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Sleep Initiation and Maintenance Disorders: HELP
Articles by Megan R. Crawford
Based on 9 articles published since 2009
(Why 9 articles?)

Between 2009 and 2019, Megan R. Crawford wrote the following 9 articles about Sleep Initiation and Maintenance Disorders.
+ Citations + Abstracts
1 Review Towards standardisation and improved understanding of sleep restriction therapy for insomnia disorder: A systematic examination of CBT-I trial content. 2015

Kyle, Simon D / Aquino, Maria Raisa Jessica / Miller, Christopher B / Henry, Alasdair L / Crawford, Megan R / Espie, Colin A / Spielman, Arthur J. ·School of Psychological Sciences, University of Manchester, UK. Electronic address: simon.kyle@manchester.ac.uk. · School of Health Sciences, City University London, UK. · Woolcock Institute of Medical Research, University of Sydney, Australia. · Institute of Inflammation & Repair, University of Manchester, UK. · Rush University Medical Center, Chicago, USA. · Sleep & Circadian Neuroscience Institute, University of Oxford, UK. · Weill Cornell Medical College, Center for Sleep Medicine, NY, USA. ·Sleep Med Rev · Pubmed #25771293.

ABSTRACT: Sleep restriction therapy is a core element of contemporary cognitive-behavioural therapy for insomnia and is also effective as a single-component therapeutic strategy. Since its original description, sleep restriction therapy has been applied in several different ways, potentially limiting understanding of key therapeutic ingredients, mode of action, evidence synthesis, and clinical implementation. We sought to examine the quality of reporting and variability in the application of sleep restriction therapy within the context of insomnia intervention trials. Systematic literature searches revealed 88 trials of cognitive-behavioural therapy/sleep restriction therapy that met pre-defined inclusion/exclusion criteria. All papers were coded in relation to their description of sleep restriction therapy procedures. Findings indicate that a large proportion of papers (39%) do not report any details regarding sleep restriction therapy parameters and, for those papers that do, variability in implementation is present at every level (sleep window generation, minimum time-in-bed, sleep efficiency titration criteria, and positioning of sleep window). Only 7% of papers reported all parameters of sleep restriction treatment. Poor reporting and variability in the application of sleep restriction therapy may hinder progress in relation to evidence synthesis, specification of mechanistic components, and refinement of therapeutic procedures for patient benefit. We set out guidelines for the reporting of sleep restriction therapy as well as a research agenda aimed at advancing understanding of sleep restriction therapy.

2 Clinical Trial The Glasgow Sleep Impact Index (GSII): a novel patient-centred measure for assessing sleep-related quality of life impairment in Insomnia Disorder. 2013

Kyle, Simon D / Crawford, Megan R / Morgan, Kevin / Spiegelhalder, Kai / Clark, Ailie A / Espie, Colin A. ·University of Glasgow Sleep Centre, Institute of Neuroscience & Psychology, University of Glasgow, Scotland, United Kingdom. simon.kyle@manchester.ac.uk ·Sleep Med · Pubmed #23347908.

ABSTRACT: OBJECTIVES: Daytime dysfunction and quality of life impairment are important and salient consequences of poor sleep in those with insomnia. Existing measurement approaches to functional impact tend to rely on non-specific generic tools, non-validated scales, or ad hoc single scale items. Here we report the development and validation of the Glasgow Sleep Impact Index (GSII), a novel self-report measure which asks patients to generate, and assess, three domains of impairment unique to their own individual context. These three patient-generated areas of impairment are ranked in order of concern (1-3; i.e. 1=the most concerning impairment), and then rated on a visual analogue scale with respect to impact in the past two weeks. Patients re-rate these specified areas of impairment, post-intervention, permitting both individual and group-level analyses. METHODS: One-hundred and eight patients (71% female; Mean age=45 yrs) meeting Research Diagnostic Criteria for Insomnia Disorder completed the GSII, resulting in the generation of 324 areas (ranks) of sleep-related daytime and quality of life impairment. Fifty-five patients also completed the GSII pre- and post-sleep restriction therapy. The following psychometric properties were assessed: content validity of generated domains; relationship between ranks of impairment; and sensitivity to change post-behavioural intervention. RESULTS: Content analysis of generated domains support recent DSM-5 proposals for specification of daytime consequences of insomnia; with the most commonly cited areas reflecting impairments in energy/motivation, work performance, cognitive functioning, emotional regulation, health/well-being, social functioning and relationship/family functioning. Preliminary results with 108 patients indicate the GSII to have excellent face and construct validity. The GSII was found to be sensitive to change, post-behavioural treatment (p<0.001; Cohen's d≥0.85 for all three ranks of impairment), and improvements were associated with reductions in insomnia severity in both correlational (range of r=0.28-0.56) and responder versus non-responder analyses (all p<0.05). CONCLUSIONS: The development of the GSII represents a novel attempt to capture and measure sleep-related quality of life impairment in a valid and meaningful way. Further psychometric and clinical evaluation is suggested.

3 Article Characterization of Patients Who Present With Insomnia: Is There Room for a Symptom Cluster-Based Approach? 2017

Crawford, Megan R / Chirinos, Diana A / Iurcotta, Toni / Edinger, Jack D / Wyatt, James K / Manber, Rachel / Ong, Jason C. ·Department of Psychology, Swansea University, Swansea, United Kingdom. · Department of Behavioral Sciences, Rush University Medical Center, Chicago, Illinois. · Department of Psychology, Rice University, Houston, Texas. · Hofstra Northwell School of Medicine, Hempstead, New York. · Department of Medicine, National Jewish Health, Denver, Colorado. · Department of Psychiatry, Stanford University Medical Center, Palo Alto, California. · Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois. ·J Clin Sleep Med · Pubmed #28633722.

ABSTRACT: STUDY OBJECTIVES: This study examined empirically derived symptom cluster profiles among patients who present with insomnia using clinical data and polysomnography. METHODS: Latent profile analysis was used to identify symptom cluster profiles of 175 individuals (63% female) with insomnia disorder based on total scores on validated self-report instruments of daytime and nighttime symptoms (Insomnia Severity Index, Glasgow Sleep Effort Scale, Fatigue Severity Scale, Beliefs and Attitudes about Sleep, Epworth Sleepiness Scale, Pre-Sleep Arousal Scale), mean values from a 7-day sleep diary (sleep onset latency, wake after sleep onset, and sleep efficiency), and total sleep time derived from an in-laboratory PSG. RESULTS: The best-fitting model had three symptom cluster profiles: "High Subjective Wakefulness" (HSW), "Mild Insomnia" (MI) and "Insomnia-Related Distress" (IRD). The HSW symptom cluster profile (26.3% of the sample) reported high wake after sleep onset, high sleep onset latency, and low sleep efficiency. Despite relatively comparable PSG-derived total sleep time, they reported greater levels of daytime sleepiness. The MI symptom cluster profile (45.1%) reported the least disturbance in the sleep diary and questionnaires and had the highest sleep efficiency. The IRD symptom cluster profile (28.6%) reported the highest mean scores on the insomnia-related distress measures (eg, sleep effort and arousal) and waking correlates (fatigue). Covariates associated with symptom cluster membership were older age for the HSW profile, greater obstructive sleep apnea severity for the MI profile, and, when adjusting for obstructive sleep apnea severity, being overweight/obese for the IRD profile. CONCLUSIONS: The heterogeneous nature of insomnia disorder is captured by this data-driven approach to identify symptom cluster profiles. The adaptation of a symptom cluster-based approach could guide tailored patient-centered management of patients presenting with insomnia, and enhance patient care.

4 Article Management of Obstructive Sleep Apnea and Comorbid Insomnia: A Mixed-Methods Evaluation. 2017

Ong, Jason C / Crawford, Megan R / Kong, Allison / Park, Margaret / Cvengros, Jamie A / Crisostomo, M Isabel / Alexander, Ewa I / Wyatt, James K. ·a Department of Behavioral Sciences , Rush University Medical Center , Chicago , Illinois. ·Behav Sleep Med · Pubmed #26670949.

ABSTRACT: The purpose of this study was to examine the process of care in an interdisciplinary sleep clinic for patients with obstructive sleep apnea (OSA) and comorbid insomnia. A mixed-methods approach was used to examine clinical and patient-centered measures for 34 patients who received positive-airway pressure for OSA or cognitive-behavior therapy for insomnia. The results revealed baseline-to-follow-up improvements on several self-reported sleep parameters and measures of daytime functioning. Qualitative analyses from patient interviews revealed three themes: conceptual distinctions about each sleep disorder, importance of treating both sleep disorders, and preferences with regard to the sequence of treatment. These findings indicate that patients with OSA and comorbid insomnia encounter unique challenges. A dimensional approach to assessment and treatment is proposed for future research.

5 Article Evaluating the treatment of obstructive sleep apnea comorbid with insomnia disorder using an incomplete factorial design. 2016

Crawford, Megan R / Turner, Arlener D / Wyatt, James K / Fogg, Louis F / Ong, Jason C. ·Rush University Medical Center, 1653 W. Congress Parkway, Chicago, IL 60612-3833, United States. Electronic address: Megan_Crawford@rush.edu. · Rush University Medical Center, 1653 W. Congress Parkway, Chicago, IL 60612-3833, United States. ·Contemp Clin Trials · Pubmed #26733360.

ABSTRACT: Chronic insomnia disorder is a prevalent condition and a significant proportion of these individuals also have obstructive sleep apnea (OSA). These two sleep disorders have distinct pathophysiology and are managed with different treatment approaches. High comorbidity rates have been a catalyst for emerging studies examining multidisciplinary treatment for OSA comorbid with insomnia disorder. In this article, we describe a randomized clinical trial of cognitive behavioral treatment for insomnia (CBT-I) and positive airway pressure (PAP) for OSA. Participants are randomized to receive one of three treatment combinations. Individuals randomized to treatment Arm A receive sequential treatment beginning with CBT-I followed by PAP, in treatment Arm B CBT-I and PAP are administered concurrently. These treatment arms are compared to a control condition, treatment Arm C, where individuals receive PAP alone. Adopting an incomplete factorial study design will allow us to evaluate the efficacy of multidisciplinary treatment (Arms A & B) versus standard treatment alone (Arm C). In addition, the random allocation of individuals to the two different combined treatment sequences (Arm A and Arm B) will allow us to understand the benefits of the sequential administration of CBT-I and PAP relative to concurrent treatment of PAP and CBT-I. These findings will provide evidence of the clinical benefits of treating insomnia disorder in the context of OSA.

6 Article There are two sides to every question: exploring the construct of sleep quality. 2015

Crawford, Megan R / Ong, Jason C. ·Department of Behavioral Sciences, Rush University Medical Center, 1653 W. Congress Pkwy, Chicago, IL 60612 Megan_Crawford@rush.edu. ·J Clin Psychiatry · Pubmed #26132694.

ABSTRACT: -- No abstract --

7 Article The relationship between beliefs about sleep and adherence to behavioral treatment combined with meditation for insomnia. 2015

Cvengros, Jamie A / Crawford, Megan R / Manber, Rachel / Ong, Jason C. ·a Sleep Disorders Service and Research Center Rush University Medical Center. ·Behav Sleep Med · Pubmed #24354360.

ABSTRACT: This study examined beliefs about sleep, as measured by the Dysfunctional Beliefs and Attitudes about Sleep (DBAS) scale, as predictors of adherence to 3 specific insomnia treatment recommendations: restriction of time spent in bed, maintenance of a consistent rise time, and completion of daily meditation practice. Higher DBAS scores predicted poorer adherence to restriction of time spent in bed and to maintenance of a prescribed rise time. DBAS scores were not associated with completion of daily meditation. These preliminary findings suggest that pre-treatment beliefs about sleep may impact patient engagement with behavioral recommendations regarding time in bed and consistent rise time during treatment for insomnia.

8 Article From bedside back to bench? A commentary on: "The future of cognitive behavioral therapy for insomnia: what important research remains to be done?". 2013

Kyle, Simon D / Crawford, Megan R / Espie, Colin A. ·University of Manchester. ·J Clin Psychol · Pubmed #23801567.

ABSTRACT: In this month's issue of the Journal of Clinical Psychology, Vitiello and colleagues articulate an important research agenda that will help advance cognitive-behavioral therapy for insomnia (CBT-I) research and clinical practice. In addition to this ambitious agenda, we also propose that pursuing a parallel research program, focusing on treatment mechanisms and process will help move the CBT-I field forward and optimize therapeutic dissemination and uptake.

9 Article Dysfunctional beliefs and attitudes about sleep in children. 2009

Gregory, Alice M / Cox, Jenny / Crawford, Megan R / Holland, Jessica / Harvey, Allison G / Anonymous2390636. ·Goldsmiths, University of London, London, UK. a.gregory@gold.ac.uk ·J Sleep Res · Pubmed #19686237.

ABSTRACT: The objective of the study was to determine whether associations between dysfunctional beliefs and attitudes about sleep and sleep disturbance are evident in children. Cross-sectional data were collected from 123 children aged 8-10 years (49% boys). The participants came from ethnically diverse backgrounds from two inner-city schools in London, UK. Children completed the Sleep Self-Report (SSR) and the Dysfunctional Beliefs and Attitudes about Sleep (DBAS) questionnaire (which was adapted for use with children). Parents completed the Child Sleep Habits Questionnaire (CSHQ). The total DBAS score was associated with sleep disturbances defined as total SSR score (beta = 0.40, P < 0.001, r(2) = 0.15), the SSR insomnia items (beta = 0.29, P < 0.01, r(2) = 0.08) and the total CSHQ score (beta = 0.22, P < 0.05, r(2) = 0.04). Some dysfunctional beliefs about sleep predicted sleep disturbance to a greater extent than others. For example, when controlling for the other DBAS subscales, the 'control and predictability of sleep' subscale, but not the 'sleep requirements expectations' subscale, predicted total SSR score and SSR insomnia items. Given this preliminary evidence that dysfunctional beliefs and attitudes about sleep appear to be associated with sleep difficulties in children, future work is needed to further developmentally adapt a version of the DBAS appropriate for use with children.