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Sleep Initiation and Maintenance Disorders: HELP
Articles by Sheila N. Garland
Based on 20 articles published since 2009
(Why 20 articles?)
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Between 2009 and 2019, S. Garland wrote the following 20 articles about Sleep Initiation and Maintenance Disorders.
 
+ Citations + Abstracts
1 Guideline A Pan-Canadian practice guideline: prevention, screening, assessment, and treatment of sleep disturbances in adults with cancer. 2013

Howell, Doris / Oliver, Thomas K / Keller-Olaman, Sue / Davidson, Judith / Garland, Sheila / Samuels, Charles / Savard, Josée / Harris, Cheryl / Aubin, Michèle / Olson, Karin / Sussman, Jonathan / Macfarlane, James / Taylor, Claudette / Anonymous3410759. ·University Health Network (Princess Margaret Hospital), 610 University Avenue PMH, Room 15-617, Toronto, ON, Canada, doris.howell@uhn.on.ca. ·Support Care Cancer · Pubmed #23708820.

ABSTRACT: PURPOSE: This study aims to provide recommendations on the optimal strategies and interventions for the prevention, screening, assessment, and management of cancer-related sleep disturbance (insomnia and insomnia syndrome) in adult cancer populations. METHODS: A systematic search of the published health literature was conducted to identify randomized controlled trials, clinical practice guidelines, systematic reviews, and other guidance documents. The Sleep Disturbance Expert Panel [comprised of nurses, psychologists, primary care physicians, oncologists, physicians specialized in sleep disturbances, researchers, and guideline methodologists] reviewed, discussed, and approved the final version of the guideline. Health care professionals across Canada were asked to provide feedback through an external review process. RESULTS: Three clinical practice guidelines and 12 randomized controlled trials were identified as the evidence base. Overall, despite the paucity of evidence, the evidence and expert consensus suggest that it is important to screen and assess adult cancer patients for sleep disturbances using standardized screening tools on a routine basis. While prevention of sleep disturbance is the desired objective, cognitive behavioral therapies are effective in improving sleep outcomes. As part of the external review with 16 health care providers, 81 % indicated that they agreed with the recommendations as written. CONCLUSIONS: Sleep difficulty is a prevalent problem in cancer populations that needs greater recognition by health professionals. Prevention, screening, assessment, and treatment strategies supported by the best available evidence are critical. Recommendations and care path algorithms for practice are offered.

2 Review A Meta-Analysis of Mindfulness-Based Therapies for Insomnia and Sleep Disturbance: Moving Towards Processes of Change. 2019

Rash, Joshua A / Kavanagh, Victoria A J / Garland, Sheila N. ·Department of Psychology, Faculty of Science, Memorial University of Newfoundland, 232 Elizabeth Avenue, St John's, Newfoundland A1B 3X9, Canada. · Department of Psychology, Faculty of Science, Memorial University of Newfoundland, 232 Elizabeth Avenue, St John's, Newfoundland A1B 3X9, Canada; Division of Oncology, Faculty of Medicine, Memorial University of Newfoundland, 300 Prince Phillip Drive, St John's, Newfoundland A1B 3V6, Canada. Electronic address: sheila.garland@mun.ca. ·Sleep Med Clin · Pubmed #31029188.

ABSTRACT: Mindfulness-based therapies (MBTs) are increasingly being investigated as a treatment for insomnia and general sleep disturbance, but significant gaps remain in the evidence base. In this article, the authors present (1) a unifying psychological process model that relates mindfulness to sleep; (2) a systematic review of the literature reporting on trials of MBTs for insomnia and sleep disturbance, which includes an assessment of quality of trial reporting, adaptation of MBTs for sleep, and whether mindfulness practice was associated with effects observed; and (3) a meta-analysis of MBTs for insomnia and sleep disturbance compared with attention/education and waitlist control groups.

3 Review A systematic review and meta-analysis of randomized controlled trials of cognitive behavior therapy for insomnia (CBT-I) in cancer survivors. 2016

Johnson, Jillian A / Rash, Joshua A / Campbell, Tavis S / Savard, Josée / Gehrman, Philip R / Perlis, Michael / Carlson, Linda E / Garland, Sheila N. ·Department of Psychology, University of Calgary, Calgary, Alberta, Canada. · School of Psychology, Laval University, Quebec City, Quebec, Canada. · Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA. · Department of Oncology, University of Calgary, Calgary, Alberta, Canada. · Department of Family Medicine and Community Health, University of Pennsylvania, Philadelphia, PA, USA; Department of Psychology, Memorial University of Newfoundland, St. John's, Newfoundland, Canada. Electronic address: sheila.garland@mun.ca. ·Sleep Med Rev · Pubmed #26434673.

ABSTRACT: This review examined the efficacy of cognitive behavior therapy for insomnia (CBT-I) in people diagnosed with cancer. Studies were identified through November 2014 using multiple databases, clinical trial records, and bibliography searches. Inclusion was limited to randomized controlled trials of CBT-I conducted in individuals with a cancer diagnosis who had clinically relevant insomnia. The primary outcome variable was sleep efficiency (SE) as measured by sleep diary. Eight studies including data from 752 cancer survivors met inclusion criteria. CBT-I resulted in a 15.5% improvement in SE relative to control conditions (6.1%) from pre- to post-intervention, with a medium effect size (ES: d = 0.53). Overall, sleep latency was reduced by 22 min with an ES of d = 0.43, compared to a reduction of 8 min in the control conditions. Wake after sleep onset was reduced by 30 min with an ES of d = 0.41, compared to 13 min in the control conditions. Large effect sizes were observed for self-reported insomnia severity (d = 0.77) for those patients who received CBT-I, representing a clinically relevant eight point reduction. Effects were durable up to 6 mo. The quality of the evidence supports a strong recommendation for the use of CBT-I among cancer survivors.

4 Review Sleep disturbance in adults with cancer: a systematic review of evidence for best practices in assessment and management for clinical practice. 2014

Howell, D / Oliver, T K / Keller-Olaman, S / Davidson, J R / Garland, S / Samuels, C / Savard, J / Harris, C / Aubin, M / Olson, K / Sussman, J / MacFarlane, J / Taylor, C. ·University Health Network & Faculty of Nursing, University of Toronto, Toronto. ·Ann Oncol · Pubmed #24287882.

ABSTRACT: Sleep disturbance is prevalent in cancer with detrimental effects on health outcomes. Sleep problems are seldom identified or addressed in cancer practice. The purpose of this review was to identify the evidence base for the assessment and management of cancer-related sleep disturbance (insomnia and insomnia syndrome) for oncology practice. The search of the health literature included grey literature data sources and empirical databases from June 2004 to June 2012. The evidence was reviewed by a Canadian Sleep Expert Panel, comprised of nurses, psychologists, primary care physicians, oncologists, physicians specialized in sleep disturbances, researchers and guideline methodologists to develop clinical practice recommendations for pan-Canadian use reported in a separate paper. Three clinical practice guidelines and 12 randomized, controlled trials were identified as the main source of evidence. Additional guidelines and systematic reviews were also reviewed for evidence-based recommendations on the assessment and management of insomnia not necessarily in cancer. A need to routinely screen for sleep disturbances was identified and the randomized, controlled trial (RCT) evidence suggests benefits for cognitive behavioural therapy for improving sleep quality in cancer. Sleep disturbance is a prevalent problem in cancer that needs greater recognition in clinical practice and in future research.

5 Article Social Support, Insomnia, and Adherence to Cognitive Behavioral Therapy for Insomnia After Cancer Treatment. 2019

Kamen, Charles / Garland, Sheila N / Heckler, Charles E / Peoples, Anita R / Kleckner, Ian R / Cole, Calvin L / Perlis, Michael L / Morrow, Gary R / Mustian, Karen M / Roscoe, Joseph A. ·a Department of Surgery , University of Rochester Medical Center , Rochester , New York. · b Department of Psychology , Memorial University of Newfoundland , St. John's , Newfoundland and Labrador , Canada. · c Department of Psychiatry , University of Pennsylvania , Philadelphia , Pennsylvania. ·Behav Sleep Med · Pubmed #28128982.

ABSTRACT: OBJECTIVE/BACKGROUND: While cognitive-behavioral therapy for insomnia (CBT-I) has been shown to be efficacious in treating cancer survivors' insomnia, 30-60% of individuals have difficulty adhering to intervention components. Psychosocial predictors of adherence and response to CBT-I, such as social support, have not been examined in intervention studies for cancer survivors. PARTICIPANTS: Data from a randomized placebo-controlled 2 x 2 trial of CBT-I and armodafinil (a wakefulness promoting agent) were used to assess adherence. Ninety-six cancer survivors participated in the trial (mean age 56, 86% female, 68% breast cancer). METHODS: CBT-I and armodafinil were administered over the course of seven weeks, and participants were assessed at baseline, during intervention, postintervention, and at a three-month follow-up. Social support was assessed using a Functional Assessment of Chronic Illness Therapy subscale, insomnia severity was assessed using the Insomnia Severity Index, and adherence was measured based on CBT-I sleep prescriptions. RESULTS: At baseline, social support was negatively correlated with insomnia severity (r = -0.30, p = 0.002) and associations between social support, CBT-I, and insomnia were maintained through the three-month follow-up. Social support was positively associated with adherence to CBT-I during intervention weeks 3, 4, and 5, and with overall intervention adherence. At postintervention, both social support and treatment with CBT-I independently predicted decreased insomnia severity (p < 0.01) when controlling for baseline insomnia severity. CONCLUSIONS: Higher social support is associated with better intervention adherence and improved sleep independent of CBT-I. Additional research is needed to determine whether social support can be leveraged to improve adherence and response to CBT-I.

6 Article Are sleep continuity disturbance and fatigue prodromal symptoms of cancer development? 2018

Garland, Sheila N / Irwin, Michael R / Posner, Donn / Perlis, Michael L. ·Departments of Psychology and Oncology, Memorial University, 232 Elizabeth Avenue, St. John's, Newfoundland A1B 3X9, Canada. Electronic address: sheila.garland@mun.ca. · Cousins Center for Psychoneuroimmunology at the UCLA Semel Institute for Neuroscience, and the Departments of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, 300 UCLA Medical Plaza #3109, Los Angeles, CA 90095, United States. · Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, Stanford, CA 94305-5717, United States. · Behavioral Sleep Medicine Program, Department of Psychiatry, University of Pennsylvania, 3535 Market Street, Suite 670, Philadelphia, PA 19104, United States. ·Med Hypotheses · Pubmed #30220346.

ABSTRACT: Sleep continuity disturbance (also known as insomnia) and fatigue are common complaints of individuals diagnosed with cancer. Traditionally, many have believed that sleep continuity disturbance and fatigue are caused, in large measure, by the impact of the cancer diagnosis and treatment. Recent prospective research suggests however, that sleep continuity disturbance and fatigue may actually precede a cancer diagnosis. We suggest that sleep continuity disturbance and fatigue may in fact represent prodromal symptoms of cancer. We review the current perspectives of this sequence of events and present a revised schematic that accounts for the role of biological, behavioural, and cognitive factors that contribute to the development and maintenance of sleep continuity disturbances in cancer patients. Monitoring emergent and unexplained patient-reported fatigue, sleepiness, and insomnia may serve as early warning signs of new onset cancer, providing opportunity for early detection and early intervention.

7 Article A decade's difference: 10-year change in insomnia symptom prevalence in Canada depends on sociodemographics and health status. 2018

Garland, Sheila N / Rowe, Hillary / Repa, Lily M / Fowler, Ken / Zhou, Eric S / Grandner, Michael A. ·Department of Psychology, Faculty of Science, Memorial University, St. John's, NL, Canada; Division of Oncology, Faculty of Medicine, Memorial University, St. John's, NL, Canada. Electronic address: sheila.garland@mun.ca. · Department of Psychology, Faculty of Science, Memorial University, St. John's, NL, Canada. · Department of Pediatrics, Harvard Medical School, Boston, MA, USA. · Department of Psychiatry, University of Arizona, Tucson, AZ, USA. ·Sleep Health · Pubmed #29555129.

ABSTRACT: INTRODUCTION: Insomnia is recognized as a public health issue. The objectives of this study were to characterize and compare the prevalence of insomnia symptoms in the Canadian population in 2002 and 2012, and to identify sociodemographic and psychosocial predictors of trouble sleeping. METHODS: Data from adult participants in the Canadian Community Health Survey-Mental Health cycles 2000-2002 (n = 34,118) and 2011-2012 (n = 23,089) were used. Participants responded to the question "How often do you have trouble going to sleep or staying asleep?", with those who indicated "most of the time" or "all of the time" classified as having insomnia symptoms. Logistic regressions, adjusted for covariates, were used to examine differences between cycles. RESULTS: The unadjusted prevalence of insomnia symptoms increased from 15.6% to 17.1% between 2002 and 2012, representing an absolute increase of 1.5%. The likelihood of insomnia symptoms was significantly influenced by age, sex, education, physical health, and mental health status. A 3-way year-age-sex interaction was statistically significant such that women aged 40-59 demonstrated approximately 29% increased likelihood of insomnia symptoms from 2002 to 2012. This was reduced to 24% when adjusted for physical and mental health. There were no significant differences for men across age groups. CONCLUSION: Over a 10-year period, the prevalence of insomnia symptoms increased in Canada. This trend appears to be driven in part by greater levels of insomnia symptoms among middle-aged women.

8 Article Factors that shape preference for acupuncture or cognitive behavioral therapy for the treatment of insomnia in cancer patients. 2018

Garland, Sheila N / Eriksen, Whitney / Song, Sarah / Dearing, Joshua / Barg, Frances K / Gehrman, Philip / Mao, Jun J. ·Departments of Psychology and Oncology, Memorial University of Newfoundland, St. John's, NL, Canada. sheila.garland@mun.ca. · Department of Family Medicine and Community Health, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA. · Geisinger Commonwealth School of Medicine, Scranton, PA, USA. · Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA. · The Bendheim Center for Integrative Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, USA. ·Support Care Cancer · Pubmed #29423681.

ABSTRACT: PURPOSE: Patient preference is an essential component of patient-centered supportive cancer care; however, little is known about the factors that shape preference for treatment. This study sought to understand what factors may contribute to patient preference for two non-pharmacological interventions, acupuncture or cognitive behavioral therapy for insomnia (CBT-I). METHODS: We conducted individual, open-ended, semi-structured interviews among cancer survivors who had completed active treatment and met the diagnostic criteria for insomnia disorder. Two forms of codes were used for analysis: a priori set of codes derived from the key ideas and a set of codes that emerged from the data. RESULTS: Among 53 participants, the median age was 60.7 (range 27-83), 30 participants (56.6%) were female, and 18 (34%) were non-white. We identified three themes that contributed to an individual's treatment preference: perception of the treatment's evidence base, experience with the treatment, and consideration of personal factors. Participants gave preference to the treatment perceived as having stronger evidence. Participants also reflected on positive or negative experiences with both of the interventions, counting their own experiences, as well as those of trusted sources. Lastly, participants considered their own unique circumstances and factors such as the amount of work involved, fit with personality, or fit with their "type" of insomnia. CONCLUSIONS: Knowledge of the evidence base, past experience, and personal factors shaped patient preference regardless of whether they accurately represent the evidence. Acknowledging these salient factors may help inform patient-centered decision-making and care.

9 Article Effects of cognitive behavioral therapy for insomnia and armodafinil on quality of life in cancer survivors: a randomized placebo-controlled trial. 2017

Peoples, Anita R / Garland, Sheila N / Perlis, Michael L / Savard, Josée / Heckler, Charles E / Kamen, Charles S / Ryan, Julie L / Mustian, Karen M / Janelsins, Michelle C / Peppone, Luke J / Morrow, Gary R / Roscoe, Joseph A. ·Department of Surgery, University of Rochester Medical Center, 265 Crittenden Blvd., CU 420658, Rochester, NY, 14642-0658, USA. Anita_Peoples@urmc.rochester.edu. · Departments of Psychology and Oncology, Memorial University, Newfoundland, Canada. · Department of Psychiatry, University of Pennsylvania, 3535 Market Street, Suite 670, Philadelphia, PA, 19104, USA. · School of Psychology, Laval University, Quebec City, QC, Canada. · Department of Surgery, University of Rochester Medical Center, 265 Crittenden Blvd., CU 420658, Rochester, NY, 14642-0658, USA. · Department of Dermatology, University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY, 14642, USA. ·J Cancer Surviv · Pubmed #28105576.

ABSTRACT: PURPOSE: Cancer-related insomnia is associated with diminished quality of life (QOL), suggesting that improvement in insomnia may improve QOL in cancer survivors. Cognitive behavioral therapy for insomnia (CBT-I) has been shown to improve insomnia, but less is known regarding its effect on QOL and whether improvement in insomnia corresponds to improved QOL. The present analysis examines the effects of CBT-I, with and without armodafinil, on QOL both directly and indirectly through improvements of insomnia. METHODS: This is an analysis of 95 cancer survivors for a specified secondary aim of a four-arm randomized controlled trial assessing the combined and individual effects of CBT-I and armodafinil to improve insomnia. QOL and insomnia severity were assessed before, during the intervention, at post-intervention, and 3 months later by Functional Assessment of Cancer Therapy-General and Insomnia Severity Index, respectively. RESULTS: Mean change in QOL from pre- to post-intervention for CBT-I + placebo, CBT-I + armodafinil, armodafinil, and placebo was 9.6 (SE = 1.8; p < 0.0001), 11.6 (SE = 1.8; p < 0.0001), -0.2 (SE = 3.2; p = 0.964), and 3.3 (SE = 2.0; p = 0.124), respectively. ANCOVA controlling for pre-intervention scores showed that participants receiving CBT-I had significantly improved QOL at post-intervention compared to those not receiving CBT-I (p < 0.0001, effect size = 0.57), with benefits being maintained at the 3-month follow-up. Path analysis revealed that this improvement in QOL was due to improvement in insomnia severity (p = 0.002), and Pearson correlations showed that changes in QOL from pre- to post-intervention were significantly associated with concurrent changes in insomnia severity (r = -0.56; p < 0.0001). Armodafinil had no effect on QOL for those who did or did not receive it (p = 0.976; effect size = -0.004). CONCLUSION: In cancer survivors with insomnia, CBT-I resulted in clinically significant improvement in QOL via improvement in insomnia. This improvement in QOL remained stable even 3 months after completing CBT-I. IMPLICATIONS FOR CANCER SURVIVORS: Considering the high prevalence of insomnia and its detrimental impact on QOL in cancer survivors and the effectiveness of CBT-I in alleviating insomnia, it is important that evidence-based non-pharmacological sleep interventions such as CBT-I be provided as an integral part of cancer care.

10 Article Insomnia in breast cancer: Independent symptom or symptom cluster? 2017

Gehrman, Philip R / Garland, Sheila N / Matura, Lea Ann / Mao, Jun. ·Perelman School of Medicine,University of Pennsylvania,Philadelphia,Pennsylvania. · Department of Psychology,Memorial University of Newfoundland,St. John's, Newfoundland,Canada. · School of Nursing,University of Pennsylvania,Philadelphia,Pennsylvania. · Memorial Sloan Kettering Cancer Center,New York,New York. ·Palliat Support Care · Pubmed #27917746.

ABSTRACT: OBJECTIVE: This study examined insomnia in the context of breast cancer, both as an independent symptom and as a component of a symptom cluster that includes depression, anxiety, fatigue, and pain. METHOD: Women with a history of breast cancer currently taking an aromatase inhibitor and who had completed cancer treatment at least one month prior to enrollment were included (n = 413). Participants completed validated measures of insomnia, fatigue, pain, depression, and anxiety. Factor analysis was utilized to examine the extent to which these symptoms could be represented by common latent factors. Insomnia severity was then separated into a symptom cluster component (I-SC) and an insomnia-unique (I-U) component. The associations between each insomnia component and demographic and clinical factors were examined in multivariate models. RESULTS: A single-factor solution provided the best fit to the symptom measures. Some 53.3% of the variance in insomnia severity was captured by this symptom cluster (I-SC), with the remaining 43.7% being unique to insomnia (I-U). Unique patterns of demographic factors (e.g., age and body-mass index), but not clinical factors, were associated with each insomnia measure. SIGNIFICANCE OF RESULTS: Approximately 50% of insomnia severity was related to the symptom cluster, with the rest being unique to insomnia. Different sociodemographic risk factors were related to the different insomnia measures. Stronger underlying foundations for the mechanisms of each component could lead to refined diagnoses and targeted interventions for addressing the overall insomnia burden in cancer patients.

11 Article Effects of armodafinil and cognitive behavior therapy for insomnia on sleep continuity and daytime sleepiness in cancer survivors. 2016

Garland, Sheila N / Roscoe, Joseph A / Heckler, Charles E / Barilla, Holly / Gehrman, Philip / Findley, James C / Peoples, Anita R / Morrow, Gary R / Kamen, Charles / Perlis, Michael L. ·Department of Family Medicine and Community Health, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA; Abramson Cancer Center, University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA 19104, USA; Behavioral Sleep Medicine Program, Department of Psychiatry, University of Pennsylvania, 3535 Market Street, Suite 670, Philadelphia, PA 19104, USA; Department of Psychology, Memorial University of Newfoundland, 232 Elizabeth Avenue, St. John's, NL A1B 3X9, Canada. Electronic address: sheila.garland@mun.ca. · James P. Wilmot Cancer Center, University of Rochester, 265 Crittenden Blvd. CU 420658, Rochester, NY 14642, USA. · Behavioral Sleep Medicine Program, Department of Psychiatry, University of Pennsylvania, 3535 Market Street, Suite 670, Philadelphia, PA 19104, USA. · Behavioral Sleep Medicine Program, Department of Psychiatry, University of Pennsylvania, 3535 Market Street, Suite 670, Philadelphia, PA 19104, USA. Electronic address: mperlis@exchange.upenn.edu. ·Sleep Med · Pubmed #27318221.

ABSTRACT: STUDY OBJECTIVES: This study involves the analysis of a secondary outcome of a trial examining whether cognitive behavior therapy for insomnia (CBT-I), a wake-promoting medication (armodafinil), or both results in greater improvement in prospectively assessed sleep continuity and daytime sleepiness than a placebo-alone group among a heterogeneous group of cancer survivors. Whether or not armodafinil alone, and/or when combined with CBT-I, affected adherence with CBT-I was evaluated. DESIGN: This study is a randomized, placebo-controlled, clinical trial. SETTING: This study was conducted at two northeastern academic medical centers. PARTICIPANTS: Eighty-eight cancer survivors with chronic insomnia were recruited between October 2008 and November 2012. Participants were assigned to one of four conditions: 1) CBT-I and placebo (CBT-I+P); 2) CBT-I and armodafinil (CBT-I + A); 2) armodafinil alone (ARM); or 4) placebo alone (PLA). INTERVENTIONS: CBT-I was delivered in seven weekly individual therapy sessions (three in person, four via telephone). The armodafinil dosage was 50 mg BID. MEASUREMENTS AND RESULTS: Sleep continuity was measured with daily sleep diaries assessing sleep latency (SL), wake after sleep onset (WASO), and total sleep time (TST). The Epworth Sleepiness Scale (ESS) measured daytime sleepiness. Compared to the PLA group, the CBT-I+P and CBT-I+A groups reported a significant reduction in SL with effect sizes of 0.67 and 0.58, respectively. A significant reduction was observed in WASO in the CBT-I+A group with an effect size of 0.64. An increasing trend of TST was observed in the CBT-I+P, CBT-I+A, and PLA groups, but not in the ARM group. No statistically significant reductions in daytime sleepiness (ESS) were observed for any of the groups. CONCLUSION: CBT-I alone and in combination with armodafinil caused significant improvement in sleep continuity. The addition of armodafinil did not appear to improve daytime sleepiness or enhance adherence to CBT-I.

12 Article CHoosing Options for Insomnia in Cancer Effectively (CHOICE): Design of a patient centered comparative effectiveness trial of acupuncture and cognitive behavior therapy for insomnia. 2016

Garland, Sheila N / Gehrman, Philip / Barg, Frances K / Xie, Sharon X / Mao, Jun J. ·Department of Psychology, Memorial University of Newfoundland, St. John's, NL, Canada. · Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States. · Department of Family Medicine and Community Health, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States. · Department of Biostatistics and Epidemiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States. · The Bendheim Center for Integrative Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, United States. Electronic address: maoj@mskcc.org. ·Contemp Clin Trials · Pubmed #26956541.

ABSTRACT: Insomnia is a prevalent and persistent side effect of cancer, which if left unaddressed, can be unremitting and negatively influence physical and mental well-being. Acupuncture and Cognitive Behavioral Therapy (CBT) are commonly used non-pharmacological treatments that are efficacious for treating insomnia in cancer patients; however, little is known about the comparative effectiveness of these options. The goal of personalized medicine is to determine which treatments are most effective for which individuals, and patient preference for treatment is a particularly important contributor to adherence and outcomes. Here we describe the design of a clinical trial that begins to determine how best to personalize the treatment of insomnia for cancer survivors. This project is a randomized controlled comparative effectiveness trial with a nested qualitative study comparing acupuncture and CBT for insomnia and co-morbid symptoms in a heterogeneous sample of 160 cancer survivors. The primary aim is to determine which treatment is associated with the largest reduction in insomnia severity. The secondary aim is to examine the demographic, clinical, and psychological characteristics that predict and/or moderate treatment effect. Patients will receive ten treatments of acupuncture or 7 sessions of CBT over eight weeks and complete validated patient-reported outcome measures of sleep and co-morbid symptoms at baseline, mid-treatment, post-treatment, and at three-months to assess durability of effect. The results of the proposed study have the potential to improve healthcare outcomes by helping cancer survivors and their caregivers make informed and evidence-based decisions, leading to patient-centered and personalized care for cancer survivors with insomnia.

13 Article Insomnia symptoms and heart rate recovery among patients in cardiac rehabilitation. 2016

Horsley, Kristin J / Rouleau, Codie R / Garland, Sheila N / Samuels, Charles / Aggarwal, Sandeep G / Stone, James A / Arena, Ross / Campbell, Tavis S. ·Department of Psychology, McGill University, Montreal, QC, Canada. · Department of Psychology, University of Calgary, Calgary, AB, Canada. · Department of Psychology, Memorial University, St. John's, NL, Canada. · Department of Family Medicine, University of Calgary, Calgary, AB, Canada. · TotalCardiology™ Rehabilitation, Calgary, AB, Canada. · Department of Cardiac Sciences, University of Calgary, Calgary, AB, Canada. · Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA. · Department of Psychology, University of Calgary, Calgary, AB, Canada. t.s.campbell@ucalgary.ca. ·J Behav Med · Pubmed #26944765.

ABSTRACT: Insomnia symptoms (i.e., difficulty falling asleep, difficulty staying asleep, and early morning awakenings) are common among people with cardiovascular disease, and have been linked to adverse cardiovascular health outcomes. Reduced parasympathetic tone is one pathway through which risk may be conferred. The purpose of this study was to evaluate whether insomnia symptoms are associated with lower parasympathetic tone in cardiac rehabilitation patients with suspected insomnia. Participants (N = 121) completed a self-report measure of insomnia severity. 1-min heart rate recovery (HRR), an index of parasympathetic tone, was obtained during a maximal exercise test. Difficulty falling asleep, but not difficulty staying asleep or early awakenings, was associated with attenuated 1-min HRR. When analyses were restricted to participants with moderate and severe insomnia severity (n = 51), the strength of this association increased. In a sample of cardiac rehabilitation patients with insomnia, only the symptom of difficulty falling asleep was associated with lower parasympathetic tone, suggesting that individual insomnia symptoms may show specificity in their associations with physiological mechanisms.

14 Article Cognitive behavioral therapy for insomnia, but not armodafinil, improves fatigue in cancer survivors with insomnia: a randomized placebo-controlled trial. 2016

Heckler, Charles E / Garland, Sheila N / Peoples, Anita R / Perlis, Michael L / Shayne, Michelle / Morrow, Gary R / Kamen, Charles / Hoefler, Jenine / Roscoe, Joseph A. ·Department of Surgery, University of Rochester James P. Wilmot Cancer Center, 265 Crittenden Blvd. CU 420658, Rochester, NY, 14642, USA. Charles_Heckler@urmc.rochester.edu. · Department of Psychology, Memorial University of Newfoundland, St. John's, NL, Canada. · Department of Surgery, University of Rochester James P. Wilmot Cancer Center, 265 Crittenden Blvd. CU 420658, Rochester, NY, 14642, USA. · Department of Psychiatry, University of Pennsylvania, 3535 Market Street, Suite 670, Philadelphia, PA, 19104, USA. ·Support Care Cancer · Pubmed #26542272.

ABSTRACT: PURPOSE: Fatigue is a prevalent, distressing side effect of cancer and cancer treatment which commonly coexists with insomnia. Cognitive behavioral therapy for insomnia (CBT-I) has been shown to improve insomnia in cancer patients, but less is known about its ability to impact fatigue. This work is the analysis for a secondary aim of a four-arm randomized controlled trial (RCT) study assessing the combined and comparative effect of CBT-I and a wakefulness-promoting agent, armodafinil (A), to improve sleep and daytime functioning in cancer survivors. Herein, we examine the effect of CBT-I, with and without A, on fatigue in cancer survivors. PATIENTS AND METHODS: This study was a four-arm factorial study with CBTI-I (yes/no) versus A (yes/no). It consisted of 96 cancer survivors (average age 56 years; 88 % female; 68 % breast cancer). Fatigue was assessed by the brief fatigue inventory (BFI) and the FACIT-Fatigue scale. The analysis assessed the additive effects of CBT-I and A and possible non-additive effects where the effect of CBT-I changes depending on the presence or absence of A. RESULTS: Analyses adjusting for baseline differences showed that CBT-I improved fatigue as measured by two separate scales (BFI: P = 0.002, Std. error = 0.32, effect size (ES) = 0.46; FACIT-Fatigue: P < 0.001, Std. error = 1.74, ES = 0.64). Armodafinil alone did not show a statistically significant effect on fatigue levels (all Ps > 0.40) nor did the drug influence the efficacy of CBT-I. Structural equation analysis revealed that reductions in insomnia severity were directly responsible for improving cancer-related fatigue. CONCLUSIONS: CBT-I with and without armodafinil resulted in a clinically and statistically significant reduction of subjective daytime fatigue in cancer survivors with chronic insomnia. Armodafinil did not improve cancer-related fatigue (CRF) and did not change the efficacy of CBT-I. Patients reporting CRF should be screened and, if indicated, treated for insomnia as part of a comprehensive fatigue management program.

15 Article The Comparative Impact of Mindfulness-Based Cancer Recovery (MBCR) and Cognitive Behavior Therapy for Insomnia (CBT-I) on Sleep and Mindfulness in Cancer Patients. 2015

Garland, Sheila N / Rouleau, Codie R / Campbell, Tavis / Samuels, Charles / Carlson, Linda E. ·Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, 415 Curie Blvd, Philadelphia, PA 19104. Electronic address: sheila.garland@mun.ca. · Department of Psychology, Faculty of Arts, University of Calgary, Calgary, Alberta, Canada. · Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada. · Department of Psychology, Faculty of Arts, University of Calgary, Calgary, Alberta, Canada; Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada. ·Explore (NY) · Pubmed #26386748.

ABSTRACT: BACKGROUND: Insomnia is an important but often overlooked side effect of cancer. Dysfunctional sleep beliefs have been identified as an important perpetuating factor for insomnia. Mindfulness practice has been demonstrated to improve sleep quality but it is unknown whether these effects relate to changes in dysfunctional sleep beliefs. PURPOSE: This study is a secondary analysis of a randomized controlled trial comparing mindfulness-based cancer recovery (MBCR) to cognitive behavior therapy for insomnia (CBT-I) in cancer patients with insomnia. This present analysis compares program impact on mindfulness, dysfunctional sleep beliefs, and insomnia severity clinical cutoffs. METHODS: Patients (MBCR, n = 32; CBT-I, n = 40) were assessed at baseline, post-program, and 3-month follow-up. RESULTS: Across both groups, patients showed improvements over time in acting with awareness (P = .021) and not judging experiences (P = .023). Changes in dysfunctional sleep beliefs produced by the CBT-I group exceeded those produced by MBCR at post-program and follow-up (P < .001). Acting with awareness, non-judging, and non-reacting were the facets of mindfulness associated with an overall reduction in dysfunctional sleep beliefs. There were no significant differences between the MBCR and CBT-I groups in the percentage of patients exceeding insomnia severity clinical cutoffs at post-program or follow-up. CONCLUSIONS: This study supports the use of both CBT-I and MBCR to reduce insomnia severity and suggests the development of mindfulness facets as a method of reducing dysfunctional sleep beliefs.

16 Article Self-reported memory problems in adult-onset cancer survivors: effects of cardiovascular disease and insomnia. 2015

Jean-Pierre, Pascal / Grandner, Michael A / Garland, Sheila N / Henry, Elizabeth / Jean-Louis, Girardin / Burish, Thomas G. ·Department of Psychology, Neurocognitive Translational Research Lab, Harper Cancer Research Institute, University of Notre Dame, Notre Dame, IN, USA; Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN, USA. Electronic address: PJeanPierre@ND.edu. · Center for Sleep and Circadian Neurobiology, University of Pennsylvania, Philadelphia, PA, USA; Department of Psychiatry, Behavioral Sleep Medicine Program, University of Pennsylvania, Philadelphia, PA, USA. · Department of Psychiatry, Behavioral Sleep Medicine Program, University of Pennsylvania, Philadelphia, PA, USA; Department of Family Medicine and Community Health, University of Pennsylvania, Philadelphia, PA, USA. · Department of Hematology/Oncology, Cardinal Bernardin Cancer Center, Loyola University Medical Center, Maywood, IL, USA. · Department of Population Health, Center for Healthful Behavior Change, New York University, New York, NY, USA. · Department of Psychology, Neurocognitive Translational Research Lab, Harper Cancer Research Institute, University of Notre Dame, Notre Dame, IN, USA. ·Sleep Med · Pubmed #26026625.

ABSTRACT: BACKGROUND: Cancer and its treatments can deleteriously affect memory. Cardiac function and insomnia can exacerbate memory problems. OBJECTIVE: To examine the relationships among cardiovascular disease, insomnia, and self-reported memory problems (SRMP) in adult-onset cancer survivors. METHODS: We included data from participants (41-64 year-old) of the 2007-2008 National Health and Nutrition Examination Survey, a nationally representative probability sample of the civilian, non-institutionalized population of the US. We excluded participants with brain cancer/stroke history since these conditions are expected to cause cognitive problems. Using binary logistic regression, we determined the prevalence of SRMP relative to cardiac problems and insomnia by weighting our results proportionally. We adjusted for predictors of memory problems: age, sex, race, education and general health. RESULTS: The sample included 2289 adults (49% females), 9% with a cancer history. The results pertain only to cancer survivors. Those with insomnia were 16 times as likely to have SRMP. Only insomnia symptoms (OR, 15.74; 95% CI, 1.73-143.30; p < 0.01) significantly predicted SRMP, uniquely explaining 12% of the variance. Insomnia accounted for 18.8% of the association between cardiac issues and SRMP, demonstrating mediation (Sobel p < 0.05). The large CI is a consequence of analyzing a sub-group of a subpopulation. Among participants without a cancer history, cardiovascular disease and insomnia were not associated with SRMP (p > 0.05). LIMITATIONS: We could not determine severity and time-related changes in SRMP. CONCLUSION: Likelihood of SRMP was higher in cancer survivors with a history of cardiovascular disease and insomnia symptoms. Future studies are needed to delineate the cardiac-insomnia-memory interrelationships.

17 Article Randomized placebo-controlled trial of cognitive behavioral therapy and armodafinil for insomnia after cancer treatment. 2015

Roscoe, Joseph A / Garland, Sheila N / Heckler, Charles E / Perlis, Michael L / Peoples, Anita R / Shayne, Michelle / Savard, Josée / Daniels, Nina P / Morrow, Gary R. ·Joseph A. Roscoe, Charles E. Heckler, Anita R. Peoples, Michelle Shayne, Nina P. Daniels, and Gary R. Morrow, University of Rochester, Rochester, NY · Sheila N. Garland and Michael L. Perlis, University of Pennsylvania, Philadelphia, PA · and Josée Savard, Université Laval, Quebec City, Quebec, Canada. ·J Clin Oncol · Pubmed #25452447.

ABSTRACT: PURPOSE: Insomnia is a distressing and often persisting consequence of cancer. Although cognitive behavioral therapy for insomnia (CBT-I) is the treatment of choice in the general population, the use of CBT-I in patients with cancer is complicated, because it can result in transient but substantial increases in daytime sleepiness. In this study, we evaluated whether CBT-I, in combination with the wakefulness-promoting agent armodafinil (A), results in better insomnia treatment outcomes in cancer survivors than CBT-I alone. PATIENTS AND METHODS: We report on a randomized trial of 96 cancer survivors (mean age, 56 years; female, 87.5%; breast cancer, 68%). The primary analyses examined whether ≥ one of the 7-week intervention conditions (ie, CBT-I, A, or both), when compared with a placebo capsule (P) group, produced significantly greater clinical gains. Insomnia was assessed by the Insomnia Severity Index and sleep quality by the Pittsburgh Sleep Quality Inventory. All patients received sleep hygiene instructions. RESULTS: Analyses controlling for baseline differences showed that both the CBT-I plus A (P = .001) and CBT-I plus P (P = .010) groups had significantly greater reductions in insomnia severity postintervention than the P group, with effect sizes of 1.31 and 1.02, respectively. Similar improvements were seen for sleep quality. Gains on both measures persisted 3 months later. CBT-I plus A was not significantly different from CBT-I plus P (P = .421), and A alone was not significantly different from P alone (P = .584). CONCLUSION: CBT-I results in significant and durable improvements in insomnia and sleep quality. A did not significantly improve the efficacy of CBT-I or independently affect insomnia or sleep quality.

18 Article A nested case-controlled comparison of telomere length and psychological functioning in breast cancer survivors with and without insomnia symptoms. 2014

Garland, Sheila N / Palmer, Christina / Donelson, Michelle / Gehrman, Philip / Johnson, F Brad / Mao, Jun J. ·1 Department of Family Medicine and Community Health, University of Pennsylvania , Philadelphia, Pennsylvania. ·Rejuvenation Res · Pubmed #25111028.

ABSTRACT: The ability to achieve sufficient restorative sleep is important in the maintenance of physical and mental health; however, disturbed sleep and insomnia symptoms are a common experience among women with breast cancer. In non-cancer populations, insufficient sleep quantity and quality has been associated with shortened telomere length (TL), a measure of accumulated cellular damage and human aging. This feasibility study compared TL in women previously diagnosed with breast cancer with clinically significant insomnia symptoms (n=70) to an age- and body mass index (BMI)-matched comparison group (n=70) of breast cancer survivors. Women with significant insomnia symptoms had higher levels of unemployment compared to women without insomnia. TL was positively skewed and shorter in the insomnia group (Median=6.000, S=1.000, standard error [SE]=0.287) than the control group (Median=6.195, S=-0.269, SE=0.287); however, this was not significant (p=0.29). Women with insomnia also reported significantly higher levels of depression (p<0.001), anxiety (p<0.001), and fatigue (p<0.001). This study provides the first measure of effect size and variability of TL in women with breast cancer and highlights the need for larger sample sizes to investigate the impact of insomnia and co-morbid symptom distress on cellular aging.

19 Article Mindfulness-based stress reduction compared with cognitive behavioral therapy for the treatment of insomnia comorbid with cancer: a randomized, partially blinded, noninferiority trial. 2014

Garland, Sheila N / Carlson, Linda E / Stephens, Alisa J / Antle, Michael C / Samuels, Charles / Campbell, Tavis S. ·Sheila N. Garland, Abramson Cancer Center, University of Pennsylvania Health System, and Perelman School of Medicine · Alisa J. Stephens, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA · Sheila N. Garland, Linda E. Carlson, Michael C. Antle, Charles Samuels, and Tavis S. Campbell, University of Calgary, Calgary, Alberta, Canada. ·J Clin Oncol · Pubmed #24395850.

ABSTRACT: PURPOSE: Our study examined whether mindfulness-based stress reduction (MBSR) is noninferior to cognitive behavioral therapy for insomnia (CBT-I) for the treatment of insomnia in patients with cancer. PATIENTS AND METHODS: This was a randomized, partially blinded, noninferiority trial involving patients with cancer with insomnia recruited from a tertiary cancer center in Calgary, Alberta, Canada, from September 2008 to March 2011. Assessments were conducted at baseline, after the program, and after 3 months of follow-up. The noninferiority margin was 4 points measured by the Insomnia Severity Index. Sleep diaries and actigraphy measured sleep onset latency (SOL), wake after sleep onset (WASO), total sleep time (TST), and sleep efficiency. Secondary outcomes included sleep quality, sleep beliefs, mood, and stress. RESULTS: Of 327 patients screened, 111 were randomly assigned (CBT-I, n = 47; MBSR, n = 64). MBSR was inferior to CBT-I for improving insomnia severity immediately after the program (P = .35), but MBSR demonstrated noninferiority at follow-up (P = .02). Sleep diary-measured SOL was reduced by 22 minutes in the CBT-I group and by 14 minutes in the MBSR group at follow-up. Similar reductions in WASO were observed for both groups. TST increased by 0.60 hours for CBT-I and 0.75 hours for MBSR. CBT-I improved sleep quality (P < .001) and dysfunctional sleep beliefs (P < .001), whereas both groups experienced reduced stress (P < .001) and mood disturbance (P < .001). CONCLUSION: Although MBSR produced a clinically significant change in sleep and psychological outcomes, CBT-I was associated with rapid and durable improvement and remains the best choice for the nonpharmacologic treatment of insomnia.

20 Article I-CAN SLEEP: rationale and design of a non-inferiority RCT of Mindfulness-based Stress Reduction and Cognitive Behavioral Therapy for the treatment of Insomnia in CANcer survivors. 2011

Garland, Sheila N / Carlson, Linda E / Antle, Michael C / Samuels, Charles / Campbell, Tavis. ·Department of Psychology, Faculty of Arts, University of Calgary, Calgary, Alberta, Canada. ·Contemp Clin Trials · Pubmed #21658476.

ABSTRACT: METHODS: This study is a randomized controlled non-inferiority trial comparing Cognitive Behavior Therapy for Insomnia (CBT-I; a known efficacious treatment) to Mindfulness-Based Stress Reduction (MBSR; a treatment with demonstrated potential). This design can efficiently compare these two treatments directly and determine whether MBSR performs to the same standard as CBT-I for the treatment of insomnia with additional benefits of reducing cancer-related distress. Participants are randomly assigned to an 8-week CBT-I or MBSR group. Sleep indices are measured using subjective (sleep diaries) and objective (actigraphy) assessment tools. The primary outcome is insomnia severity. Secondary outcomes include sleep quality, symptoms of stress, mood disturbance, mindfulness, and dysfunctional beliefs and attitudes toward sleep. Assessments are completed at three time periods: pre-treatment, post-treatment and at 3month follow up. CONCLUSIONS: Considering the high prevalence of distress and sleep disturbances in the cancer population, should MBSR produce sleep effects comparable to CBT-I, it may be more comprehensive - making it the treatment of choice for addressing cancer-related psychological sequelae.