Pick Topic
Review Topic
List Experts
Examine Expert
Save Expert
  Site Guide ··   
Sleep Initiation and Maintenance Disorders: HELP
Articles from San Francisco VA Medical Center
Based on 17 articles published since 2008
||||

These are the 17 published articles about Sleep Initiation and Maintenance Disorders that originated from San Francisco VA Medical Center during 2008-2019.
 
+ Citations + Abstracts
1 Review An evidence-based review of insomnia treatment in early recovery. 2014

Kaplan, Katherine A / McQuaid, John / Primich, Charles / Rosenlicht, Nicholas. ·From the Department of Psychiatry (KAK), Stanford University School of Medicine, Stanford, CA · Department of Psychiatry (JM, NR), University of California, San Francisco · and San Francisco VA Medical Center (JM, CP, NR), San Francisco, CA. ·J Addict Med · Pubmed #25369938.

ABSTRACT: Accruing evidence indicates that insomnia is prevalent and persistent in early recovery from substance use disorders and may predict relapse. As such, insomnia treatment after abstinence represents an important area for intervention. This article reviews the literature on insomnia predicting new-onset alcohol and substance use disorders, along with evidence for insomnia predicting relapse in recovering populations. Pharmacological and psychological treatment options are presented, and cognitive-behavioral therapy for insomnia applied to recovering populations is described in detail.

2 Review Treatment of sleep disturbances in posttraumatic stress disorder: a review. 2012

Schoenfeld, Frank B / Deviva, Jason C / Manber, Rachel. ·San Francisco Department of Veterans Affairs (VA) Medical Center, San Francisco, CA 94121, USA. Frank.schoenfeld@va.gov ·J Rehabil Res Dev · Pubmed #23015583.

ABSTRACT: Sleep disturbances are among the most commonly reported posttraumatic stress disorder (PTSD) symptoms. It is essential to conduct a careful assessment of the presenting sleep disturbance to select the optimal available treatment. Cognitive-behavioral therapies (CBTs) are at least as effective as pharmacologic treatment in the short-term and more enduring in their beneficial effects. Cognitive-behavioral treatment for insomnia and imagery rehearsal therapy have been developed to specifically treat insomnia and nightmares and offer promise for more effective relief of these very distressing symptoms. Pharmacotherapy continues to be an important treatment choice for PTSD sleep disturbances as an adjunct to CBT, when CBT is ineffective or not available, or when the patient declines CBT. Great need exists for more investigation into the effectiveness of specific pharmacologic agents for PTSD sleep disturbances and the dissemination of the findings to prescribers. The studies of prazosin and the findings of its effectiveness for PTSD sleep disturbance are examples of studies of pharmacologic agents needed in this area. Despite the progress made in developing more specific treatments for sleep disturbances in PTSD, insomnia and nightmares may not fully resolve.

3 Clinical Conference Behavioral treatment of insomnia in early recovery. 2014

Kaplan, Katherine A / McQuaid, John / Batki, Steven L / Rosenlicht, Nicholas. ·From the Department of Psychiatry (KAK), Stanford University School of Medicine, Stanford, CA · and Department of Psychiatry (JM, SLB, NR), University of California, and San Francisco VA Medical Center, San Francisco, CA. ·J Addict Med · Pubmed #25369939.

ABSTRACT: -- No abstract --

4 Article Insomnia severity as a mediator of the association between mental health symptoms and alcohol use in young adult veterans. 2017

Miller, Mary Beth / DiBello, Angelo M / Carey, Kate B / Borsari, Brian / Pedersen, Eric R. ·Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences, Brown University School of Public Health, Box G-S121-5, Providence, RI 02912, USA. Electronic address: millerme04@gmail.com. · Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences, Brown University School of Public Health, Box G-S121-5, Providence, RI 02912, USA. Electronic address: angelo_dibello@brown.edu. · Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences, Brown University School of Public Health, Box G-S121-5, Providence, RI 02912, USA. Electronic address: kate_carey@brown.edu. · Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences, Brown University School of Public Health, Box G-S121-5, Providence, RI 02912, USA; San Francisco Veterans Affairs Health Care System, 4150 Clement Street, San Francisco, CA 94121, USA; University of California, 505 Parnassus Ave., San Francisco, CA 94143, USA. Electronic address: brian.borsari@va.gov. · RAND Corporation, 1776 Main St., Santa Monica, CA 90407, USA. Electronic address: ericp@rand.org. ·Drug Alcohol Depend · Pubmed #28618286.

ABSTRACT: PURPOSE: Prior research has documented associations between mental health and alcohol use, mental health and insomnia, and insomnia and alcohol use. This study examined insomnia severity as a mediator of the association between mental health and alcohol-related outcomes in young adult veterans. PROCEDURES: Veterans aged 18-34 years (N=622, 83% male) who reported drinking in the past year completed assessments at baseline and one-month follow-up as part of a larger intervention trial. Participants reported symptoms of depression and posttraumatic stress disorder (PTSD) at baseline, insomnia severity at one month, and alcohol use and related consequences at baseline and one month. Mediation analyses using bootstrapped confidence intervals were used to examine the indirect effects of baseline mental health symptoms on alcohol-related outcomes at one month via insomnia severity. MAIN FINDINGS: Insomnia severity was associated with both drinking quantity and alcohol-related consequences. Greater depressive (but not PTSD) symptoms were associated directly with more alcohol-related consequences. Neither depressive nor PTSD symptoms had direct effects on drinking quantity when controlling for the other mental health symptoms (e.g., depressive symptoms did not predict drinking quantity when controlling for symptoms of PTSD). However, symptoms of depression and PTSD predicted drinks per week and alcohol-related consequences indirectly through insomnia severity. CONCLUSIONS: Symptoms of depression and PTSD increase risk for alcohol use and related consequences in part by increasing symptoms of insomnia. Findings suggest that insomnia may be an appropriate target for prevention and intervention efforts among heavy-drinking Veterans reporting symptoms of depression or PTSD.

5 Article Symptom Presentation and Prescription of Sleep Medications for Veterans With Posttraumatic Stress Disorder. 2017

Greenbaum, Mark A / Neylan, Thomas C / Rosen, Craig S. ·*Department of Veterans Affairs (DVA), PTSD Methods and Evaluation Core, VISN 21 Sierra Pacific MIRECC; National Center for PTSD, DVA Palo Alto Healthcare System, Menlo Park Division; †DVA, PTSD Research Core, VISN 21 Sierra Pacific MIRECC; DVA San Francisco Healthcare System; ‡University of California at San Francisco Medical School; §DVA Affairs Palo Alto Healthcare System and HSR&D Center for Implementation to Innovation, Menlo Park; and ∥Stanford University Department of Psychology and Behavioral Sciences, CA. ·J Nerv Ment Dis · Pubmed #28106623.

ABSTRACT: This study tested whether sleep medications prescribed to veterans diagnosed with posttraumatic stress disorder (PTSD) are being targeted to patients who report more severe insomnia or nightmares. Secondary analysis of survey and pharmacy data was conducted in samples of veterans from two periods: from 2006 to 2008 and from 2009 to 2013. Logistic regression tested associations between self-reported insomnia and nightmare severity, and being prescribed trazodone, prazosin, zolpidem, and benzodiazepines, controlling for PTSD severity and other covariates. In both samples, insomnia severity independently predicted trazodone receipt, and nightmare severity independently predicted prazosin receipt. In the later study, insomnia severity predicted receipt of zolpidem. Veterans in the later sample were more likely to receive trazodone, prazosin, and non-benzodiazepine hypnotics, and less likely to receive benzodiazepines than those in the earlier sample. Further research is needed to evaluate and optimize pharmacological and psychosocial treatments for sleep problems among veterans with PTSD.

6 Article Longitudinal changes in menopausal symptoms comparing women randomized to low-dose oral conjugated estrogens or transdermal estradiol plus micronized progesterone versus placebo: the Kronos Early Estrogen Prevention Study. 2017

Santoro, Nanette / Allshouse, Amanda / Neal-Perry, Genevieve / Pal, Lubna / Lobo, Rogerio A / Naftolin, Frederick / Black, Dennis M / Brinton, Eliot A / Budoff, Matthew J / Cedars, Marcelle I / Dowling, N Maritza / Dunn, Mary / Gleason, Carey E / Hodis, Howard N / Isaac, Barbara / Magnani, Maureen / Manson, JoAnn E / Miller, Virginia M / Taylor, Hugh S / Wharton, Whitney / Wolff, Erin / Zepeda, Viola / Harman, S Mitchell. ·1Department of Obstetrics & Gynecology 2Department of Biostatistics, University of Colorado School of Medicine, Aurora, CO 3Department of Obstetrics, Gynecology & Women's Health and Neurosciences, Albert Einstein College of Medicine, Bronx, NY 4Department of Obstetrics & Gynecology, Yale University School of Medicine, New Haven, CT 5Department of Obstetrics & Gynecology, Columbia University College of Physicians and Surgeons, New York, NY 6Department of Obstetrics & Gynecology, New York University School of Medicine, New York, NY 7Department of Epidemiology & Biostatistics, University of California at San Francisco, San Francisco, CA 8Utah Foundation for Biomedical Research, Salt Lake City, UT 9Department of Cardiology, Los Angeles Biomedical Research Institute at Harbor UCLA, Torrance, CA 10Department of Obstetrics & Gynecology, University of California at San Francisco, San Francisco, CA 11Departments of Biostatistics and Medical Informatics, University of Wisconsin, Madison, WI 12Kronos Longevity Research Institute, Phoenix, AZ 13Department of Medicine and Public Health, University of Wisconsin, Madison, WI 14Atherosclerosis Research Unit, University of Southern California, Los Angeles, CA 15Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 16Departments of Surgery and Physiology & Biomedical Engineering, Mayo Clinic, Rochester, MN 17Department of Neurology, Emory University, Atlanta, GA 18Department of Reproductive Biology and Medicine, National Institutes of Health, Bethesda, MD 19Department of Medicine, Endocrine Division, Phoenix VA Health Care System, Phoenix, AZ. ·Menopause · Pubmed #27779568.

ABSTRACT: OBJECTIVE: The objective of the present study was to compare the efficacy of two forms of menopausal hormone therapy in alleviating vasomotor symptoms, insomnia, and irritability in early postmenopausal women during 4 years. METHODS: A total of 727 women, aged 42 to 58, within 3 years of their final menstrual period, were randomized to receive oral conjugated estrogens (o-CEE) 0.45 mg (n = 230) or transdermal estradiol (t-E2) 50 μg (n = 225; both with micronized progesterone 200 mg for 12 d each mo), or placebos (PBOs; n = 275). Menopausal symptoms were recorded at screening and at 6, 12, 24, 36, and 48 months postrandomization. Differences in proportions of women with symptoms at baseline and at each follow-up time point were compared by treatment arm using exact χ tests in an intent-to-treat analysis. Differences in treatment effect by race/ethnicity and body mass index were tested using generalized linear mixed effects modeling. RESULTS: Moderate to severe hot flashes (from 44% at baseline to 28.3% for PBO, 7.4% for t-E2, and 4.2% for o-CEE) and night sweats (from 35% at baseline to 19% for PBO, 5.3% for t-E2, and 4.7% for o-CEE) were reduced significantly by 6 months in women randomized to either active hormone compared with PBO (P < 0.001 for both symptoms), with no significant differences between the active treatment arms. Insomnia and irritability decreased from baseline to 6 months postrandomization in all groups. There was an intermittent reduction in insomnia in both active treatment arms versus PBO, with o-CEE being more effective than PBO at 36 and 48 months (P = 0.002 and 0.05) and t-E2 being more effective than PBO at 48 months (P = 0.004). Neither hormone treatment significantly affected irritability compared with PBO. Symptom relief for active treatment versus PBO was not significantly modified by body mass index or race/ethnicity. CONCLUSIONS: Recently postmenopausal women had similar and substantial reductions in hot flashes and night sweats with lower-than-conventional doses of oral or transdermal estrogen. These reductions were sustained during 4 years. Insomnia was intermittently reduced compared with PBO for both hormone regimens.

7 Article Incorporating development of a patient-reported outcome instrument in a clinical drug development program: examples from a heart failure program. 2016

Wiklund, Ingela / Anatchkova, Milena / Oko-Osi, Hafiz / von Maltzahn, Robyn / Chau, Dina / Malik, Fady I / Patrick, Donald L / Spertus, John / Teerlink, John R. ·Evidera, Metro Building 6th Floor, 1 Butterwick, London, W6 8DL, UK. ingela.wiklund@evidera.com. · Evidera, Bethesda, MD, USA. · Evidera, Metro Building 6th Floor, 1 Butterwick, London, W6 8DL, UK. · Amgen Inc., Thousand Oaks, USA. · Cytokinetics, Inc., San Francisco, CA, USA. · University of Washington, Seattle, WA, USA. · University of Missouri, Kansas City, KS, USA. · San Francisco Veterans Affairs Medical Center and University of California San Francisco School of Medicine, San Francisco, CA, USA. ·Health Qual Life Outcomes · Pubmed #27629389.

ABSTRACT: BACKGROUND: Patient-reported outcome (PRO) measures can be used to support label claims if they adhere to US Food & Drug Administration guidance. The process of developing a new PRO measure is expensive and time-consuming. We report the results of qualitative studies to develop new PRO measures for use in clinical trials of omecamtiv mecarbil (a selective, small molecule activator of cardiac myosin) for patients with heart failure (HF), as well as the lessons learned from the development process. METHODS: Concept elicitation focus groups and individual interviews were conducted with patients with HF to identify concepts for the instrument. Cognitive interviews with HF patients were used to confirm that no essential concepts were missing and to assess patient comprehension of the instrument and items. RESULTS: During concept elicitation, the most frequently reported HF symptoms were shortness of breath, tiredness, fluid retention, fatigue, dizziness/light-headedness, swelling, weight fluctuation, and trouble sleeping. Two measures were developed based on the concepts: the Heart Failure Symptom Diary (HF-SD) and the Heart Failure Impact Scale (HFIS). Findings from cognitive interviews suggested that the items in the HF-SD and HFIS were relevant and well understood by patients. Multiple iterations of concept elicitation and cognitive interviews were needed based on FDA request for a broader patient population in the qualitative study. Lessons learned from the omecamtiv mecarbil PRO/clinical development program are discussed, including challenges of qualitative studies, patient recruitment, expected and actual timelines, cost, and engagement with various stakeholders. CONCLUSION: Development of a new PRO measure to support a label claim requires significant investment and early planning, as demonstrated by the omecamtiv mecarbil program.

8 Article Insomnia Severity, Subjective Sleep Quality, and Risk for Obstructive Sleep Apnea in Veterans With Gulf War Illness. 2016

Chao, Linda L / Abadjian, Linda R / Esparza, Iva L / Reeb, Rosemary. ·Center for Imaging of Neurodegenerative Diseases, San Francisco VA Medical Center, 4150 Clement Street (114M), San Francisco, CA 94121. ·Mil Med · Pubmed #27612364.

ABSTRACT: Despite the fact that sleep disturbances are common in veterans with Gulf War Illness (GWI), there has been a paucity of published sleep studies in this veteran population to date. Therefore, the present study examined subjective sleep quality (assessed with the Pittsburgh Sleep Quality Index), insomnia severity (assessed with the Insomnia Severity Index), and risk for obstructive sleep apnea (assessed with the STOP questionnaire) in 98 Gulf War veterans. Veterans with GWI, defined either by the Kansas or Centers for Disease Control and Prevention criteria, had greater risk for obstructive sleep apnea (i.e., higher STOP scores) than veterans without GWI. This difference persisted even after accounting for potentially confounding demographic (e.g., age, gender) and clinical variables. Veterans with GWI, defined by either the Kansas or Centers for Disease Control and Prevention criteria, also had significantly greater insomnia severity and poorer sleep quality than veterans without GWI (p < 0.05), even after accounting for potentially confounding variables. Furthermore, there were significant, positive correlations between insomnia severity, subjective sleep quality, and GWI symptom severity (p ≤ 0.01). In stepwise linear regression models, insomnia severity significantly predicted GWI status over and above demographic and clinical variables. Together these findings provide good rationale for treating sleep disturbances in the management of GWI.

9 Article Measures of Sleep-Wake Patterns and Risk of Mild Cognitive Impairment or Dementia in Older Women. 2016

Diem, Susan J / Blackwell, Terri L / Stone, Katie L / Yaffe, Kristine / Tranah, Greg / Cauley, Jane A / Ancoli-Israel, Sonia / Redline, Susan / Spira, Adam P / Hillier, Teresa A / Ensrud, Kristine E. ·Department of Medicine and Division of Epidemiology & Community Health, University of Minnesota, Minneapolis, MN. Electronic address: sdiem@umn.edu. · California Pacific Medical Center Research Institute, San Francisco, CA. · Departments of Psychiatry, Neurology, and Epidemiology, University of California, San Francisco and the San Francisco VA Medical Center, San Francisco, CA. · Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA. · Departments of Medicine and Psychiatry, University of California, San Diego, CA. · Department of Medicine, Brigham and Women's Hospital and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA. · Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. · Kaiser Permanente Center for Health Research, Portland, OR. · Department of Medicine and Division of Epidemiology & Community Health, University of Minnesota, Minneapolis, MN; Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System, Minneapolis, MN. ·Am J Geriatr Psychiatry · Pubmed #26964485.

ABSTRACT: OBJECTIVE: Sleep disturbances are common in older adults. Little is known about the sleep of cognitively intact older adults and its relationship to subsequent cognitive impairment. The objective of this study was to examine the association between objective sleep-wake measures and risk of incident cognitive impairment. METHODS: In this prospective cohort study encompassing four U.S. sites, 1,245 women (mean age: 82.6 years) without dementia participated in the Study of Osteoporotic Fractures and completed actigraphy at the baseline visit and comprehensive cognitive assessment at follow-up. The association between sleep-wake patterns measured by actigraphy and risk of incident mild cognitive impairment (MCI) and dementia was examined. RESULTS: A total of 473 women (38%) developed cognitive impairment during an average (SD) follow-up of 4.9 (0.6) years; 290 (23.3%) developed MCI and 183 (14.7%) developed dementia. After controlling for multiple potential confounders, women in the lowest quartile of average sleep efficiency (<74%) had a 1.5-fold higher odds of developing MCI or dementia compared with women in the highest quartile of sleep efficiency (>86%) (odds ratio: Q1 versus Q4 1.53; 95% CI: 1.07, 2.19; Wald χ(2) [1, N = 1,223] = 5.34 for p for trend = 0.03). Longer average sleep latency, but not total sleep time, was also associated with higher odds of developing cognitive impairment. Greater variability in both sleep efficiency and total sleep time was associated with an increased odds of developing MCI or dementia. CONCLUSION: Lower average sleep efficiency, longer average sleep latency, and greater variability in sleep efficiency and total sleep time are associated with increased odds of developing cognitive impairment. Further research is needed to explore the mechanisms underlying these associations.

10 Article Change in Dysfunctional Beliefs About Sleep in Behavior Therapy, Cognitive Therapy, and Cognitive-Behavioral Therapy for Insomnia. 2016

Eidelman, Polina / Talbot, Lisa / Ivers, Hans / Bélanger, Lynda / Morin, Charles M / Harvey, Allison G. ·Cognitive Behavior Therapy and Science Center. · San Francisco VA Medical Center. · Université Laval. · University of California, Berkeley. Electronic address: aharvey@berkeley.edu. ·Behav Ther · Pubmed #26763501.

ABSTRACT: As part of a larger randomized controlled trial, 188 participants were randomized to behavior therapy (BT), cognitive therapy (CT), or cognitive-behavioral therapy (CBT) for insomnia. The aims of this study were threefold: (a) to determine whether change in dysfunctional beliefs about sleep was related to change in sleep, insomnia symptoms, and impairment following treatment; (b) to determine whether BT, CT, and CBT differ in their effects on dysfunctional beliefs; and (c) to determine whether the treatments differ in their effects on particular kinds of dysfunctional beliefs. Beliefs, sleep, insomnia symptoms, and sleep-related psychosocial impairment were assessed at pretreatment, posttreatment, and 6- and 12-month follow-up. Greater change in dysfunctional beliefs occurring over the course of BT, CT, or CBT was associated with greater improvement in insomnia symptoms and impairment at posttreatment and both follow-ups. All groups experienced a significant decrease in dysfunctional beliefs during treatment, which were sustained through 6- and 12-month follow-up. Compared with the BT group, a greater proportion of participants in the CT and/or CBT groups endorsed dysfunctional beliefs below a level considered clinically significant at posttreatment and 12-month follow-up. The results demonstrate the importance of targeting dysfunctional beliefs in insomnia treatment, suggest that beliefs may be significantly modified with BT alone, and indicate that cognitive interventions may be particularly powerful in enhancing belief change.

11 Article Are hippocampal size differences in posttraumatic stress disorder mediated by sleep pathology? 2014

Mohlenhoff, Brian S / Chao, Linda L / Buckley, Shannon T / Weiner, Michael W / Neylan, Thomas C. ·Department of Psychiatry, University of California, San Francisco, San Francisco, CA, USA; Center for Imaging of Neurodegenerative Diseases, Department of Veterans Affairs Medical Center, San Francisco, CA, USA; Mental Health Service, Department of Veterans Affairs Medical Center, San Francisco, CA, USA. Electronic address: brian.mohlenhoff@ucsf.edu. · Department of Psychiatry, University of California, San Francisco, San Francisco, CA, USA; Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA; Center for Imaging of Neurodegenerative Diseases, Department of Veterans Affairs Medical Center, San Francisco, CA, USA. · Center for Imaging of Neurodegenerative Diseases, Department of Veterans Affairs Medical Center, San Francisco, CA, USA. · Department of Psychiatry, University of California, San Francisco, San Francisco, CA, USA; Mental Health Service, Department of Veterans Affairs Medical Center, San Francisco, CA, USA. ·Alzheimers Dement · Pubmed #24924666.

ABSTRACT: Posttraumatic stress disorder (PTSD) is associated with smaller volumes of the hippocampus, as has been demonstrated by meta-analyses. Proposed mechanistic relationships are reviewed briefly, including the hypothesis that sleep disturbances mediate the effects of PTSD on hippocampal volume. Evidence for this includes findings that insomnia and restricted sleep are associated with changes in hippocampal cell regulation and impairments in cognition. We present results of a new study of 187 subjects in whom neither PTSD nor poor sleep was associated with lower hippocampal volume. We outline a broad research agenda centered on the hypothesis that sleep changes mediate the relationship between PTSD and hippocampal volume.

12 Article Cortical gamma-aminobutyric acid and glutamate in posttraumatic stress disorder and their relationships to self-reported sleep quality. 2014

Meyerhoff, Dieter J / Mon, Anderson / Metzler, Thomas / Neylan, Thomas C. ·Department of Radiology and Biomedical Imaging, Center for Imaging of Neurodegenerative Diseases, DVA Medical Center, and University of California San Francisco, San Francisco, CA. · Psychiatry Research Service VAMC, and University of California San Francisco, San Francisco, CA. ·Sleep · Pubmed #24790267.

ABSTRACT: STUDY OBJECTIVES: To test if posttraumatic stress disorder (PTSD) is associated with low brain gamma-aminobutyric acid (GABA) levels and if reduced GABA is mediated by poor sleep quality. DESIGN: Laboratory study using in vivo proton magnetic resonance spectroscopy (1H MRS) and behavioral testing. SETTING: VA Medical Center Research Service, Psychiatry and Radiology. PATIENTS OR PARTICIPANTS: Twenty-seven patients with PTSD (PTSD+) and 18 trauma-exposed controls without PTSD (PTSD-), recruited from United States Army reservists, Army National Guard, and mental health clinics. INTERVENTIONS: None. MEASUREMENTS AND RESULTS: 1H MRS at 4 Tesla yielded spectra from three cortical brain regions. In parieto-occipital and temporal cortices, PTSD+ had lower GABA concentrations than PTSD-. As expected, PTSD+ had higher depressive and anxiety symptom scores and a higher Insomnia Severity Index (ISI) score. Higher ISI correlated with lower GABA and higher glutamate levels in parieto-occipital cortex and tended to correlate with lower GABA in the anterior cingulate. The relationship between parieto-occipital GABA and PTSD diagnosis was fully mediated through insomnia severity. Lower N-acetylaspartate and glutamate concentrations in the anterior cingulate cortex correlated with higher arousal scores, whereas depressive and anxiety symptoms did generally not influence metabolite concentrations. CONCLUSIONS: Low brain gamma-aminobutyric acid (GABA) concentration in posttraumatic stress disorder (PTSD) is consistent with most findings in panic and social anxiety disorders. Low GABA associated with poor sleep quality is consistent with the hyperarousal theory of both primary insomnia and PTSD. Our data demonstrate that poor sleep quality mediates low parieto-occipital GABA in PTSD. The findings have implications for PTSD treatment approaches.

13 Article Associations between subjective sleep quality and brain volume in Gulf War veterans. 2014

Chao, Linda L / Mohlenhoff, Brian S / Weiner, Michael W / Neylan, Thomas C. ·Departments of Radiology and Biomedical Imaging ; Psychiatry, University of California, San Francisco, CA ; Center for Imaging of Neurodegenerative Diseases. · Psychiatry, University of California, San Francisco, CA ; Center for Imaging of Neurodegenerative Diseases. · Psychiatry, University of California, San Francisco, CA ; Mental Health Service, Department of Veterans Affairs Medical Center, San Francisco, CA. ·Sleep · Pubmed #24587566.

ABSTRACT: STUDY OBJECTIVES: To investigate whether subjective sleep quality is associated with brain volume independent of comorbid psychiatric conditions. DESIGN: Cross-sectional. SETTING: Department of Veterans Affairs (VA) Medical Center. PARTICIPANTS: One hundred forty-four Gulf War Veterans (mean age 45 years; range: 31-70 years; 14% female). INTERVENTIONS: None. MEASUREMENTS AND RESULTS: Total cortical, lobar gray matter, and hippocampal volumes were quantified from 1.5 Tesla magnetic resonance images using Freesurfer version 4.5. Subjective sleep quality was assessed with the Pittsburgh Sleep Quality Index (PSQI). Multiple linear regressions were used to determine the association of sleep quality with total and regional brain volumes. The global PSQI score was positively correlated with lifetime and current posttraumatic stress disorder (PTSD) and current depressive symptoms (P < 0.001) and was higher in veterans with Gulf War Illness, trauma exposure, and those using psychotropic medication (P ≤ 0.03). After adjusting for these comorbid variables, age, intracranial volume, and multiple comparisons, global PSQI was inversely associated with total cortical and frontal gray matter volume (adjusted P ≤ 0.03). Within the frontal lobe, total PSQI was inversely associated with the superior and middle frontal, orbitofrontal, anterior cingulate, and frontal pole volumes (adjusted P ≤ 0.02). Examination of the 3-factor structure of the PSQI revealed that the associations were driven by perceived sleep quality. CONCLUSIONS: Poorer subjective sleep quality was associated with reduced total cortical and regional frontal lobe volumes independent of comorbid psychiatric conditions. Future work will be needed to examine if effective treatment of disturbed sleep leads to improved structural and functional integrity of the frontal lobes.

14 Article Cognitive behavioral therapy for insomnia in posttraumatic stress disorder: a randomized controlled trial. 2014

Talbot, Lisa S / Maguen, Shira / Metzler, Thomas J / Schmitz, Martha / McCaslin, Shannon E / Richards, Anne / Perlis, Michael L / Posner, Donn A / Weiss, Brandon / Ruoff, Leslie / Varbel, Jonathan / Neylan, Thomas C. ·San Francisco VA Medical Center, San Francisco, CA ; Department of Psychiatry, University of California, San Francisco, CA. · San Francisco VA Medical Center, San Francisco, CA. · San Francisco VA Medical Center, San Francisco, CA ; Department of Psychiatry, University of California, San Francisco, CA ; National Center for PTSD, VA Palo Alto Health Care System, Palo Alto, CA. · Department of Psychiatry, University of Pennsylvania, Philadelphia, PA. · Department of Psychiatry and Human Behavior, Brown University, Providence, RI. ·Sleep · Pubmed #24497661.

ABSTRACT: STUDY OBJECTIVES: Examine whether cognitive behavioral therapy for insomnia (CBT-I) improves sleep in posttraumatic stress disorder (PTSD) as well as nightmares, nonsleep PTSD symptoms, depression symptoms, and psychosocial functioning. DESIGN: RANDOMIZED CONTROLLED TRIAL WITH TWO ARMS: CBT-I and monitor-only waitlist control. SETTING: Department of Veterans Affairs (VA) Medical Center. PARTICIPANTS: Forty-five adults (31 females: [mean age 37 y (22-59 y)] with PTSD meeting research diagnostic criteria for insomnia, randomly assigned to CBT-I (n = 29; 22 females) or monitor-only waitlist control (n = 16; nine females). INTERVENTIONS: Eight-session weekly individual CBT-I delivered by a licensed clinical psychologist or a board-certified psychiatrist. MEASUREMENTS AND RESULTS: Measures included continuous monitoring of sleep with diary and actigraphy; prepolysomnography and postpolysomnography and Clinician-Administered PTSD Scale (CAPS); and pre, mid, and post self-report questionnaires, with follow-up of CBT-I participants 6 mo later. CBT-I was superior to the waitlist control condition in all sleep diary outcomes and in polysomnography-measured total sleep time. Compared to waitlist participants, CBT-I participants reported improved subjective sleep (41% full remission versus 0%), disruptive nocturnal behaviors (based on the Pittsburgh Sleep Quality Index-Addendum), and overall work and interpersonal functioning. These effects were maintained at 6-mo follow-up. Both CBT-I and waitlist control participants reported reductions in PTSD symptoms and CAPS-measured nightmares. CONCLUSIONS: Cognitive behavioral therapy for insomnia (CBT-I) improved sleep in individuals with posttraumatic stress disorder, with durable gains at 6 mo. Overall psychosocial functioning improved following CBT-I. The initial evidence regarding CBT-I and nightmares is promising but further research is needed. Results suggest that a comprehensive approach to treatment of posttraumatic stress disorder should include behavioral sleep medicine. CLINICAL TRIAL INFORMATION: TRIAL NAME: Cognitive Behavioral Treatment Of Insomnia In Posttraumatic Stress Disorder. URL: http://clinicaltrials.gov/ct2/show/NCT00881647. REGISTRATION NUMBER: NCT00881647.

15 Article Relationship of screen-based symptoms for mild traumatic brain injury and mental health problems in Iraq and Afghanistan veterans: Distinct or overlapping symptoms? 2012

Maguen, Shira / Lau, Karen M / Madden, Erin / Seal, Karen. ·San Francisco VA Medical Center, 4150 Clement St 116-P, San Francisco, CA 94121, USA. Shira.Maguen@va.gov ·J Rehabil Res Dev · Pubmed #23341283.

ABSTRACT: This study used factor analytic techniques to differentiate distinct from overlapping screen-based symptoms of traumatic brain injury (TBI), posttraumatic stress disorder (PTSD), and depression in Iraq and Afghanistan veterans. These symptoms were derived from screen results of 1,549 veterans undergoing Department of Veterans Affairs postdeployment screening between April 2007 and January 2010. Veterans with positive TBI screens were approximately twice as likely to also screen positive for depression and PTSD (adjusted relative risks = 1.9 and 2.1, respectively). Irritability was a shared symptom between TBI and PTSD, and emotional numbing was a shared symptom between PTSD and depression. Symptoms unique to TBI included dizziness, headaches, memory problems, and light sensitivity. Four separate constructs emerged: TBI, PTSD, depression, and a fourth construct consisting of hypervigilance and sleep problems. These findings illuminate areas of overlap between TBI and common postdeployment mental health problems. Discriminating symptoms of TBI from mental health problems may facilitate diagnosis, triage to specialty care, and targeted symptom management. The emergence of a fourth factor consisting of sleep problems and hypervigilance highlights the need to attend to specific symptoms in the postdeployment screening process.

16 Article Subclinical anxiety symptoms, sleep, and daytime dysfunction in older adults with primary insomnia. 2008

Spira, Adam P / Friedman, Leah / Aulakh, Jasdeep S / Lee, Tina / Sheikh, Javaid I / Yesavage, Jerome A. ·University of California, San Francisco, Department of Medicine, Division of Geriatrics, San Francisco Veterans Affairs Medical Center, USA. adam.spira@ucsf.edu ·J Geriatr Psychiatry Neurol · Pubmed #18474724.

ABSTRACT: Both insomnia complaints and anxiety disorders are common in older adults, and are associated with poor daytime functioning. The present study investigated whether subclinical levels of anxiety were associated with sleep disturbance and daytime functioning in older adults who met diagnostic criteria for primary insomnia, and therefore did not meet criteria for depression or an anxiety disorder. After adjustment for depressive symptoms, elevated state anxiety was associated with higher levels of wake after sleep onset (measured by both actigraphy and sleep log) and shorter sleep onset latency (measured by sleep log). Higher levels of trait anxiety were associated with greater wake after sleep onset (measured by sleep log). Elevated state and trait anxiety were associated with worse social functioning, and higher levels of trait anxiety were associated with worse role functioning. Thus, subclinical anxiety symptoms may be an important target for clinical intervention to improve sleep and functioning in older adults with primary insomnia.

17 Minor Reply to: Insomnia-related sleep disruptions, cognition and detailed concurrent anxiety testing during the inter-episode phase of bipolar disorder: A Herculean task or a necessity? 2017

Kanady, Jennifer C / Soehner, Adriane M / Klein, Alexandra B / Harvey, Allison G. ·San Francisco VA Medical Center, 4150 Clement St., San Francisco, CA 94121, USA. · Department of Psychiatry, University of Pittsburgh School of Medicine, 3811 Ohara St, Pittsburgh, PA 15213, USA. · VA Boston Healthcare System, 150 S, Huntington Ave, Boston, MA 02130, USA. · Department of Psychology, University of California, Berkeley, 3321 Tolman Hall, Berkeley, CA 94720, USA. Electronic address: aharvey@berkeley.edu. ·J Psychiatr Res · Pubmed #28803144.

ABSTRACT: -- No abstract --