour (4:00 to 4:59) was significantly associated with elevated suicidal thoughts the next day (standardized β = 0.31, P = .008). This relationship persisted after controlling for age, gender, diagnosis, and severity of depressive symptoms. CONCLUSIONS: Greater nocturnal wakefulness, particularly in the early morning hours, was significantly associated with next-day suicidal thoughts. Polysomnographically documented sleep disruption at specific times of night may represent an acute risk factor of suicidal ideation that warrants additional research. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT00024635.

5 Article Obsessive compulsive symptoms and sleep difficulties: exploring the unique relationship between insomnia and obsessions. 2014

Timpano, Kiara R / Carbonella, Julia Y / Bernert, Rebecca A / Schmidt, Norman B. ·University of Miami, United States. Electronic address: kiaratimpano@gmail.com. · University of Miami, United States. · Stanford School of Medicine, United States. · Florida State University, United States. ·J Psychiatr Res · Pubmed #25038630.

ABSTRACT: BACKGROUND: Sleep complaints have been linked with Obsessive Compulsive Disorder (OCD), though there is a dearth of research exploring the association between a range of disturbed sleep indicators and obsessive compulsive symptoms (OCS). Two separate studies were conducted to rigorously investigate this relationship in further detail, considering a number of different sleep indices and also the heterogeneous nature of OCS. METHODS: Study 1 (n = 167) examined the relationship between OCS and the gold standard self-report assessments for delayed bedtime, sleep quality, nightmares, and insomnia symptoms. Study 2 (n = 352) replicated the primary findings from Study 1 in an independent sample and with an alternative measure of OCD, which takes into account the different OCS dimensions. RESULTS: Results revealed a significant, independent link between obsessions and insomnia symptoms, but not between insomnia and compulsions. When examining the different OCS dimensions, insomnia was again found to bear a specific relationship to obsessions, above and beyond that with the other dimensions. Although depression is often highly comorbid with both OCD and sleep disturbances, depressive symptoms did not explain the OCS-sleep relationship in either study, suggesting a unique association between obsessions and insomnia. CONCLUSIONS: Findings indicate that high levels of intrusive thoughts exhibit a specific association with insomnia symptoms-one that is not observed with other OCS. Future research may help elucidate the mechanisms and causal nature of this relationship.

6 Article Clinical significance of night-to-night sleep variability in insomnia. 2012

Suh, Sooyeon / Nowakowski, Sara / Bernert, Rebecca A / Ong, Jason C / Siebern, Allison T / Dowdle, Claire L / Manber, Rachel. ·Stanford University School of Medicine, Department of Psychiatry and Behavioral Science, Stanford, CA 94301, USA. alysuh@stanford.edu ·Sleep Med · Pubmed #22357064.

ABSTRACT: OBJECTIVES: To evaluate the clinical relevance of night-to-night variability of sleep schedules and insomnia symptoms. METHODS: The sample consisted of 455 patients (193 men, mean age=48) seeking treatment for insomnia in a sleep medicine clinic. All participants received group cognitive behavioral therapy for insomnia (CBTI). Variability in sleep parameters was assessed using sleep diary data. Two composite scores were computed, a behavioral schedule composite score (BCS) and insomnia symptom composite score (ICS). The Insomnia Severity Index, the Beck Depression Inventory, and the Morningness-Eveningness Composite Scale were administered at baseline and post-treatment. RESULTS: Results revealed that greater BCS scores were significantly associated with younger age, eveningness chronotype, and greater depression severity (p<0.001). Both depression severity and eveningness chronotype independently predicted variability in sleep schedules (p<0.001). Finally, CBTI resulted in reduced sleep variability for all sleep diary variables except bedtime. Post-treatment symptom reductions in depression severity were greater among those with high versus low baseline BCS scores (p<0.001). CONCLUSIONS: Results suggest that variability in sleep schedules predict reduction in insomnia and depressive severity following group CBTI. Schedule variability may be particularly important to assess and address among patients with high depression symptoms and those with the evening chronotype.

7 Article CBT for insomnia in patients with high and low depressive symptom severity: adherence and clinical outcomes. 2011

Manber, Rachel / Bernert, Rebecca A / Suh, Sooyeon / Nowakowski, Sara / Siebern, Allison T / Ong, Jason C. ·Stanford University School of Medicine, Department of Psychiatry and Behavioral Science, Stanford, CA 94301-5597, USA. rmanber@stanford.edu ·J Clin Sleep Med · Pubmed #22171204.

ABSTRACT: STUDY OBJECTIVES: To evaluate whether depressive symptom severity leads to poorer response and perceived adherence to cognitive behavioral therapy for insomnia (CBTI) and to examine the impact of CBTI on well-being, depressive symptom severity, and suicidal ideation. DESIGN: Pre- to posttreatment case replication series comparing low depression (LowDep) and high depression (HiDep) groups (based on a cutoff of 14 on the Beck Depression Inventory [BDI]). PARTICIPANTS: 127 men and 174 women referred for the treatment of insomnia. INTERVENTIONS: Seven sessions of group CBTI. MEASUREMENTS AND RESULTS: Improvement in the insomnia severity, perceived energy, productivity, self-esteem, other aspects of wellbeing, and overall treatment satisfaction did not differ between the HiDep and LowDep groups (p > 0.14). HiDep patients reported lower adherence to a fixed rise time, restricting time in bed, and changing expectations about sleep (p < 0.05). HiDep participants experienced significant reductions in BDI, after removing the sleep item. Levels of suicidal ideation dropped significantly among patients with pretreatment elevations (p < 0.0001). CONCLUSION: Results suggest that pre- to post CBTI improvements in insomnia symptoms, perceived energy, productivity, self-esteem, and other aspects of well-being were similar among patients with and without elevation in depressive symptom severity. Thus, the benefits of CBTI extend beyond insomnia and include improvements in non-sleep outcomes, such as overall well-being and depressive symptom severity, including suicidal ideation, among patients with baseline elevations. Results identify aspects of CBTI that may merit additional attention to further improve outcomes among patients with insomnia and elevated depressive symptom severity.