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Sleep Initiation and Maintenance Disorders: HELP
Articles by Stella Jouldjian
Based on 8 articles published since 2008
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Between 2008 and 2019, Stella Jouldjian wrote the following 8 articles about Sleep Initiation and Maintenance Disorders.
 
+ Citations + Abstracts
1 Article A Four-Session Sleep Intervention Program Improves Sleep for Older Adult Day Health Care Participants: Results of a Randomized Controlled Trial. 2017

Martin, Jennifer L / Song, Yeonsu / Hughes, Jaime / Jouldjian, Stella / Dzierzewski, Joseph M / Fung, Constance H / Rodriguez Tapia, Juan Carlos / Mitchell, Michael N / Alessi, Cathy A. ·Geriatric Research, Education and Clinical Center, VA Greater Los Angeles Healthcare System, North Hills, CA. · David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA. · University of North Carolina, Chapel Hill, NC. · Health Services Research & Development, Durham VA Medical Center, Durham, NC. · Department of Psychology, Virginia Commonwealth University, Richmond, VA. · Department of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile. ·Sleep · Pubmed #28482053.

ABSTRACT: Study Objective: To test the effectiveness of a 4-week behavioral Sleep Intervention Program (SIP: sleep compression, modified stimulus control, and sleep hygiene) compared to a 4-week information-only control (IC) among older adults attending a VA Adult Day Health Care (ADHC) program in a double-blind, randomized, clinical trial. Methods: Forty-two individuals (mean age: 77 years, 93% male) enrolled in a VA ADHC program were randomized to receive SIP or IC. All completed in-person sleep and health assessments at baseline, post-treatment and 4-months follow-up that included 3 days/nights of wrist actigraphy, the Pittsburgh Sleep Quality Index (PSQI), and the Insomnia Severity Index (ISI). Mixed repeated measures analysis was used to compare sleep outcomes at post-treatment and 4-months follow-up, with baseline values as covariates. Results: SIP participants (n = 21) showed significant improvement on actigraphy sleep efficiency (p = .007), number of nighttime awakenings (p = .016), and minutes awake at night (p = .001) at post-treatment, compared to IC participants (n = 21). Benefits were slightly attenuated but remained significant at 4-month follow-up (all p's < .05). There were no differences in total sleep time between groups. There was significant improvement on PSQI factor 3 (daily disturbances) at 4-month follow-up (p = .016), but no differences were observed between SIP and IC on other PSQI components or ISI scores at post-treatment or 4-month follow-up. Conclusions: A short behavioral sleep intervention may have important benefits in improving objectively measured sleep in older adults participating in ADHC. Future studies are needed to study implementation of this intervention into routine clinical care within ADHC.

2 Article Estimated Prevalence of Insomnia among Women Veterans: Results of a Postal Survey. 2017

Martin, Jennifer L / Schweizer, C Amanda / Hughes, Jaime M / Fung, Constance H / Dzierzewski, Joseph M / Washington, Donna L / Kramer, B Josea / Jouldjian, Stella / Mitchell, Michael N / Josephson, Karen R / Alessi, Cathy A. ·VA Greater Los Angeles Healthcare System, Geriatric Research, Education and Clinical Center, Los Angeles, California; David Geffen School of Medicine at the University of California, Los Angeles, California. Electronic address: Jennifer.Martin@va.gov. · VA Greater Los Angeles Healthcare System, HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy, Los Angeles, California. · Durham VA Healthcare System, Center for Health Services Research in Primary Care, Durham, North Carolina. · VA Greater Los Angeles Healthcare System, Geriatric Research, Education and Clinical Center, Los Angeles, California; David Geffen School of Medicine at the University of California, Los Angeles, California. · Virginia Commonwealth University, Department of Psychology, Richmond, Virginia. · David Geffen School of Medicine at the University of California, Los Angeles, California; VA Greater Los Angeles Healthcare System, HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy, Los Angeles, California. · VA Greater Los Angeles Healthcare System, Geriatric Research, Education and Clinical Center, Los Angeles, California. ·Womens Health Issues · Pubmed #28110799.

ABSTRACT: OBJECTIVES: Insomnia is a significant public health concern known to particularly impact women and the veteran population; however, rates of insomnia disorder among women veterans are not known. METHOD: Women veterans who had received health care at VA Greater Los Angeles Healthcare System between 2008 and 2010 and resided within 25 miles of the facility were sent a postal survey assessing sleep, demographics, and other related patient characteristics. RESULTS: A total of 660 women (43.1% of potential responders) returned the postal survey and provided sufficient information for insomnia diagnosis. On average, women reported 6.2 hours of sleep per night. The prevalence of insomnia, determined according to diagnostic criteria from the International Classification of Sleep Disorders-2, was 52.3%. Women with insomnia reported more severely disturbed sleep, and more pain, menopausal symptoms, stress/worries, and nightmares compared with women without insomnia. There was a quadratic relationship between age and insomnia with women in their mid-40s, most likely to have insomnia. CONCLUSIONS: This survey study found that insomnia symptoms were endorsed by more than one-half of the women veterans in this sample of VA users, highlighting the critical need for enhanced clinical identification and intervention. Further research is needed to establish national rates of insomnia among women veterans and to improve access to evidence-based treatment of insomnia disorder.

3 Article Acceptability of Medication and Nonmedication Treatment for Insomnia Among Female Veterans: Effects of Age, Insomnia Severity, and Psychiatric Symptoms. 2016

Culver, Najwa C / Song, Yeonsu / Kate McGowan, Sarah / Fung, Constance H / Mitchell, Michael N / Rodriguez, Juan Carlos / Dzierzewski, Joseph M / Josephson, Karen R / Jouldjian, Stella / Washington, Donna L / Yano, Elizabeth M / Schweizer, C Amanda / Alessi, Cathy A / Martin, Jennifer L. ·Geriatric Research Education and Clinical Center, VA Greater Los Angeles Healthcare System. Electronic address: najwa.culver@va.gov. · Geriatric Research Education and Clinical Center, VA Greater Los Angeles Healthcare System; David Geffen School of Medicine, University of California, Los Angeles, California. · Geriatric Research Education and Clinical Center, VA Greater Los Angeles Healthcare System. · Geriatric Research Education and Clinical Center, VA Greater Los Angeles Healthcare System; Department of Medicine, Pontificia Universidad Catolica de Chile. · Geriatric Research Education and Clinical Center, VA Greater Los Angeles Healthcare System; Department of Psychology, Virginia Commonwealth University, Virginia. · David Geffen School of Medicine, University of California, Los Angeles, California; VA Health Services Research & Development Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California. · VA Health Services Research & Development Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California; Fielding School of Public Health, University of California, Los Angeles, California. ·Clin Ther · Pubmed #28314434.

ABSTRACT: PURPOSE: Female veterans are at high risk for sleep problems, and there is a need to provide effective treatment for this population who experience insomnia. This study's primary goal was to compare the acceptability of medication versus nonmedication treatments for insomnia among female veterans. In addition, we examined the role of patient age, severity of sleep disturbance, and psychiatric symptoms on acceptability of each treatment approach and on the differences in acceptability between these approaches. METHODS: A large nationwide postal survey was sent to a random sample of 4000 female veterans who had received health care at a Veterans Administration (VA) facility in the previous 6 months (May 29, 2012-November 28, 2012). A total of 1559 completed surveys were returned. Survey items used for the current analyses included: demographic characteristics, sleep quality, psychiatric symptoms, military service experience, and acceptability of medication and nonmedication treatments for insomnia. For analysis, only ratings of "very acceptable" were used to indicate an interest in the treatment approach (vs ratings of "not at all acceptable," "a little acceptable," "somewhat acceptable," and "no opinion/don׳t know"). FINDINGS: In the final sample of 1538 women with complete data, 57.7% rated nonmedication treatment as very acceptable while only 33.5% rated medication treatment as very acceptable. This difference was statistically significant for the group as a whole and when examining subgroups of patients based on age, sleep quality, psychiatric symptoms, and military experience. The percentage of respondents rating medication treatment as very acceptable was higher for women who were younger, had more severe sleep disturbances, had more psychiatric symptoms, who were not combat exposed, and who had experienced military sexual trauma. By contrast, the percentage of respondents rating nonmedication treatment as very acceptable differed only by age (younger women were more likely to find nonmedication treatment acceptable) and difficulty falling asleep. IMPLICATIONS: Female veterans are more likely to find nonmedication insomnia treatment acceptable compared with medication treatment. Thus, it is important to match these patients with effective behavioral interventions such as cognitive behavioral therapy for insomnia. Efforts to educate providers about these preferences and about the efficacy of cognitive behavioral therapy for insomnia may serve to connect female veterans who have insomnia to the treatment they prefer. These findings also suggest that older female veterans may be less likely to find either approach as acceptable as their younger counterparts.

4 Article Cognitive Behavioral Therapy for Insomnia in Older Veterans Using Nonclinician Sleep Coaches: Randomized Controlled Trial. 2016

Alessi, Cathy / Martin, Jennifer L / Fiorentino, Lavinia / Fung, Constance H / Dzierzewski, Joseph M / Rodriguez Tapia, Juan C / Song, Yeonsu / Josephson, Karen / Jouldjian, Stella / Mitchell, Michael N. ·Geriatric Research, Education and Clinical Center, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California. cathy.alessi@va.gov. · Department of Medicine, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California. cathy.alessi@va.gov. · Geriatric Research, Education and Clinical Center, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California. · Department of Medicine, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California. · Department of Psychiatry, University of California at San Diego, San Diego, California. · Department of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile. ·J Am Geriatr Soc · Pubmed #27550552.

ABSTRACT: OBJECTIVES: To test a new cognitive behavioral therapy for insomnia (CBT-I) program designed for use by nonclinicians. DESIGN: Randomized controlled trial. SETTING: Department of Veterans Affairs healthcare system. PARTICIPANTS: Community-dwelling veterans aged 60 and older who met diagnostic criteria for insomnia of 3 months duration or longer (N = 159). INTERVENTION: Nonclinician "sleep coaches" delivered a five-session manual-based CBT-I program including stimulus control, sleep restriction, sleep hygiene, and cognitive therapy (individually or in small groups), with weekly telephone behavioral sleep medicine supervision. Controls received five sessions of general sleep education. MEASUREMENTS: Primary outcomes, including self-reported (7-day sleep diary) sleep onset latency (SOL-D), wake after sleep onset (WASO-D), total wake time (TWT-D), and sleep efficiency (SE-D); Pittsburgh Sleep Quality Index (PSQI); and objective sleep efficiency (7-day wrist actigraphy, SE-A) were measured at baseline, at the posttreatment assessment, and at 6- and 12-month follow-up. Additional measures included the Insomnia Severity Index (ISI), depressive symptoms (Patient Health Questionnaire-9 (PHQ-9)), and quality of life (Medical Outcomes Study 12-item Short-form Survey version 2 (SF-12v2)). RESULTS: Intervention subjects had greater improvement than controls between the baseline and posttreatment assessments, the baseline and 6-month assessments, and the baseline and 12-month assessments in SOL-D (-23.4, -15.8, and -17.3 minutes, respectively), TWT-D (-68.4, -37.0, and -30.9 minutes, respectively), SE-D (10.5%, 6.7%, and 5.4%, respectively), PSQI (-3.4, -2.4, and -2.1 in total score, respectively), and ISI (-4.5, -3.9, and -2.8 in total score, respectively) (all P < .05). There were no significant differences in SE-A, PHQ-9, or SF-12v2. CONCLUSION: Manual-based CBT-I delivered by nonclinician sleep coaches improves sleep in older adults with chronic insomnia.

5 Article Efficacy of Cognitive Behavioral Therapy for Insomnia in Older Adults With Occult Sleep-Disordered Breathing. 2016

Fung, Constance H / Martin, Jennifer L / Josephson, Karen / Fiorentino, Lavinia / Dzierzewski, Joseph M / Jouldjian, Stella / Tapia, Juan Carlos Rodriguez / Mitchell, Michael N / Alessi, Cathy. ·From the Geriatric Research, Education and Clinical Center (Fung, Martin, Josephson, Dzierzewski, Jouldjian, Rodriguez, Mitchell, Alessi), VA Greater Los Angeles Healthcare System, Los Angeles, California · Department of Medicine (Fung, Martin, Dzierzewski, Rodriguez, Alessi), David Geffen School of Medicine at UCLA, Los Angeles, California · School of Medicine (Fiorentino), University of California, San Diego, California · and Department of Medicine (Rodriguez), Pontificia Universidad Catolica de Chile, Santiago, Región Metropolitana, Chile. ·Psychosom Med · Pubmed #27136498.

ABSTRACT: OBJECTIVES: The aims of the study were to determine whether mild, occult sleep-disordered breathing (SDB) moderates the efficacy of cognitive behavioral therapy for insomnia (CBTI) in older adults and to explore whether CBTI reduces the number of patients eligible for positive airway pressure (PAP) therapy. METHODS: Data were analyzed for 134 adults 60 years or older with insomnia and apnea-hypopnea index (AHI) of less than 15 who were randomized to a larger study of CBTI versus a sleep education control. Sleep outcomes (sleep onset latency, total wake time, wake after sleep onset, sleep efficiency, Pittsburgh Sleep Quality Index) were compared between CBTI and control at 6 months using repeated-measures analysis of variance adjusted for baseline values. AHI of 5 or greater versus less than 5 was included as an interaction term to evaluate changes in sleep outcomes. The number of participants at baseline and 6 months with mild SDB for whom insomnia was their only other indication for PAP was also compared between CBTI and control. RESULTS: AHI status (AHI ≥ 5 [75.5% of participants] versus AHI < 5) did not moderate improvements in sleep associated with CBTI (all p values ≥ .12). Nine (45.0%) of 20 participants with mild SDB for whom insomnia was their only other indication for PAP therapy at baseline no longer had another indication for PAP at 6 months, with no significant difference between CBTI and control. CONCLUSIONS: CBTI improves sleep in older veterans with insomnia and untreated mild SDB. Larger trials are needed to assess whether CBTI reduces the number of patients with mild SDB eligible for PAP.

6 Article Prevalence and symptoms of occult sleep disordered breathing among older veterans with insomnia. 2013

Fung, Constance H / Martin, Jennifer L / Dzierzewski, Joseph M / Jouldjian, Stella / Josephson, Karen / Park, Michelle / Alessi, Cathy. ·Geriatric Research, Education and Clinical Center (GRECC): Veterans Administration Greater Los Angeles Healthcare System, Los Angeles, CA ; David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA. ·J Clin Sleep Med · Pubmed #24235899.

ABSTRACT: STUDY OBJECTIVES: To determine the prevalence of occult sleep disordered breathing (SDB) and describe the relationship between classic SDB symptoms (e.g., loud snoring) and occult SDB in older veterans with insomnia. METHODS: We analyzed baseline survey and in-home sleep study data for 435 veterans (mean age = 72.0 years [SD 8.0]) who had no known history of SDB, met International Classification of Sleep Disorders 2(nd) Edition criteria for insomnia, and were enrolled in a behavioral intervention trial for insomnia. Variables of interest included apnea-hypopnea index (AHI) ≥ 15, age, race/ethnicity, marital status, body mass index (BMI), insomnia subtype (i.e., onset, maintenance, or terminal), self-reported excessive daytime sleepiness, snoring, and witnessed breathing pause items from the Berlin Questionnaire. We computed the frequency of AHI ≥ 15 and assessed whether each classic SDB symptom was associated with an AHI ≥ 15 in 4 separate multivariate logistic regression models. RESULTS: Prevalence of AHI ≥ 15 was 46.7%. Excessive daytime sleepiness (adjusted odds ratio 1.63, 95% CI 1.02, 2.60, p = 0.04), but not snoring loudness, snoring frequency, or witnessed breathing pauses was associated with occult SDB (AHI ≥ 15). Insomnia subtypes were not significantly associated with occult SDB (p > 0.38). CONCLUSIONS: In our sample of older veterans with insomnia, nearly half had occult SDB, which was characterized by reported excessive daytime sleepiness, but not loud or frequent snoring or witnessed breathing pauses. Insomnia subtype was unrelated to the presence of occult SDB.

7 Article Insomnia and symptoms of post-traumatic stress disorder among women veterans. 2013

Hughes, Jaime / Jouldjian, Stella / Washington, Donna L / Alessi, Cathy A / Martin, Jennifer L. ·Geriatric Research, Education, and Clinical Center, VA Greater Los Angeles Healthcare System. ·Behav Sleep Med · Pubmed #23205531.

ABSTRACT: Women will account for 10% of the Veteran population by 2020, yet there has been little focus on sleep issues among women Veterans. In a descriptive study of 107 women Veterans with insomnia (mean age = 49 years, 44% non-Hispanic white), 55% had probable post traumatic stress disorder (PTSD) (total score ≥33). Probable PTSD was related to more severe self-reported sleep disruption and greater psychological distress. In a regression model, higher PTSD Checklist-Civilian (PCL-C) total score was a significant independent predictor of worse insomnia severity index score while other factors were not. Women Veterans preferred behavioral treatments over pharmacotherapy in general, and efforts to increase the availability of such treatments should be undertaken. Further research is needed to better understand the complex relationship between insomnia and PTSD among women Veterans.

8 Article Poor self-reported sleep quality predicts mortality within one year of inpatient post-acute rehabilitation among older adults. 2011

Martin, Jennifer L / Fiorentino, Lavinia / Jouldjian, Stella / Mitchell, Michael / Josephson, Karen R / Alessi, Cathy A. ·David Geffen School of Medicine, University of California, Los Angeles, USA. ·Sleep · Pubmed #22131610.

ABSTRACT: STUDY OBJECTIVE: To evaluate the association between self-reported sleep quality among older adults during inpatient post-acute rehabilitation and one-year survival. DESIGN: Prospective, observational cohort study. SETTING: Two inpatient post-acute rehabilitation sites (one community and one Veterans Administration). PARTICIPANTS: Older patients (aged ≥ 65 years, n = 245) admitted for inpatient post-acute rehabilitation. INTERVENTIONS: None. MEASUREMENTS AND RESULTS: Within one year of post-acute rehabilitation, 57 participants (23%) were deceased. Cox proportional hazards models showed that worse Pittsburgh Sleep Quality Index (PSQI) total scores during the post-acute care stay were associated with increased mortality risk when controlling for amount of rehabilitation therapy received, comorbidities, and cognitive functioning (Hazard ratio [95% CI] = 1.11 [1.02-1.20]). Actigraphically estimated sleep was unrelated to mortality risk. CONCLUSIONS: Poorer self-reported sleep quality, but not objectively estimated sleep parameters, during post-acute rehabilitation was associated with shorter survival among older adults. This suggests self-reported poor sleep may be an important and potentially modifiable risk factor for negative outcomes in these vulnerable older adults. Studies of interventions to improve sleep quality during inpatient rehabilitation should therefore be undertaken, and the long-term health benefits of improved sleep should be explored.