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Sleep Initiation and Maintenance Disorders: HELP
Articles by Jason C. Ong
Based on 27 articles published since 2008

Between 2008 and 2019, Jason Ong wrote the following 27 articles about Sleep Initiation and Maintenance Disorders.
+ Citations + Abstracts
Pages: 1 · 2
1 Review The more the merrier? Working towards multidisciplinary management of obstructive sleep apnea and comorbid insomnia. 2013

Ong, Jason C / Crisostomo, M Isabel. ·Rush University Medical Center. ·J Clin Psychol · Pubmed #23382086.

ABSTRACT: OBJECTIVES: The goal of this article was to provide an overview of the diagnostic considerations, clinical features, pathophysiology, and treatment approaches for patients with obstructive sleep apnea (OSA) and comorbid insomnia. METHOD: We begin with a review of the literature on OSA and comorbid insomnia. We then present a multidisciplinary approach using pulmonary and behavioral sleep medicine treatments. RESULTS: OSA and insomnia co-occur at a high rate and such patients have distinct clinical features. Empirically supported treatments are available for OSA and insomnia independently but there are no standards or guidelines for how to implement these treatments for patients who suffer from both disorders. CONCLUSIONS: Multidisciplinary treatment holds promise for patients with comorbid sleep disorders. Further research should be aimed at optimizing treatments and developing standards of practice for this population.

2 Review Improving sleep with mindfulness and acceptance: a metacognitive model of insomnia. 2012

Ong, Jason C / Ulmer, Christi S / Manber, Rachel. ·Rush University Medical Center, Chicago, IL 60612, USA. Jason_Ong@rush.edu ·Behav Res Ther · Pubmed #22975073.

ABSTRACT: While there is an accumulating evidence to suggest that therapies using mindfulness and acceptance-based approaches have benefits for improving the symptoms of insomnia, it is unclear how these treatments work. The goal of this paper is to present a conceptual framework for the cognitive mechanisms of insomnia based upon mindfulness and acceptance approaches. The existing cognitive and behavioral models of insomnia are first reviewed and a two-level model of cognitive (primary) and metacognitive (secondary) arousal is presented in the context of insomnia. We then focus on the role of metacognition in mindfulness and acceptance-based therapies, followed by a review of these therapies in the treatment of insomnia. A conceptual framework is presented detailing the mechanisms of metacognition in the context of insomnia treatments. This model proposes that increasing awareness of the mental and physical states that are present when experiencing insomnia symptoms and then learning how to shift mental processes can promote an adaptive stance to one's response to these symptoms. These metacognitive processes are characterized by balanced appraisals, cognitive flexibility, equanimity, and commitment to values and are posited to reduce sleep-related arousal, leading to remission from insomnia. We hope that this model will further the understanding and impact of mindfulness and acceptance-based approaches to insomnia.

3 Review Chronic headaches and insomnia: working toward a biobehavioral model. 2012

Ong, Jason C / Park, Margaret. ·Department of Behavioral Sciences, Rush University Medical Center, Chicago, IL 60612-3833, USA. Jason_Ong@rush.edu ·Cephalalgia · Pubmed #22875878.

ABSTRACT: BACKGROUND: Sleep disturbances are consistently associated with chronic headaches, yet the mechanisms underlying this relationship remain unclear. One potential barrier to generating new hypotheses is the lack of synthesis between models of headache and models of sleep. The goal of this paper is to present a perspective on the chronification of migraine and tension-type headaches based upon conceptual models used in sleep research. METHODS: We provide a critical review of the literature on sleep and headache, highlighting the limitations in sleep methodology. Models of sleep physiology and insomnia are discussed, along with the potential implications for the chronification of migraine and tension-type headache. In addition, we propose a biobehavioral model that describes the interaction between behaviors related to coping with headache, the impact of these behaviors on insomnia and sleep physiology and the downstream propensity for future headache attacks. CONCLUSIONS: We hope that this perspective will stimulate interdisciplinary activity toward uncovering the pathway for more effective interventions for chronic headache patients.

4 Article The mediating role of sleep-related metacognitive processes in trait and pre-sleep state hyperarousal in insomnia disorder. 2017

Palagini, Laura / Ong, Jason C / Riemann, Dieter. ·Department of Clinical Experimental Medicine, Psychiatric Unit, University of Pisa, Italy. Electronic address: lpalagini@tiscali.it. · Department of Neurology, Northwestern Feinberg School of Medicine, Chicago, IL, USA. · Department of Clinical Psychology and Psychophysiology/Sleep Medicine, Center for Mental Disorders, University of Freiburg Medical Center, Freiburg, Germany. ·J Psychosom Res · Pubmed #28712431.

ABSTRACT: OBJECTIVE: Trait predisposition to hyperarousal and pre-sleep state hyperarousal are considered key factors in insomnia, but research also supports the role of cognitive and metacognitive processes. Therefore, the aim of this study was to evaluate the relationship between unhelpful sleep-related beliefs, sleep-related metacognition and trait/pre-sleep state arousal in insomnia disorder. METHOD: Sixty-eight subjects with insomnia disorder (DSM-5) and 36 good sleepers were evaluated with a set of questionnaires that included Dysfunctional Beliefs about Sleep scale (DBAS), Metacognitions Questionnaire - Insomnia (MCQI), Arousal Predisposition Scale (APS), and Pre-sleep Arousal Scale (PSAS). The statistical analyses included univariate, multivariate regression and mediation analyses. RESULTS: Subjects with insomnia reported higher scores on the DBAS, MCQI, APS, and PSAS (p's<0.001) compared to good sleepers. In the insomnia group, trait hyper-arousal was best determined by insomnia-related metacognition (p=0.02). Pre-sleep cognitive arousal was determined by insomnia-related metacognition (p=0.001) and trait hyperarousal (p<0.0001) after controlling for years of insomnia. Insomnia-metacognitive activity mediated the association between trait-hyperarousal and cognitive arousal (p=0.01, p=0.002) and the bidirectional association between pre-sleep cognitive and somatic arousal (p=0.002, p=0.04). CONCLUSION: This study suggests that a broad range of cognitive and metacognitive processes may be involved in the development of sleep-related arousal among people with insomnia. Insomnia metacognitive activity may influence trait factors and pre-sleep state factors depending on insomnia duration. Both insomnia evaluation and treatment may also be focused on insomnia metacognitive processes especially in subject with a long history of insomnia.

5 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.

6 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.

7 Article Sleep Misperception in Chronic Insomnia Patients with Obstructive Sleep Apnea Syndrome: Implications for Clinical Assessment. 2016

Choi, Su Jung / Suh, Sooyeon / Ong, Jason / Joo, Eun Yeon. ·Department of Nursing, Samsung Medical Center, Department of Clinical Nursing Science, Graduate School of Clinical Nursing Science, Sungkyunkwan University, Seoul, Korea. · Department of Neurology, Neuroscience Center, Samsung Biomedical Research Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. · Sungshin Women's University, Department of Psychology, Seoul, Korea. · Stanford University, Department of Psychiatry, Palo Alto, CA. · Rush University, Department of Behavioral Sciences, Chicago, IL. · Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, Korea. ·J Clin Sleep Med · Pubmed #27568893.

ABSTRACT: STUDY OBJECTIVES: To investigate whether sleep perception (SP), defined by the ratio of subjective and objective total sleep time, and habitual sleep time in various sleep disorders may be based on comorbid insomnia status. METHODS: We enrolled 420 patients (age 20-79 y) who underwent polysomnography (PSG). They were divided into three groups based on chief complaints: chronic insomnia (CI, n = 69), patients with both obstructive sleep apnea and insomnia (OSA-I, n = 49) or OSA only (OSA, n = 149). Healthy volunteers were also recruited (normal controls [NC], n = 80). We compared differences in PSG parameters and habitual sleep duration and investigated the discrepancy between objective and subjective total sleep time (TST) and sleep latency among four groups. Subjective TST was defined as sleep time perceived by participants the next morning of PSG. RESULTS: SP for TST was highest in the OSA group (median 92.9%), and lowest in the CI group (80.3%). SP of the NC group (91.4%) was higher than the CI, but there was no difference between OSA-I and OSA groups. OSA-I had higher depressive mood compared to the OSA group (p < 0.001). SP was positively associated with the presence of OSA and habitual sleep duration and negatively related to the presence of insomnia and arousal index of PSG. Insomnia patients with (OSA-I) or without OSA (CI) reported the smallest discrepancy between habitual sleep duration and objective TST. CONCLUSIONS: Patients with OSA with or without insomnia have different PSG profiles, which suggests that objective measures of sleep are an important consideration for differentiating subtypes of insomnia and tailoring proper treatment. COMMENTARY: A commentary on this articles appears in this issue on page 1437.

8 Article Digital Cognitive Behavioural Therapy for Insomnia versus sleep hygiene education: the impact of improved sleep on functional health, quality of life and psychological well-being. Study protocol for a randomised controlled trial. 2016

Espie, Colin A / Luik, Annemarie I / Cape, John / Drake, Christopher L / Siriwardena, A Niroshan / Ong, Jason C / Gordon, Christopher / Bostock, Sophie / Hames, Peter / Nisbet, Mhairi / Sheaves, Bryony / G Foster, Russell / Freeman, Daniel / Costa-Font, Joan / Emsley, Richard / Kyle, Simon D. ·Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Sir William Dunn School of Pathology, Oxford, UK. colin.espie@ndcn.ox.ac.uk. · Big Health Ltd., London, UK. colin.espie@ndcn.ox.ac.uk. · Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Sir William Dunn School of Pathology, Oxford, UK. · Big Health Ltd., London, UK. · Division of Psychology and Language Sciences, Faculty of Brain Sciences, University College London, London, UK. · Department of Sleep Disorders and Research Center, Henry Ford Health System, Detroit, MI, USA. · School of Health and Social Care, University of Lincoln, Lincoln, UK. · Rush University Medical Center, Chicago, IL, USA. · CIRUS Centre for Integrated Research and Understanding of Sleep, Woolcock Institute of Medical Research, University of Sydney, Sydney, Australia. · Sleep and Circadian Neuroscience Institute, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK. · The London School of Economics and Political Science, London, UK. · Centre for Biostatistics, Institute of Population Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK. ·Trials · Pubmed #27216112.

ABSTRACT: BACKGROUND: Previous research has demonstrated that digital CBT (dCBT), delivered via the Internet, is a scalable and effective intervention for treating insomnia in otherwise healthy adults and leads to significant improvements in primary outcomes relating to sleep. The majority of people with insomnia, however, seek help because of the functional impact and daytime consequences of poor sleep, not because of sleep discontinuity per se. Although some secondary analyses suggest that dCBT may have wider health benefits, no adequately powered study has investigated these as a primary endpoint. This study specifically aims to investigate the impact of dCBT for insomnia upon health and well-being, and will investigate sleep-related changes as mediating factors. METHODS/DESIGN: We propose a pragmatic, parallel-group, randomised controlled trial of 1000 community participants meeting criteria for insomnia disorder. In the DIALS trial (Digital Insomnia therapy to Assist your Life as well as your Sleep), participants will be randomised to dCBT delivered using web and/or mobile channels (in addition to treatment as usual (TAU)) or to sleep hygiene education (SHE), comprising a website plus a downloadable booklet (in addition to TAU). Online assessments will take place at 0 (baseline), 4 (mid-treatment), 8 (post-treatment), and 24 (follow-up) weeks. At week 25 all participants allocated to SHE will be offered dCBT, at which point the controlled element of the trial will be complete. Naturalistic follow-up will be invited at weeks 36 and 48. Primary outcomes are functional health and well-being at 8 weeks. Secondary outcomes are mood, fatigue, sleepiness, cognitive function, productivity and social functioning. All main analyses will be carried out at the end of the final controlled follow-up assessments and will be based on the intention-to-treat principle. Further analyses will determine whether observed changes in functional health and well-being are mediated by changes in sleep. The trial is funded by Big Health Ltd. DISCUSSION: This study will be the first large-scale, specifically designed investigation of the health and well-being benefits of CBT for insomnia, and the first examination of the association between CBT-mediated sleep improvement and health status. TRIAL REGISTRATION: ISRCTN60530898 .

9 Article Examining the Variability of Sleep Patterns during Treatment for Chronic Insomnia: Application of a Location-Scale Mixed Model. 2016

Ong, Jason C / Hedeker, Donald / Wyatt, James K / Manber, Rachel. ·Department of Behavioral Sciences, Rush University Medical Center, Chicago, IL. · Department of Public Health Sciences, University of Chicago, Chicago, IL. · Department of Psychiatry and Behavioral Sciences, Stanford University Medical Center, Palo Alto, CA. ·J Clin Sleep Med · Pubmed #26951414.

ABSTRACT: STUDY OBJECTIVES: The purpose of this study was to introduce a novel statistical technique called the location-scale mixed model that can be used to analyze the mean level and intra-individual variability (IIV) using longitudinal sleep data. METHODS: We applied the location-scale mixed model to examine changes from baseline in sleep efficiency on data collected from 54 participants with chronic insomnia who were randomized to an 8-week Mindfulness-Based Stress Reduction (MBSR; n = 19), an 8-week Mindfulness-Based Therapy for Insomnia (MBTI; n = 19), or an 8-week self-monitoring control (SM; n = 16). Sleep efficiency was derived from daily sleep diaries collected at baseline (days 1-7), early treatment (days 8-21), late treatment (days 22-63), and post week (days 64-70). The behavioral components (sleep restriction, stimulus control) were delivered during late treatment in MBTI. RESULTS: For MBSR and MBTI, the pre-to-post change in mean levels of sleep efficiency were significantly larger than the change in mean levels for the SM control, but the change in IIV was not significantly different. During early and late treatment, MBSR showed a larger increase in mean levels of sleep efficiency and a larger decrease in IIV relative to the SM control. At late treatment, MBTI had a larger increase in the mean level of sleep efficiency compared to SM, but the IIV was not significantly different. CONCLUSIONS: The location-scale mixed model provides a two-dimensional analysis on the mean and IIV using longitudinal sleep diary data with the potential to reveal insights into treatment mechanisms and outcomes.

10 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.

11 Article Cognitive Behavioral Therapy for Insomnia Comorbid With Psychiatric and Medical Conditions: A Meta-analysis. 2015

Wu, Jade Q / Appleman, Erica R / Salazar, Robert D / Ong, Jason C. ·Department of Psychological and Brain Sciences, Boston University, Boston, Massachusetts. · Sleep Disorders Service and Research Center, Department of Behavioral Sciences, Rush University Medical Center, Chicago, Illinois. ·JAMA Intern Med · Pubmed #26147487.

ABSTRACT: IMPORTANCE: Cognitive behavioral therapy for insomnia (CBT-I) is the most prominent nonpharmacologic treatment for insomnia disorders. Although meta-analyses have examined primary insomnia, less is known about the comparative efficacy of CBT-I on comorbid insomnia. OBJECTIVE: To examine the efficacy of CBT-I for insomnia comorbid with psychiatric and/or medical conditions for (1) remission from insomnia; (2) self-reported sleep efficiency, sleep onset latency, wake after sleep onset, total sleep time, and subjective sleep quality; and (3) comorbid symptoms. DATA SOURCES: A systematic search was conducted on June 2, 2014, through PubMed, PsycINFO, the Cochrane Library, and manual searches. Search terms included (1) CBT-I or CBT or cognitive behavioral [and its variations] or behavioral therapy [and its variations] or behavioral sleep medicine or stimulus control or sleep restriction or relaxation therapy or relaxation training or progressive muscle relaxation or paradoxical intention; and (2) insomnia or sleep disturbance. STUDY SELECTION: Studies were included if they were randomized clinical trials with at least one CBT-I arm and had an adult population meeting diagnostic criteria for insomnia as well as a concomitant condition. Inclusion in final analyses (37 studies) was based on consensus between 3 authors' independent screenings. DATA EXTRACTION AND SYNTHESIS: Data were independently extracted by 2 authors and pooled using a random-effects model. Study quality was independently evaluated by 2 authors using the Cochrane risk of bias assessment tool. MAIN OUTCOMES AND MEASURES: A priori main outcomes (ie, clinical sleep and comorbid outcomes) were derived from sleep diary and other self-report measures. RESULTS: At posttreatment evaluation, 36.0% of patients who received CBT-I were in remission from insomnia compared with 16.9% of those in control or comparison conditions (pooled odds ratio, 3.28; 95% CI, 2.30-4.68; P < .001). Pretreatment and posttreatment controlled effect sizes were medium to large for most sleep parameters (sleep efficiency: Hedges g = 0.91 [95% CI, 0.74 to 1.08]; sleep onset latency: Hedges g = 0.80 [95% CI, 0.60 to 1.00]; wake after sleep onset: Hedges g = 0.68; sleep quality: Hedges g = 0.84; all P < .001), except total sleep time. Comorbid outcomes yielded a small effect size (Hedges g = 0.39 [95% CI, 0.60-0.98]; P < .001); improvements were greater in psychiatric than in medical populations (Hedges g = 0.20 [95% CI, 0.09-0.30]; χ2 test for interaction = 12.30; P < .001). CONCLUSIONS AND RELEVANCE: Cognitive behavioral therapy for insomnia is efficacious for improving insomnia symptoms and sleep parameters for patients with comorbid insomnia. A small to medium positive effect was found across comorbid outcomes, with larger effects on psychiatric conditions compared with medical conditions. Large-scale studies with more rigorous designs to reduce detection and performance bias are needed to improve the quality of the evidence.

12 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 --

13 Article Quality measures for the care of patients with insomnia. 2015

Edinger, Jack D / Buysse, Daniel J / Deriy, Ludmila / Germain, Anne / Lewin, Daniel S / Ong, Jason C / Morgenthaler, Timothy I. ·National Jewish Health, Denver, CO. · Duke University Medical Center, Durham, NC. · University of Pittsburgh Medical School, Pittsburgh, PA. · American Academy of Sleep Medicine, Darien, IL. · Children's National Medical Center, Washington, DC. · Rush University Medical Center, Chicago, IL. · Mayo Clinic, Rochester, MN. ·J Clin Sleep Med · Pubmed #25700881.

ABSTRACT: ABSTRACT: The American Academy of Sleep Medicine (AASM) commissioned five Workgroups to develop quality measures to optimize management and care for patients with common sleep disorders including insomnia. Following the AASM process for quality measure development, this document describes measurement methods for two desirable outcomes of therapy, improving sleep quality or satisfaction, and improving daytime function, and for four processes important to achieving these goals. To achieve the outcome of improving sleep quality or satisfaction, pre- and post-treatment assessment of sleep quality or satisfaction and providing an evidence-based treatment are recommended. To realize the outcome of improving daytime functioning, pre- and post-treatment assessment of daytime functioning, provision of an evidence-based treatment, and assessment of treatment-related side effects are recommended. All insomnia measures described in this report were developed by the Insomnia Quality Measures Workgroup and approved by the AASM Quality Measures Task Force and the AASM Board of Directors. The AASM recommends the use of these measures as part of quality improvement programs that will enhance the ability to improve care for patients with insomnia.

14 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.

15 Article A randomized controlled trial of mindfulness meditation for chronic insomnia. 2014

Ong, Jason C / Manber, Rachel / Segal, Zindel / Xia, Yinglin / Shapiro, Shauna / Wyatt, James K. · ·Sleep · Pubmed #25142566.

ABSTRACT: STUDY OBJECTIVES: To evaluate the efficacy of mindfulness meditation for the treatment of chronic insomnia. DESIGN: Three-arm, single-site, randomized controlled trial. SETTING: Academic medical center. PARTICIPANTS: Fifty-four adults with chronic insomnia. INTERVENTIONS: Participants were randomized to either mindfulness-based stress reduction (MBSR), mindfulness-based therapy for insomnia (MBTI), or an eight-week self-monitoring (SM) condition. MEASUREMENTS AND RESULTS: Patient-reported outcome measures were total wake time (TWT) from sleep diaries, the pre-sleep arousal scale (PSAS), measuring a prominent waking correlate of insomnia, and the Insomnia Severity Index (ISI) to determine remission and response as clinical endpoints. Objective sleep measures were derived from laboratory polysomnography and wrist actigraphy. Linear mixed models showed that those receiving a meditation-based intervention (MBSR or MBTI) had significantly greater reductions on TWT minutes (43.75 vs 1.09), PSAS (7.13 vs 0.16), and ISI (4.56 vs 0.06) from baseline-to-post compared to SM. Post hoc analyses revealed that each intervention was superior to SM on each of the patient-reported measures, but no significant differences were found when comparing MBSR to MBTI from baseline-to-post. From baseline to 6-month follow-up, MBTI had greater reductions in ISI scores than MBSR (P < 0.05), with the largest difference occurring at the 3-month follow-up. Remission and response rates in MBTI and MBSR were sustained from post-treatment through follow-up, with MBTI showing the highest rates of treatment remission (50%) and response (78.6%) at the 6-month follow-up. CONCLUSIONS: Mindfulness meditation appears to be a viable treatment option for adults with chronic insomnia and could provide an alternative to traditional treatments for insomnia. TRIAL REGISTRATION: Mindfulness-Based Approaches to Insomnia: clinicaltrials.gov, identifier: NCT00768781.

16 Article Attribution, cognition and psychopathology in persistent insomnia disorder: outcome and mediation analysis from a randomized placebo-controlled trial of online cognitive behavioural therapy. 2014

Espie, Colin A / Kyle, Simon D / Miller, Christopher B / Ong, Jason / Hames, Peter / Fleming, Leanne. ·Sleep & Circadian Neuroscience Institute, University of Oxford, Oxford, UK; Sleepio Ltd, London, UK. Electronic address: colin.espie@ndcn.ox.ac.uk. · School of Psychological Sciences, University of Manchester, Manchester, UK. Electronic address: simon.kyle@manchester.ac.uk. · Woolcock Institute of Medical Research, University of Sydney, NSW, Australia. · Rush University Medical Center, Chicago, IL, USA. · Sleepio Ltd, London, UK. · University of Glasgow, Glasgow, Scotland, UK. ·Sleep Med · Pubmed #24791643.

ABSTRACT: OBJECTIVES: Insomnia patients complain that mental events keep them awake. This study investigates how cognitive behavioural therapy (CBT) affects such events and considers how attributional, cognitive and psychopathological symptoms may mediate sleep improvement. METHOD: A pragmatic, parallel-group randomized controlled trial of 164 adults (120 F: (mean 49 years (18-78 years)) meeting Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) criteria for insomnia disorder, assigned to CBT (n=55; 40 F), imagery relief therapy (IRT placebo; n=55; 42 F), or treatment as usual (TAU; n=54; 38 F), was conducted. CBT/IRT comprised six online sessions delivered by an animated therapist, with automated web/e-mail support. CBT users had access to a moderated community. TAU comprised 'usual care'. Participants completed the Sleep Disturbance Questionnaire (SDQ), Glasgow Content of Thoughts Inventory (GCTI), Depression Anxiety and Stress Scales (DASS) and Sleep Condition Indicator (SCI) at baseline, post treatment and 8-week follow-up. RESULTS: The sample was characterised by mental arousal, notably 'trying too hard' to sleep (SDQ), and by 'sleep and sleeplessness' and 'rehearsal and planning' thoughts (GCTI). Treatment effects were observed for all SDQ domains (e.g., CBT vs. IRT: d=0.76 for 'trying too hard'). CBT was also superior to IRT on the GCTI (e.g., 'rehearsal and planning', d=0.62; 'sleep and sleeplessness', d=0.74). CBT vs. TAU comparisons yielded larger effects, whereas placebo effects (IRT vs. TAU) were small to moderate. Hierarchical regression demonstrated partial mediation of SCI improvement by attributional and cognitive factors (R2 = 21-27%) following CBT. Improvement in sleep efficiency appears to be independent of such factors. CONCLUSION: Online CBT modifies sleep-related attributions, night-time thought content and psychopathology. This process partly mediates improvement in DSM-5-defined insomnia.

17 Article Gender and cognitive-emotional factors as predictors of pre-sleep arousal and trait hyperarousal in insomnia. 2013

Hantsoo, Liisa / Khou, Christina S / White, Corey N / Ong, Jason C. ·Department of Psychiatry, University of Pennsylvania, USA. LiisaHantsoo@gmail.com ·J Psychosom Res · Pubmed #23497828.

ABSTRACT: OBJECTIVE: Elevated pre-sleep arousal has been consistently associated with insomnia, yet the cognitive-emotional mechanisms involved in sleep-related arousal remain unclear. The purpose of this study was to identify predictors of pre-sleep arousal and trait hyperarousal from a set of variables that included self-reported affect, sleep-related cognitions, locus of control, and gender. METHODS: Cross-sectional data were analyzed for 128 participants (89 females) who met criteria for psychophysiological insomnia and completed a set of questionnaires that included the beliefs and attitudes about sleep (BAS), positive and negative affect schedule (negative subscale (nPANAS) and positive subscale (pPANAS)), sleep locus of control (SLOC), Pre-Sleep Arousal Scale (PSAS), hyperarousal scale (HAS) and demographic information. Step-wise regression was conducted with a set of independent variables, with PSAS and HAS serving as separate dependent variables. RESULTS: Trait hyperarousal was associated with higher levels of both negative and positive emotionality, as well as negative beliefs about sleep, in both genders. Pre-sleep arousal was associated with greater negative emotionality and internal sleep locus of control, varying by gender. Among women, high pre-sleep arousal was associated with negative emotionality, while in men greater pre-sleep arousal was associated with an internal sleep locus of control. CONCLUSION: These findings have clinical implications, suggesting that men and women may require different cognitive targets when addressing pre-sleep arousal.

18 Article A randomized, placebo-controlled trial of online cognitive behavioral therapy for chronic insomnia disorder delivered via an automated media-rich web application. 2012

Espie, Colin A / Kyle, Simon D / Williams, Chris / Ong, Jason C / Douglas, Neil J / Hames, Peter / Brown, June S L. ·University of Glasgow Sleep Centre, Glasgow, Scotland, UK. Colin.Espie@glasgow.ac.uk ·Sleep · Pubmed #22654196.

ABSTRACT: STUDY OBJECTIVES: The internet provides a pervasive milieu for healthcare delivery. The purpose of this study was to determine the effectiveness of a novel web-based cognitive behavioral therapy (CBT) course delivered by an automated virtual therapist, when compared with a credible placebo; an approach required because web products may be intrinsically engaging, and vulnerable to placebo response. DESIGN: Randomized, placebo-controlled trial comprising 3 arms: CBT, imagery relief therapy (IRT: placebo), treatment as usual (TAU). SETTING: Online community of participants in the UK. PARTICIPANTS: One hundred sixty-four adults (120 F: [mean age 49y (18-78y)] meeting proposed DSM-5 criteria for Insomnia Disorder, randomly assigned to CBT (n = 55; 40 F), IRT placebo (n = 55; 42 F) or TAU (n = 54; 38 F). INTERVENTIONS: CBT and IRT each comprised 6 online sessions delivered by an animated personal therapist, with automated web and email support. Participants also had access to a video library/back catalogue of session content and Wikipedia style articles. Online CBT users had access to a moderated social network/community of users. TAU comprised no restrictions on usual care and access to an online sleep diary. MEASUREMENTS AND RESULTS: Major assessments at baseline, post-treatment, and at follow-up 8-weeks post-treatment; outcomes appraised by online sleep diaries and clinical status. On the primary endpoint of sleep efficiency (SE; total time asleep expressed as a percentage of the total time spent in bed), online CBT was associated with sustained improvement at post-treatment (+20%) relative to both TAU (+6%; d = 0.95) and IRT (+6%: d = 1.06), and at 8 weeks (+20%) relative to IRT (+7%: d = 1.00) and TAU (+9%: d = 0.69) These findings were mirrored across a range of sleep diary measures. Clinical benefits of CBT were evidenced by modest superiority over placebo on daytime outcomes (d = 0.23-0.37) and by substantial improved sleep-wake functioning on the Sleep Condition Indicator (range of d = 0.77-1.20). Three-quarters of CBT participants (76% [CBT] vs. 29% [IRT] and 18% [TAU]) completed treatment with SE > 80%, more than half (55% [CBT] vs. 17% [IRT] and 8% [TAU]) with SE > 85%, and over one-third (38% [CBT] vs. 6% [IRT] and 0% [TAU]) with SE > 90%; these improvements were largely maintained during follow-up. CONCLUSION: CBT delivered using a media-rich web application with automated support and a community forum is effective in improving the sleep and associated daytime functioning of adults with insomnia disorder. CLINICAL TRIAL REGISTRATION: ISRCTN - 44615689.

19 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.

20 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.

21 Article A mindfulness-based approach to the treatment of insomnia. 2010

Ong, Jason / Sholtes, David. ·Rush University Medical Center, 1653 W. Congress Parkway, Chicago, IL 60612-3833, USA. Jason_Ong@rush.edu ·J Clin Psychol · Pubmed #20853441.

ABSTRACT: Mindfulness meditation has emerged as a novel approach to emotion regulation and stress reduction that has several health benefits. Preliminary work has been conducted on mindfulness-based therapy for insomnia (MBT-I), a meditation-based program for individuals suffering from chronic sleep disturbance. This treatment integrates behavioral treatments for insomnia with the principles and practices of mindfulness meditation. A case illustration of a chronic insomnia sufferer demonstrates the application of mindfulness principles for developing adaptive ways of working with the nocturnal symptoms and waking consequences of chronic insomnia.

22 Article The relation of trouble sleeping, depressed mood, pain, and fatigue in patients with cancer. 2009

Stepanski, Edward J / Walker, Mark S / Schwartzberg, Lee S / Blakely, L Johnetta / Ong, Jason C / Houts, Arthur C. ·Accelerated Community Oncology Research Network, 1770 Kirby Parkway, Suite 400, Memphis, TN 38138, USA. estepanski@sosacorn.com ·J Clin Sleep Med · Pubmed #19968046.

ABSTRACT: STUDY OBJECTIVES: To evaluate the relation among several symptoms that occur commonly in cancer patients: trouble sleeping, fatigue/sleepiness, depressed mood, and pain in a large cohort of cancer patients undergoing treatment in a community oncology practice. METHODS: Demographic, clinical, and patient reported outcomes data from 11,445 cancer patients undergoing treatment in a large community oncology practice were analyzed using structural equation modeling. The data were split so that a model was constructed using half of the patients; this model was then cross-validated on the remaining patients. RESULTS: Fatigue was best represented as a latent variable, and significant direct effects were found for trouble sleeping, depressed mood, and pain. Also, there were significant indirect effects of these variables on fatigue. The effect of depressed mood on fatigue and pain was mediated by trouble sleeping, and the effect of trouble sleeping on fatigue was mediated by pain. CONCLUSIONS: These results predict that interventions aimed at treatment of trouble sleeping, depressed mood, and pain will improve fatigue in patients with cancer. Further, these data predict that treatment of trouble sleeping will improve pain management in this population.

23 Article Frequency and predictors of obstructive sleep apnea among individuals with major depressive disorder and insomnia. 2009

Ong, Jason C / Gress, Jenna L / San Pedro-Salcedo, Melanie G / Manber, Rachel. ·Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA. jason_ong@rush.edu ·J Psychosom Res · Pubmed #19616140.

ABSTRACT: OBJECTIVE: Disturbances in sleep continuity are common among individuals with major depressive disorder (MDD) and can impact the course of depression and response to treatment. Several studies have examined depressive symptom severity among sleep-disordered patients with obstructive sleep apnea (OSA). In contrast, little is known about OSA in patients with MDD. The goal of this study was to examine the frequency and predictors of OSA in a sample of individuals with comorbid MDD and insomnia. METHODS: Participants were 51 individuals who enrolled in a treatment study on insomnia and depression, met criteria for MDD and comorbid insomnia, and underwent an overnight polysomnography evaluation. An apnea-hypopnea index >or=15 events per hour was used as a cutoff score for OSA. Regression analyses were conducted to examine clinical and demographic predictors of OSA severity as measured by the apnea-hypopnea index. RESULTS: The results revealed that 39% of the sample met criteria for OSA. The OSA group had significantly higher body mass index (BMI) scores and a significantly greater proportion of men. Regression analysis revealed that male sex, older age, and higher BMI were significant predictors of OSA severity. Neither depression severity nor insomnia severity was a significant predictor. CONCLUSIONS: These findings indicate that the frequency of OSA is higher among individuals with comorbid MDD and insomnia than was previously found among people with either MDD or insomnia alone. In addition, previously identified predictors of OSA (male sex, older age, and high BMI) also apply to this population.

24 Article Pain coping strategies for tension-type headache: possible implications for insomnia? 2009

Ong, Jason C / Stepanski, Edward J / Gramling, Sandra E. ·Sleep Disorders Service and Research Center, Department of Behavioral Sciences, Rush University Medical Center, 1653 West Congress Parkway, Chicago, IL 60612-3833, USA. Jason_Ong@rush.edu ·J Clin Sleep Med · Pubmed #19317381.

ABSTRACT: STUDY OBJECTIVES: Insomnia has been identified as a risk factor for tension-type headache, although the pathogenesis of sleep disturbance in this population is unclear. The present study examined pain-related self-management strategies in a nonclinical, young-adult sample for preliminary evidence to support a novel hypothesis for the development of insomnia in this population. METHODS: Self-report data on triggers of headache, pain interference with sleep, and pain-related self-management strategies were analyzed for 32 women with tension-type headache and 33 women with minimal pain who served as controls. RESULTS: The results revealed that a significantly greater proportion of the headache group relative to the control group reported sleep problems as a trigger of headaches, stress as a trigger of headache, and going to sleep as a coping strategy for pain. The headache group also reported significantly higher ratings of pain interference with sleep. Going to sleep was the most commonly used self-management strategy (81%) by headache sufferers and also rated as the most effective strategy (5.5 out of 7.0). CONCLUSIONS: These findings suggest that a bidirectional relationship between sleep disturbance and headache is present in this young-adult sample. Furthermore, the frequent use of sleep as a self-management strategy for pain is consistent with the hypothesis that sleep-seeking behavior might be a mediating factor in the development of insomnia among people with tension-type headache. This hypothesis fits within the most widely accepted conceptual model of chronic insomnia and should be further investigated in individuals with both tension-type headache and insomnia.

25 Article Mindfulness meditation and cognitive behavioral therapy for insomnia: a naturalistic 12-month follow-up. 2009

Ong, Jason C / Shapiro, Shauna L / Manber, Rachel. ·Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA. jason_c_ong@rush.edu ·Explore (NY) · Pubmed #19114261.

ABSTRACT: A unique intervention combining mindfulness meditation with cognitive behavioral therapy for insomnia (CBT-I) has been shown to have acute benefits at posttreatment in an open label study. The aim of the present study was to examine the long-term effects of this integrated intervention on measures of sleep and sleep-related distress in an attempt to characterize the natural course of insomnia following this treatment and to identify predictors of poor long-term outcome. Analyses were conducted on 21 participants, who provided follow-up data at six and 12 months posttreatment. At each time point, participants completed one week of sleep and meditation diaries and questionnaires related to mindfulness, sleep, and sleep-related distress, including the Pre-Sleep Arousal Scale, the Glasgow Sleep Effort Scale, the Kentucky Inventory of Mindfulness Skills, and the Insomnia Episode Questionnaire. Analyses examining the pattern of change across time (baseline, end of treatment, six months, and 12 months) revealed that several sleep-related benefits were maintained during the 12-month follow-up period. Participants who reported at least one insomnia episode (>or=1 month) during the follow-up period had higher scores on the Pre-Sleep Arousal Scale (P < .05) and the Glasgow Sleep Effort Scale (P < .05) at end of treatment compared with those with no insomnia episodes. Correlations between mindfulness skills and insomnia symptoms revealed significant negative correlations (P < .05) between mindfulness skills and daytime sleepiness at each of the three time points but not with nocturnal symptoms of insomnia. These results suggest that most sleep-related benefits of an intervention combining CBT-I and mindfulness meditation were maintained during the 12-month follow-up period, with indications that higher presleep arousal and sleep effort at end of treatment constitute a risk for occurrence of insomnia during the 12 months following treatment.