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Sleep Initiation and Maintenance Disorders: HELP
Articles by Michael L. Perlis
Based on 51 articles published since 2009
(Why 51 articles?)
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Between 2009 and 2019, Michael Perlis wrote the following 51 articles about Sleep Initiation and Maintenance Disorders.
 
+ Citations + Abstracts
Pages: 1 · 2 · 3
1 Editorial A commentary on the "Functioning of three attentional networks and vigilance in primary insomnia". 2015

Perlis, Michael L / Roalf, David R / Kloss, Jaqueline D. ·Behavioral Sleep Medicine Program, Department of Psychiatry, University of Pennsylvania, USA. Electronic address: mperlis@upenn.edu. · Neuropsychiatry Section, Department of Psychiatry, University of Pennsylvania, USA. · Department of Psychology, Drexel University, USA. ·Sleep Med · Pubmed #26459678.

ABSTRACT: -- No abstract --

2 Editorial Insomnia symptoms predict physical and mental impairments among postmenopausal women. 2015

Grandner, Michael A / Nowakowski, Sara / Kloss, Jacqueline D / Perlis, Michael L. ·Behavioral Sleep Medicine Program, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Center for Sleep and Circadian Neurobiology, University of Pennsylvania, Philadelphia, PA, USA. Electronic address: grandner@gmail.com. · Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, TX, USA. · Department of Psychology, Drexel University, Philadelphia, PA, USA. · Behavioral Sleep Medicine Program, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Center for Sleep and Circadian Neurobiology, University of Pennsylvania, Philadelphia, PA, USA. ·Sleep Med · Pubmed #25698406.

ABSTRACT: -- No abstract --

3 Editorial Insomnia research: 3Ps and beyond. 2014

Perlis, Michael L / Corbitt, Charles B / Kloss, Jacqueline D. ·Behavioral Sleep Medicine Program, Department of Psychiatry, University of Pennsylvania, USA; Center for Sleep and Circadian Neurobiology, University of Pennsylvania, USA. Electronic address: mperlis@upenn.edu. · Behavioral Sleep Medicine Program, Department of Psychiatry, University of Pennsylvania, USA; Center for Sleep and Circadian Neurobiology, University of Pennsylvania, USA. · Department of Psychology, Drexel University, USA. ·Sleep Med Rev · Pubmed #24685396.

ABSTRACT: -- No abstract --

4 Editorial Insomnia as a cardiometabolic risk factor. 2013

Grandner, Michael A / Perlis, Michael L. · ·Sleep · Pubmed #23288965.

ABSTRACT: -- No abstract --

5 Review Altered ultradian cortisol rhythmicity as a potential neurobiologic substrate for chronic insomnia. 2018

Vargas, Ivan / Vgontzas, Alexandros N / Abelson, James L / Faghih, Rose T / Morales, Knashawn H / Perlis, Michael L. ·Center for Sleep and Circadian Neurobiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Behavioral Sleep Medicine Program, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA. Electronic address: ivargas@pennmedicine.upenn.edu. · Sleep Research and Treatment Center, Department of Psychiatry, Pennsylvania State University College of Medicine, Hershey, PA, USA. · University of Michigan, Department of Psychiatry, Ann Arbor, MI, USA. · Computational Medicine Laboratory, Department of Electrical and Computer Engineering, University of Houston, Houston, TX, USA. · Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA. · Center for Sleep and Circadian Neurobiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Behavioral Sleep Medicine Program, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; School of Nursing, University of Pennsylvania, Philadelphia, PA, USA. ·Sleep Med Rev · Pubmed #29678398.

ABSTRACT: Chronic insomnia is highly prevalent and associated with significant morbidity (i.e., confers risk for multiple psychiatric and medical disorders, such as depression and hypertension). Therefore, it is essential to identify factors that perpetuate this disorder. One candidate factor in the neurobiology of chronic insomnia is hypothalamic-pituitary-adrenal-axis dysregulation, and in particular, alterations in circadian cortisol rhythmicity. Cortisol secretory patterns, however, fluctuate with both a circadian and an ultradian rhythm (i.e., pulses every 60-120 min). Ultradian cortisol pulses are thought to be involved in the maintenance of wakefulness during the day and their relative absence at night may allow for the consolidation of sleep and/or shorter nocturnal awakenings. It is possible that the wakefulness that occurs in chronic insomnia may be associated with the aberrant occurrence of cortisol pulses at night. While cortisol pulses naturally occur with transient awakenings, it may also be the case that cortisol pulsatility becomes a conditioned phenomenon that predisposes one to awaken and/or experience prolonged nocturnal awakenings. The current review summarizes the literature on cortisol rhythmicity in subjects with chronic insomnia, and proffers the suggestion that it may be abnormalities in the ultradian rather than circadian cortisol that is associated with the pathophysiology of insomnia.

6 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.

7 Review The neurobiology, investigation, and treatment of chronic insomnia. 2015

Riemann, Dieter / Nissen, Christoph / Palagini, Laura / Otte, Andreas / Perlis, Michael L / Spiegelhalder, Kai. ·Department of Clinical Psychology and Psychophysiology/Sleep Medicine, Centre for Mental Disorders, Freiburg University Medical Centre, Freiburg, Germany. Electronic address: dieter.riemann@uniklinik-freiburg.de. · Department of Clinical Psychology and Psychophysiology/Sleep Medicine, Centre for Mental Disorders, Freiburg University Medical Centre, Freiburg, Germany. · Department of Clinical Experimental Medicine, Psychiatric Unit, University of Pisa, School of Medicine, Pisa, Italy. · Biomedical Engineering, Faculty of Electrical Engineering and Information Technology, Offenburg University, Offenburg, Germany. · Department of Psychiatry, Penn Behavioral Health, Perelman School of Medicine, Pennsylvania University, Philadelphia, PA, USA. ·Lancet Neurol · Pubmed #25895933.

ABSTRACT: Chronic insomnia is defined by difficulties in falling asleep, maintaining sleep, and early morning awakening, and is coupled with daytime consequences such as fatigue, attention deficits, and mood instability. These symptoms persist over a period of at least 3 months (Diagnostic and Statistical Manual 5 criteria). Chronic insomnia can be a symptom of many medical, neurological, and mental disorders. As a disorder, it incurs substantial health-care and occupational costs, and poses substantial risks for the development of cardiovascular and mental disorders, including cognitive deficits. Family and twin studies confirm that chronic insomnia can have a genetic component (heritability coefficients between 42% and 57%), whereas the investigation of autonomous and central nervous system parameters has identified hyperarousal as a final common pathway of the pathophysiology, implicating an imbalance of sleep-wake regulation consisting of either overactivity of the arousal systems, hypoactivity of the sleep-inducing systems, or both. Insomnia treatments include benzodiazepines, benzodiazepine-receptor agonists, and cognitive behavioural therapy. Treatments currently under investigation include transcranial magnetic or electrical brain stimulation, and novel methods to deliver psychological interventions.

8 Review Sleep disturbances as an evidence-based suicide risk factor. 2015

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

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

9 Review Comparative effectiveness of cognitive behavioral therapy for insomnia: a systematic review. 2012

Mitchell, Matthew D / Gehrman, Philip / Perlis, Michael / Umscheid, Craig A. ·Center for Evidence-based Practice, University of Pennsylvania Health System, Philadelphia, 19104, USA. mdmitchell@uphs.upenn.edu ·BMC Fam Pract · Pubmed #22631616.

ABSTRACT: BACKGROUND: Insomnia is common in primary care, can persist after co-morbid conditions are treated, and may require long-term medication treatment. A potential alternative to medications is cognitive behavioral therapy for insomnia (CBT-I). METHODS: In accordance with PRISMA guidelines, we systematically reviewed MEDLINE, EMBASE, the Cochrane Central Register, and PsycINFO for randomized controlled trials (RCTs) comparing CBT-I to any prescription or non-prescription medication in patients with primary or comorbid insomnia. Trials had to report quantitative sleep outcomes (e.g. sleep latency) in order to be included in the analysis. Extracted results included quantitative sleep outcomes, as well as psychological outcomes and adverse effects when available. Evidence base quality was assessed using GRADE. RESULTS: Five studies met criteria for analysis. Low to moderate grade evidence suggests CBT-I has superior effectiveness to benzodiazepine and non-benzodiazepine drugs in the long term, while very low grade evidence suggests benzodiazepines are more effective in the short term. Very low grade evidence supports use of CBT-I to improve psychological outcomes. CONCLUSIONS: CBT-I is effective for treating insomnia when compared with medications, and its effects may be more durable than medications. Primary care providers should consider CBT-I as a first-line treatment option for insomnia.

10 Review Acute insomnia: current conceptualizations and future directions. 2012

Ellis, Jason G / Gehrman, Philip / Espie, Colin A / Riemann, Dieter / Perlis, Michael L. ·Northumbria Centre for Sleep Research, School of Psychology and Sports Science, Northumbria University, Northumberland Building, Newcastle upon Tyne, NE1 8ST, UK. jason.ellis@northumbria.ac.uk ·Sleep Med Rev · Pubmed #21596596.

ABSTRACT: Despite significant contributions made in the area of persistent/chronic insomnia, especially with regard to the underlying mechanisms driving its maintenance, the area of acute insomnia has received comparatively little attention. The aim of this paper is to review the literature with regard to understanding the situational and personaological circumstances that surround the development of acute insomnia. The review begins by examining how the existing diagnostic systems conceptualise acute insomnia. Theoretical models that explain, or inferentially explain, the transition between normal sleep and acute insomnia are then explored and evaluated. The review then examines the current evidence base in terms of the pathogenesis of acute insomnia from naturalistic and experimental studies. Overall, the findings from the review confirm the paucity of evidence available but perhaps more importantly highlight the need for a structured diagnosis of acute insomnia as the first step in a research and treatment strategy. To this end a diagnostic system, drawing on the existing literature on stress and the systems used to diagnose depression, is forwarded and justified and a research agenda advanced.

11 Review Problems associated with short sleep: bridging the gap between laboratory and epidemiological studies. 2010

Grandner, Michael A / Patel, Nirav P / Gehrman, Philip R / Perlis, Michael L / Pack, Allan I. ·Center for Sleep and Respiratory Neurobiology, Division of Sleep Medicine, Department of Medicine, University of Pennsylvania, 125 S. 31st Street, Philadelphia, PA 19104, USA. grandner@upenn.edu ·Sleep Med Rev · Pubmed #19896872.

ABSTRACT: Existing data from laboratory studies suggest a number of negative consequences of acute reductions in sleep time. Also, epidemiological data suggest links between shorter self-reported sleep duration and negative health outcomes. These bodies of work are growing, revealing several key points of convergence and opportunities for future exploration. In addition, they begin to highlight possible problems experienced by "short sleepers," who sleep approximately 6h or less per night. While it is likely that this group is heterogeneous, comprised both of individuals with less need for sleep and those not sleeping enough, the laboratory and epidemiological findings point towards directions that can be more fully explored in verified short sleepers. This paper discusses problems associated with the terminology used to describe "short sleep," summarizes laboratory studies exploring neurobehavioral performance, metabolism and obesity, and psychological health and epidemiological studies exploring mortality risk, obesity and metabolism, cardiovascular disease, and general health/psychosocial stress, describes studies of verified short sleepers and explores areas of convergence, laying out possible future directions.

12 Review The hyperarousal model of insomnia: a review of the concept and its evidence. 2010

Riemann, Dieter / Spiegelhalder, Kai / Feige, Bernd / Voderholzer, Ulrich / Berger, Mathias / Perlis, Michael / Nissen, Christoph. ·Department of Psychiatry & Psychotherapy, Freiburg University Medical Center, Hauptstrasse 5, D-79104 Freiburg, Germany. dieter.riemann@uniklinik-freiburg.de ·Sleep Med Rev · Pubmed #19481481.

ABSTRACT: Primary insomnia is defined as difficulties in falling asleep, maintaining sleep or non-restorative sleep accompanied by significantly impaired daytime functioning in the absence of a specific physical, mental or substance-related cause. The current review provides substantial support for the concept that hyperarousal processes from the molecular to the higher system level play a key role in the pathophysiology of primary insomnia. Autonomous, neuroendocrine, neuroimmunological, electrophysiological and neuroimaging studies demonstrate increased levels of arousal in primary insomnia during both night and daytime. In the light of neurobiological theories of sleep-wake regulation, primary insomnia may be conceptualized as a final common pathway resulting from the interplay between a genetic vulnerability for an imbalance between arousing and sleep-inducing brain activity, psychosocial/medical stressors and perpetuating mechanisms including dysfunctional sleep-related behavior, learned sleep preventing associations and other cognitive factors like tendency to worry/ruminate.

13 Review The treatments of chronic insomnia: a review of benzodiazepine receptor agonists and psychological and behavioral therapies. 2009

Riemann, Dieter / Perlis, Michael L. ·Center for Sleep Research and Sleep Medicine, Department of Psychiatry and Psychotherapy, Freiburg University Medical Center, Hauptstrasse 5, 79104 Freiburg, Germany. dieter.riemann@uniklinik-freiburg.de ·Sleep Med Rev · Pubmed #19201632.

ABSTRACT: The present review provides an assessment of the efficacy and safety of benzodiazepine receptor agonists (BZRAs) and psychological and behavioral interventions for insomnia. These methods include relaxation techniques, sleep hygiene rules, stimulus control, sleep restriction and cognitive techniques, often also referred to as cognitive-behavioral therapy (CBT) when encompassing cognitive strategies and at least one kind of behavioral intervention. In order to provide a comprehensive assessment of the literature regarding the efficacy and safety of these standard treatments for insomnia, an integrative synthesis of the existing meta-analytic studies for each of the various treatment modalities was conducted. Where meta-analytic studies were not available, data from double-blind placebo-controlled randomized controlled trials (RCTs) were included. The summary findings from this review are (1) BZRAs and psychological and behavioral methods are effective to treat insomnia in the short-term and the latter have significantly more durable effects when active treatment is discontinued; and (2) there is only very limited evidence that BZRAs retain their efficacy during long-term treatment. The present review underscores the need for further research regarding the comparative efficacy and safety of these treatments for insomnia, how this varies with age and comorbidity, and how the various treatment modalities impact (1) daytime functioning, (2) quality of life, (3) health care utilization; and (4) pharmacoeconomics. Finally, it is particularly important that studies be conducted to determine if successful insomnia treatment influences the clinical course of the diseases that often occur co-morbidly with sleep continuity disturbance.

14 Clinical Trial Stress Reactivity in Insomnia. 2016

Gehrman, Philip R / Hall, Martica / Barilla, Holly / Buysse, Daniel / Perlis, Michael / Gooneratne, Nalaka / Ross, Richard J. ·a Department of Psychiatry Perelman School of Medicine at the University of Pennsylvania. · b Philadelphia Veterans Administration Medical Center. · c Sleep Medicine Institute and Department of Psychiatry , University of Pittsburgh School of Medicine. · d Division of Geriatric Medicine Perelman School of Medicine at the University of Pennsylvania. ·Behav Sleep Med · Pubmed #25126695.

ABSTRACT: This study examined whether individuals with primary insomnia (PI) are more reactive to stress than good sleepers (GS). PI and GS (n = 20 per group), matched on gender and age, completed three nights of polysomnography. On the stress night, participants received a mild electric shock and were told they could receive additional shocks during the night. Saliva samples were obtained for analysis of cortisol and alpha amylase along with self-report and visual analog scales (VAS). There was very little evidence of increased stress on the stress night, compared to the baseline night. There was also no evidence of greater stress reactivity in the PI group for any sleep or for salivary measures. In the GS group, stress reactivity measured by VAS scales was positively associated with an increase in sleep latency in the experimental night on exploratory analyses. Individuals with PI did not show greater stress reactivity compared to GS.

15 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.

16 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.

17 Article Longitudinal Study of Insomnia Symptoms Among Women During Perimenopause. 2017

Ciano, Colleen / King, Tonya S / Wright, Robin Redmon / Perlis, Michael / Sawyer, Amy M. · ·J Obstet Gynecol Neonatal Nurs · Pubmed #28886339.

ABSTRACT: OBJECTIVE: To describe the prevalence of insomnia symptoms among women during perimenopause and to examine differences in self-reported insomnia symptoms at different stages of perimenopause over 10 years. DESIGN: Secondary analysis of self-reported sleep symptoms and clinical variables using 10 years of publicly available data from the Study of Women Across the Nation (SWAN). SETTING: The data set of women's insomnia symptoms was obtained from publicly available data from the SWAN. The parent study settings included Detroit, Michigan; Northern New Jersey; Los Angeles, California; Boston, Massachusetts; Chicago, Illinois; and Pittsburgh, Pennsylvania. PARTICIPANTS: Multiethnic midlife women with a mean age of 46 years (N = 3,302) categorized as pre- and perimenopausal at baseline. METHODS: Dependent variables included self-reported insomnia symptoms: difficulty falling asleep (sleep latency), wake after sleep onset, early morning awakenings, and sleep quality. Descriptive analysis was completed for each 1-year study interval. Repeated measures logistic regression was used to identify whether insomnia symptoms changed over time by stage of perimenopause. RESULTS: Insomnia symptoms were present in 31% to 42% of perimenopausal women at any 1-year study interval. Insomnia symptoms were more prevalent in the late stage of perimenopause than the early stage (p < .001). The odds of having any insomnia symptoms were 1.3 times greater for women in the late stage of perimenopause than in the early stage (95% confidence interval [1.2, 1.5], p < .001). CONCLUSION: Insomnia symptoms are prevalent in women transitioning to menopause, and stage of perimenopause may heighten the risk to develop symptoms of insomnia disorder, which is associated with negative cardiometabolic outcomes.

18 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.

19 Article Nocturnal Wakefulness as a Previously Unrecognized Risk Factor for Suicide. 2016

Perlis, Michael L / Grandner, Michael A / Brown, Gregory K / Basner, Mathias / Chakravorty, Subhajit / Morales, Knashawn H / Gehrman, Philip R / Chaudhary, Ninad S / Thase, Michael E / Dinges, David F. ·Behavioral Sleep Medicine Program, Department of Psychiatry, University of Pennsylvania, 3535 Market St, Ste 670, Philadelphia, PA 19104. mperlis@upenn.edu. · Behavioral Sleep Medicine Program, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia bCenter for Sleep and Circadian Neurobiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia cSchool of Nursing, University of Pennsylvania, Philadelphia dCenter for the Prevention of Suicide, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia eDivision of Sleep and Chronobiology, Unit for Experimental Psychiatry, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia fMental Illness Research, Education, and Clinical Center of the Philadelphia Veterans Affairs Medical Center, Philadelphia, Pennsylvania gCenter for Clinical Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia hMaster of Population Health Sciences Program, Washington University, St Louis, Missouri iMood and Anxiety Disorders Treatment & Research Program, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia jDepartment of Psychiatry, University of Arizona, Tucson (current affiliation) kDepartment of Emergency Medicine, University of Alabama School of Medicine, Birmingham (current affiliation) lDepartment of Epidemiology, School of Public Health, University of Alabama, Birmingham (current affiliation). ·J Clin Psychiatry · Pubmed #27337421.

ABSTRACT: OBJECTIVE: Suicide is a major public health problem and the 10th leading cause of death in the United States. The identification of modifiable risk factors is essential for reducing the prevalence of suicide. Recently, it has been shown that insomnia and nightmares significantly increase the risk for suicidal ideation, attempted suicide, and death by suicide. While both forms of sleep disturbance may independently confer risk, and potentially be modifiable risk factors, it is also possible that simply being awake at night represents a specific vulnerability for suicide. The present analysis evaluates the frequency of completed suicide per hour while taking into account the percentage of individuals awake at each hour. METHODS: Archival analyses were conducted estimating the time of fatal injury using the National Violent Death Reporting System for 2003-2010 and the proportion of the American population awake per hour across the 24-hour day using the American Time Use Survey. RESULTS: The mean ± SD incident rate from 06:00-23:59 was 2.2% ± 0.7%, while the mean ± SD incident rate from 00:00-05:59 was 10.3% ± 4.9%. The maximum incident rate was from 02:00-02:59 (16.3%). Hour-by-hour observed values differed from those that would be expected by chance (P < .001), and when 6-hour blocks were examined, the observed frequency at night was 3.6 times higher than would be expected by chance (P < .001). CONCLUSIONS: Being awake at night confers greater risk for suicide than being awake at other times of the day, suggesting that disturbances of sleep or circadian neurobiology may potentiate suicide risk.

20 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.

21 Article Where are the Behavioral Sleep Medicine Providers and Where are They Needed? A Geographic Assessment. 2016

Thomas, Arthur / Grandner, Michael / Nowakowski, Sara / Nesom, Genevieve / Corbitt, Charles / Perlis, Michael L. ·a Department of Biology , University of Pennsylvania , Philadelphia , Pennsylvania , USA. · b Behavioral Sleep Medicine Program, Department of Psychiatry , University of Pennsylvania , Philadelphia , Pennsylvania , USA. · c Department of Psychiatry , College of Medicine, University of Arizona , Tucson , Arizona , USA. · d Department of Obstetrics & Gynecology, Department of Psychiatry & Behavioral Sciences , The University of Texas (Medical Branch) , Galveston , Texas , USA. · e Center for Sleep and Circadian Neurobiology , University of Pennsylvania , Philadelphia , Pennsylvania , USA. ·Behav Sleep Med · Pubmed #27159249.

ABSTRACT: Although it is widely acknowledged that there are not enough clinicians trained in either Behavioral Sleep Medicine (BSM) in general or in Cognitive Behavioral Therapy for Insomnia (CBT-I) in specific, what is unclear is whether this problem is more acute in some regions relative to others. Accordingly, a geographic approach was taken to assess this issue. Using national directories as well as e-mail listservs (Behavioral Sleep Medicine group and Behavioral Treatment for Insomnia Roster), the present study evaluated geographic patterning of CBSM and BSM providers by city, state, and country. Overall, 88% of 752 BSM providers worldwide live in the United States (n = 659). Of these, 58% reside in 12 states with ≥ 20 providers (CA, NY, PA, IL, MA, TX, FL, OH, MI, MN, WA, and CO), and 19% reside in just 2 states (NY and CA). There were 4 states with no BSM providers (NH, HI, SD, and WY). Of the 167 U.S. cities with a population of > 150,000, 105 cities have no BSM providers. These results clearly suggest that a targeted effort is needed to train individuals in both the unserved and underserved areas.

22 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.

23 Article Durability of treatment response to zolpidem with three different maintenance regimens: a preliminary study. 2015

Perlis, Michael / Grandner, Michael / Zee, Jarcy / Bremer, Erin / Whinnery, Julia / Barilla, Holly / Andalia, Priscilla / Gehrman, Phil / Morales, Knashawn / Thase, Michael / Bootzin, Richard / Ader, Robert. ·Behavioral Sleep Medicine Program, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA; Center for Sleep and Circadian Neurobiology, Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA; School or Nursing, University of Pennsylvania, Philadelphia, PA, USA. Electronic address: mperlis@upenn.edu. · Behavioral Sleep Medicine Program, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA; Center for Sleep and Circadian Neurobiology, Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA. · Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, PA, USA. · Behavioral Sleep Medicine Program, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA. · Behavioral Sleep Medicine Program, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA; Mood and Anxiety Disorders Treatment and Research Program, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA. · Department of Psychology, University of Arizona, Tucson, AZ, USA. · Department of Psychiatry, University of Rochester, Rochester, NY, USA. ·Sleep Med · Pubmed #26298795.

ABSTRACT: BACKGROUND AND AIM: At present, there is no consensus regarding how to medically manage chronic insomnia in the long term. The unstated standard of practice is for patients to use hypnotics intermittently. The present study aimed to compare a partial reinforcement strategy with nightly and intermittent dosing strategies for its potential as a maintenance therapy. METHODS: A mixed model was used in the study. One between-subjects factor: group (n = 4). One repeated-measures factor: time (12 weekly assessments). A total of 74 subjects with chronic Insomnia were treated with 10 mg zolpidem for 4 weeks. Treatment respondents were randomized to nightly dosing with 10 mg or 5 mg (QHS-10 and QHS-5), intermittent dosing with 10 mg (IDS-10 [3-5 days weekly]), or partial reinforcement dosing with 10 mg (PRS-10 [nightly pill use with 50% active medication and 50% placebos]) for 12 weeks. RESULTS: It was found, in compliant subjects (n = 55), that all four strategies evaluated maintained treatment response over time (ie, prevented or delayed relapse). For the subjects that remained in remission, the subjects in the intermittent dosing group (IDS-10) group exhibited poorer sleep continuity. CONCLUSIONS: While best considered a preliminary study, the present findings suggest that the partial reinforcement strategy may be a viable means toward maintaining treatment gains over time with less active medication.

24 Article Treating Insomnia Disorder in the Context of Medical and Psychiatric Comorbidities. 2015

Grandner, Michael A / Perlis, Michael L. ·Center for Sleep and Circadian Neurobiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia2Behavioral Sleep Medicine Program, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia. ·JAMA Intern Med · Pubmed #26147221.

ABSTRACT: -- No abstract --

25 Article Open-Loop Neurofeedback Audiovisual Stimulation: A Pilot Study of Its Potential for Sleep Induction in Older Adults. 2015

Tang, Hsin-Yi Jean / Vitiello, Michael V / Perlis, Michael / Riegel, Barbara. ·Health Science Center, School of Nursing, University of Washington, 1959 NE Pacific St., Box 357263, Seattle, WA, 98195-7263, USA, jeantang@u.washington.edu. ·Appl Psychophysiol Biofeedback · Pubmed #25931250.

ABSTRACT: This pilot study tested the efficacy of a 30-min audio-visual stimulation (AVS) program for the treatment of chronic insomnia in older adults. Chronic insomnia has been conceptualized as entailing increased cortical high frequency EEG activity at sleep onset and during NREM sleep. We hypothesized that an AVS program gradually descending from 8 to 1 Hz would potentially reduce the excessive cortical activation that is thought to contribute to difficulties with initiating and maintaining sleep. Accordingly, we conducted an intervention study of AVS using a pre-post design. Eight older adults (88 ± 8.7 years) complaining of chronic insomnia self-administered a 30-min AVS program nightly at bedtime for one month. Sleep was assessed at baseline and throughout the 4-week intervention. After using AVS for 4 weeks, significant improvement was reported in insomnia symptoms (ISI, p = 0.002) and sleep quality (PSQI, p = 0.004); with moderate to large effect sizes (Partial Eta2: 0.20-0.55)(Cohen's d: 0.7-2.3). The training effect (self-reported sleep improvement) was observed at the end of week one and persisted through the 1-month intervention. The results from this pilot study suggest that further exploration of AVS as a treatment for insomnia is warranted.

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