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Sleep Initiation and Maintenance Disorders: HELP
Articles from Naval Medical Center San Diego
Based on 6 articles published since 2009

These are the 6 published articles about Sleep Initiation and Maintenance Disorders that originated from Naval Medical Center San Diego during 2009-2019.
+ Citations + Abstracts
1 Article Effect of concussion and blast exposure on symptoms after military deployment. 2017

Tsao, Jack W / Stentz, Lauren A / Rouhanian, Minoo / Howard, Robin S / Perry, Briana N / Haran, F Jay / Pasquina, Paul F / Wolde, Mikias / Taylor, Carolyn E / Lizardo, Radhames / Liu, Scott / Flores, Eusebio / Creason, Alia H / Sher, Katalina. ·From the University of Tennessee Health Science Center (J.W.T.) · Children's Foundation Research Center (J.W.T.), Le Bonheur Children's Hospital, Memphis, TN · Uniformed Services University of the Health Sciences (J.W.T., F.J.H., P.F.P.) · Walter Reed National Military Medical Center (L.A.S., M.R., R.S.H., B.N.P., P.F.P., M.W., C.E.T., K.S.), Bethesda, MD · Naval Medical Center San Diego (R.L.), CA · Naval Medical Center Portsmouth (S.L.) · Neuroscience Consultants, PLC (E.F.), Reston · and Information Innovators, Inc (A.H.C.), Springfield, VA. ·Neurology · Pubmed #29030450.

ABSTRACT: OBJECTIVE: To examine whether blast exposure alone and blast-associated concussion result in similar neurologic and mental health symptoms. METHODS: A 14-item questionnaire was administered to male US Marines on their return from deployment in Iraq and/or Afghanistan. RESULTS: A total of 2,612 Marines (median age 22 years) completed the survey. Of those, 2,320 (88.9%) reported exposure to ≥1 blast during their current and/or prior deployments. In addition, 1,022 (39.1%) reported ≥1 concussion during the current deployment, and 731 (28.0%) had experienced at least 1 prior lifetime concussion. Marines were more likely to have sustained a concussion during the current deployment if they had a history of 1 (odds ratio [OR] 1.5, 95% confidence interval [CI] 1.2-2.0) or ≥1 (OR 2.3, 95% CI 1.7-3.0) prior concussion. The most common symptoms were trouble sleeping (38.4%), irritability (37.9%), tinnitus (33.8%), and headaches (33.3%). Compared to those experiencing blast exposure without injury, Marines either experiencing a concussion during the current deployment or being moved or injured by a blast had an increased risk of postinjury symptoms. CONCLUSIONS: There appears to be a continuum of increasing total symptoms from no exposure to blast exposure plus both current deployment concussion and past concussion. Concussion had a greater influence than blast exposure alone on the presence of postdeployment symptoms. A high blast injury score can be used to triage those exposed to explosive blasts for evaluation.

2 Article Sleep and Health Resilience Metrics in a Large Military Cohort. 2016

Seelig, Amber D / Jacobson, Isabel G / Donoho, Carrie J / Trone, Daniel W / Crum-Cianflone, Nancy F / Balkin, Thomas J. ·Naval Health Research Center, San Diego, CA. · Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, MD. · Naval Medical Center San Diego, San Diego, CA. · Behavioral Biology Branch, Walter Reed Army Institute of Research, Silver Spring, MD. ·Sleep · Pubmed #26951391.

ABSTRACT: STUDY OBJECTIVES: Examine the relationship between self-reported sleep parameters and indicators of resilience in a US military population (n = 55,021). METHODS: Longitudinal analyses (2001-2008) were conducted using subjective data collected from Millennium Cohort Study questionnaires and objective data from military records that included demographics, military health, and deployment information. Subjective sleep duration and insomnia symptoms were collected on the study questionnaire. Resilience metrics included lost work days, self-rated health, deployment, frequency and duration of health care utilization, and early discharge from the military. Generalized estimating equations and survival analyses were adjusted for demographic, military, behavioral, and health covariates in all models. RESULTS: The presence of insomnia symptoms was significantly associated with lower self-rated health, more lost work days, lower odds of deployment, higher odds of early discharge from military service early, and more health care utilization. Those self-reporting < 6 h (short sleepers) or > 8 h (long sleepers) of sleep per night had similar findings, except for the deployment outcome in which those with the shortest sleep were more likely to deploy. CONCLUSIONS: Poor sleep is a detriment to service members' health and readiness. Leadership should redouble efforts to emphasize the importance of healthy sleep among military service members, and future research should focus on the efficacy of interventions to promote healthy sleep and resilience in this population. COMMENTARY: A commentary on this article appears in this issue on page 963.

3 Article Auricular acupuncture for sleep disturbance in veterans with post-traumatic stress disorder: a feasibility study. 2015

King, Heather C / Spence, Dennis L / Hickey, Anita H / Sargent, Paul / Elesh, Ronald / Connelly, Cynthia D. ·Naval Medical Center San Diego, 34800 Bob Wilson Drive, San Diego, CA 92134. · US Naval Hospital Okinawa, PSC 482, FPO AP 96362-1600. · University of San Diego, 5998 Alcala Drive, San Diego, CA 92110. ·Mil Med · Pubmed #25939115.

ABSTRACT: The purpose of this study was to examine the feasibility and acceptability of an auricular acupuncture (AA) insomnia regimen among Operation Iraqi Freedom and Operation Enduring Freedom veterans with post-traumatic stress disorder and sleep disturbance. Secondarily, this study examined the effect of an AA insomnia regimen on objective sleep times by wrist actigraphy, subjective sleep times by sleep diary, and sleep quality ratings utilizing the Pittsburg Sleep Quality Index. Veterans (n = 30) were randomized to receive a 3-week AA insomnia regimen. Veterans receiving the AA insomnia regimen reported it as a more acceptable treatment for sleep disturbance than subjects in the control group (AA group median = 5 vs. control group median = 3, p = 0.004). Significant differences between groups were found on the sleep quality and daytime dysfunction components of the Pittsburgh Sleep Quality Index (p = 0.003, p = 0.004). No other significant differences between groups were found for objective and subjective sleep measures. These results suggest that an AA insomnia regimen may improve sleep quality and daytime dysfunction among veterans with post-traumatic stress disorder. Future, large-scale, prospective clinical trials are needed to examine AA effects on sleep.

4 Article Amelioration of acute sequelae of blast induced mild traumatic brain injury by N-acetyl cysteine: a double-blind, placebo controlled study. 2013

Hoffer, Michael E / Balaban, Carey / Slade, Martin D / Tsao, Jack W / Hoffer, Barry. ·Department of Otolaryngology, Naval Medical Center San Diego, San Diego, California, United States of America. Michael.hoffer@med.navy.mil ·PLoS One · Pubmed #23372680.

ABSTRACT: BACKGROUND: Mild traumatic brain injury (mTBI) secondary to blast exposure is the most common battlefield injury in Southwest Asia. There has been little prospective work in the combat setting to test the efficacy of new countermeasures. The goal of this study was to compare the efficacy of N-acetyl cysteine (NAC) versus placebo on the symptoms associated with blast exposure mTBI in a combat setting. METHODS: This study was a randomized double blind, placebo-controlled study that was conducted on active duty service members at a forward deployed field hospital in Iraq. All symptomatic U.S. service members who were exposed to significant ordnance blast and who met the criteria for mTBI were offered participation in the study and 81 individuals agreed to participate. Individuals underwent a baseline evaluation and then were randomly assigned to receive either N-acetyl cysteine (NAC) or placebo for seven days. Each subject was re-evaluated at 3 and 7 days. Outcome measures were the presence of the following sequelae of mTBI: dizziness, hearing loss, headache, memory loss, sleep disturbances, and neurocognitive dysfunction. The resolution of these symptoms seven days after the blast exposure was the main outcome measure in this study. Logistic regression on the outcome of 'no day 7 symptoms' indicated that NAC treatment was significantly better than placebo (OR = 3.6, p = 0.006). Secondary analysis revealed subjects receiving NAC within 24 hours of blast had an 86% chance of symptom resolution with no reported side effects versus 42% for those seen early who received placebo. CONCLUSION: This study, conducted in an active theatre of war, demonstrates that NAC, a safe pharmaceutical countermeasure, has beneficial effects on the severity and resolution of sequelae of blast induced mTBI. This is the first demonstration of an effective short term countermeasure for mTBI. Further work on long term outcomes and the potential use of NAC in civilian mTBI is warranted. TRIAL REGISTRATION: ClinicalTrials.gov NCT00822263.

5 Article Insomnia is the most commonly reported symptom and predicts other symptoms of post-traumatic stress disorder in U.S. service members returning from military deployments. 2010

McLay, Robert N / Klam, Warren P / Volkert, Stacy L. ·Naval Medical Center San Diego, Department of Mental Health, 34800 Bob Wilson Drive, San Diego, CA 92134, USA. ·Mil Med · Pubmed #20968266.

ABSTRACT: This study retrospectively reviewed records from current members of the U.S. military who had completed the PTSD Checklist (PCL) at 0 and 3-months after returning from deployments. Insomnia was the most commonly reported symptom of PTSD on the PCL and had the highest average severity scores. At initial screen, 41% of those who had been to Iraq or Afghanistan reported sleep problems. Those who had initially reported any insomnia had significantly higher overall scores for PTSD severity at follow-up than did service members without such a complaint. These results show that insomnia is a particularly frequent, severe, and persistent complaint in service members returning from deployment. Such complaints merit particular attention in relation to the possibility of PTSD.

6 Article Use of a portable biofeedback device to improve insomnia in a combat zone, a case report. 2009

McLay, Robert N / Spira, James L. ·Department of Mental Health, Naval Medical Center San Diego, San Diego, CA 92134, USA. rmclay1@yahoo.com ·Appl Psychophysiol Biofeedback · Pubmed #19655243.

ABSTRACT: Insomnia is a common problem in situations of stress. Some forms of stress, however, may contraindicate the use of traditional, pharmacological interventions. Working in a combat zone is such a situation. Alternative means of improving sleep are clearly needed for Service Members. We report a case involving a medical provider who was serving in a military, emergency-services facility in Iraq, and who presented with anxiety, depressed mood, and insomnia. Symptoms were sub-threshold for major depressive disorder or acute stress disorder. Mood and anxiety symptoms responded to traditional therapy techniques, but problems with insomnia remained. The patient was given a portable biofeedback device that employs an infrared sensor photoplethysmograph to measure heart rate variability (HRV) from peripheral finger pulse. One week later, sleep was significantly improved. Symptom improvement lasted to at least 6 weeks while in theater. One year later, a check-in with the patient revealed that after returning home, he had been diagnosed with post traumatic stress disorder (PTSD). PTSD symptoms had resolved after 6 months of psychopharmacology and cognitive behavioral therapy. These results indicate that biofeedback may be a useful means of improving sleep in a combat zone, but that such improvements may not necessarily prevent the development of more serious symptoms later. No clear causality can be inferred from a single case, and further study is needed to determine if this finding have wider applicability.