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Sleep Initiation and Maintenance Disorders: HELP
Articles from VA Palo Alto Health Care System
Based on 14 articles published since 2008

These are the 14 published articles about Sleep Initiation and Maintenance Disorders that originated from VA Palo Alto Health Care System during 2008-2019.
+ Citations + Abstracts
1 Review Cannabis, Cannabinoids, and Sleep: a Review of the Literature. 2017

Babson, Kimberly A / Sottile, James / Morabito, Danielle. ·National Center for PTSD-Dissemination & Training Division, VA Palo Alto Health Care System, 795 Willow Road, Menlo Park, CA, 94025, USA. Kimberly.Babson@va.gov. · Palo Alto University, Palo Alto, CA, USA. · National Center for PTSD-Dissemination & Training Division, VA Palo Alto Health Care System, 795 Willow Road, Menlo Park, CA, 94025, USA. ·Curr Psychiatry Rep · Pubmed #28349316.

ABSTRACT: PURPOSE OF REVIEW: The current review aims to summarize the state of research on cannabis and sleep up to 2014 and to review in detail the literature on cannabis and specific sleep disorders from 2014 to the time of publication. RECENT FINDINGS: Preliminary research into cannabis and insomnia suggests that cannabidiol (CBD) may have therapeutic potential for the treatment of insomnia. Delta-9 tetrahydrocannabinol (THC) may decrease sleep latency but could impair sleep quality long-term. Novel studies investigating cannabinoids and obstructive sleep apnea suggest that synthetic cannabinoids such as nabilone and dronabinol may have short-term benefit for sleep apnea due to their modulatory effects on serotonin-mediated apneas. CBD may hold promise for REM sleep behavior disorder and excessive daytime sleepiness, while nabilone may reduce nightmares associated with PTSD and may improve sleep among patients with chronic pain. Research on cannabis and sleep is in its infancy and has yielded mixed results. Additional controlled and longitudinal research is critical to advance our understanding of research and clinical implications.

2 Review The evidence base of sleep restriction therapy for treating insomnia disorder. 2014

Miller, Christopher B / Espie, Colin A / Epstein, Dana R / Friedman, Leah / Morin, Charles M / Pigeon, Wilfred R / Spielman, Arthur J / Kyle, Simon D. ·Centre for Integrated Research and Understanding of Sleep (CIRUS), Woolcock Institute of Medical Research, Sydney Medical School, University of Sydney, Australia; Institute of Neuroscience & Psychology, University of Glasgow, UK. Electronic address: chris.miller@sydney.edu.au. · Nuffield Department of Clinical Neurosciences and Sleep & Circadian Neuroscience Institute, University of Oxford, UK. · Phoenix Veterans Affairs Health Care System, USA; Arizona State University College of Nursing and Health Innovation, USA. · Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, USA; Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA. · Université Laval, Québec City, Québec, Canada. · Sleep & Neurophysiology Research Lab, University of Rochester Medical Center, USA; Center of Excellence for Suicide Prevention, U.S. Department of Veterans Affairs, USA. · Cognitive Neuroscience Doctoral Program, The City College of the City University of New York, USA; Weill Cornell Medical College, Center for Sleep Medicine, NY, USA. · School of Psychological Sciences, University of Manchester, UK. ·Sleep Med Rev · Pubmed #24629826.

ABSTRACT: Sleep restriction therapy is routinely used within cognitive behavioral therapy to treat chronic insomnia. However, the efficacy for sleep restriction therapy as a standalone intervention has yet to be comprehensively reviewed. This review evaluates the evidence for the use of sleep restriction therapy in the treatment of chronic insomnia. The literature was searched using web-based databases, finding 1344 studies. Twenty-one were accessed in full (1323 were deemed irrelevant to this review). Nine were considered relevant and evaluated in relation to study design using a standardized study checklist and levels of evidence. Four trials met adequate methodological strength to examine the efficacy of therapy for chronic insomnia. Weighted effect sizes for self-reported sleep diary measures of sleep onset latency, wake time after sleep onset, and sleep efficiency were moderate-to-large after therapy. Total sleep time indicated a small improvement. Standalone sleep restriction therapy is efficacious for the treatment of chronic insomnia for sleep diary continuity variables. Studies are insufficient to evaluate the full impact on objective sleep variables. Measures of daytime functioning in response to therapy are lacking. Variability in the sleep restriction therapy implementation methods precludes any strong conclusions regarding the true impact of therapy. A future research agenda is outlined.

3 Review Insomnia in the context of traumatic brain injury. 2009

Zeitzer, Jamie M / Friedman, Leah / O'Hara, Ruth. ·VA Palo Alto Health Care System, 3801 Miranda Avenue (151Y), Palo Alto, CA 94304, USA. jzeitzer@stanford.ed ·J Rehabil Res Dev · Pubmed #20104406.

ABSTRACT: Traumatic brain injury (TBI) is one of the leading causes of morbidity and mortality in the United States. One of the most common comorbidities of TBI is the disruption of normal sleep. While often viewed as a nuisance symptom, sleep disruption can delay TBI recovery and negatively affect many of the psychological (e.g., anxiety, depression) and neuromuscular (e.g., pain) sequelae of TBI, decreasing quality of life. Treatment of sleep disruption in the context of TBI is complicated by issues of an altered neuronal milieu, polypharmacy, and the complex relationship between the various comorbidities often found in patients with TBI. Given the growing number of veterans returning from combat with TBI and the elevated risk of comorbid disrupted sleep, both caused by and independent of TBI, a comprehensive review of sleep disruption and its treatment is of great relevance to the Department of Veterans Affairs.

4 Article Smartphone apps for insomnia: examining existing apps' usability and adherence to evidence-based principles for insomnia management. 2019

Yu, Jessica S / Kuhn, Eric / Miller, Katherine E / Taylor, Katherine. ·National Center for PTSD, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA. · Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA. ·Transl Behav Med · Pubmed #30590862.

ABSTRACT: Insomnia affects up to 22% of the U.S. adult population. The use of mobile health applications (mHealth apps) has been posited as one way to increase access to evidence-based interventions for insomnia, such as cognitive behavioral therapy for insomnia (CBT-I). The purpose of the current study was to summarize the availability of mHealth apps that focus on providing users with the behavioral and/or cognitive skills to manage insomnia, assess their adherence to evidence-based principles, and examine their usability. The terms "insomnia," "insomnia treatment," and "sleep treatment" were used to search the Apple iTunes and Google Play stores in November 2016. Social network query within the authors' professional networks was also conducted. Apps that met inclusion criteria for the study were downloaded and reviewed by the research team for their general characteristics; inclusion of CBT-I skills, strategies, and principles; and aesthetics and usability. Of the 357 apps initially found, 12 met criteria for further review. Overall, the apps were moderately adherent to CBT-I principles, with a mean app score of 1.44 out of 3.00, and moderately usable, with a mean usability score of 3.54 out of 5.00. Few apps currently exist that utilize evidence-based principles to help users practice the behavioral and cognitive skills shown to manage insomnia. Thus, there are exciting opportunities for clinicians, researchers, and mHealth experts to develop effective apps that can help ease the public health burden of insomnia.

5 Article A randomized controlled pilot study of CBT-I Coach: Feasibility, acceptability, and potential impact of a mobile phone application for patients in cognitive behavioral therapy for insomnia. 2018

Koffel, Erin / Kuhn, Eric / Petsoulis, Napoleon / Erbes, Christopher R / Anders, Samantha / Hoffman, Julia E / Ruzek, Josef I / Polusny, Melissa A. ·Minneapolis Veteran Affairs Health Care System, USA; University of Minnesota Medical School, USA. · National Center for PTSD (NCPTSD), Dissemination and Training (D&T) Division, USA; Department of Veterans Affairs Palo Alto Health Care System (VAPAHCS), USA. · Widener University, USA. · Hennepin County Medical Center, USA. ·Health Informatics J · Pubmed #27354394.

ABSTRACT: There has been growing interest in utilizing mobile phone applications (apps) to enhance traditional psychotherapy. Previous research has suggested that apps may facilitate patients' completion of cognitive behavioral therapy for insomnia (CBT-I) tasks and potentially increase adherence. This randomized clinical trial pilot study ( n = 18) sought to examine the feasibility, acceptability, and potential impact on adherence and sleep outcomes related to CBT-I Coach use. All participants were engaged in CBT-I, with one group receiving the app as a supplement and one non-app group. We found that patients consistently used the app as intended, particularly the sleep diary and reminder functions. They reported that it was highly acceptable to use. Importantly, the app did not compromise or undermine benefits of cognitive behavioral therapy for insomnia and patients in both groups had significantly improved sleep outcomes following treatment.

6 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.

7 Article CBT-I Coach: A Description and Clinician Perceptions of a Mobile App for Cognitive Behavioral Therapy for Insomnia. 2016

Kuhn, Eric / Weiss, Brandon J / Taylor, Katherine L / Hoffman, Julia E / Ramsey, Kelly M / Manber, Rachel / Gehrman, Philip / Crowley, Jill J / Ruzek, Josef I / Trockel, Mickey. ·VA Palo Alto Health Care System, Palo Alto, CA. · Stanford University, Stanford, CA. · Philadelphia VA Medical Center, Philadelphia, PA. · University of Pennsylvania, Philadelphia, PA. ·J Clin Sleep Med · Pubmed #26888586.

ABSTRACT: STUDY OBJECTIVES: This paper describes CBT-I Coach, a patient-facing smartphone app designed to enhance cognitive behavioral therapy for insomnia (CBT-I). It presents findings of two surveys of U.S. Department of Veterans Affairs (VA) CBT-I trained clinicians regarding their perceptions of CBT-I Coach before it was released (n = 138) and use of it two years after it was released (n = 176). METHODS: VA-trained CBT-I clinicians completed web-based surveys before and two years after CBT-I Coach was publicly released. RESULTS: Prior to CBT-I Coach release, clinicians reported that it was moderately to very likely that the app could improve care and a majority (87.0%) intended to use it if it were available. Intention to use the app was predicted by smartphone ownership (β = 0.116, p < 0.05) and perceptions of relative advantage to existing CBT-I practices (β = 0.286, p < 0.01), compatibility with their own needs and values (β = 0.307, p < 0.01), and expectations about the complexity of the app (β = 0.245, p < 0.05). Two years after CBT-I Coach became available, 59.9% of participants reported using it with patients and had favorable impressions of its impact on homework adherence and outcomes. CONCLUSIONS: Findings suggest that before release, CBT-I Coach was perceived to have potential to enhance CBT-I and address common adherence issues and clinicians would use it. These results are reinforced by findings two years after it was released suggesting robust uptake and favorable perceptions of its value.

8 Article Sleep Disturbance, Diabetes, and Cardiovascular Disease in Postmenopausal Veteran Women. 2016

Rissling, Michelle B / Gray, Kristen E / Ulmer, Christi S / Martin, Jennifer L / Zaslavsky, Oleg / Gray, Shelly L / Hale, Lauren / Zeitzer, Jamie M / Naughton, Michelle / Woods, Nancy F / LaCroix, Andrea / Calhoun, Patrick S / Stefanick, Marcia / Weitlauf, Julie C. ·Mid-Atlantic Mental Illness Research, Education, and Clinical Center (MIRECC), Durham VA Medical Center, North Carolina. michelle.rissling@va.gov. · Department of Veterans Affairs Puget Sound Health Care System, Health Services Research and Development, Seattle, Washington. Department of Health Services, University of Washington School of Public Health, Seattle. · Health Services R&D, Durham VA Medical Center, North Carolina. Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, North Carolina. · David Geffen School of Medicine, University of California Los Angeles. VA Sepulveda Ambulatory Care Center, Geriatric Research, Education and Clinical Center, North Hills, California. · Faculty of Health Sciences and Social Welfare, University of Haifa, Israel. · University of Washington School of Pharmacy, Seattle. · Program in Public Health, Stony Brook University School of Medicine, New York. · VA Palo Alto Health Care System, Sierra Pacific Mental Illness Research, Education and Clinical Center, California. Department of Psychiatry and Behavioral Sciences, Stanford University, California. · College of Medicine, Division of Population Sciences, Department of Internal Medicine, Ohio State University. · Seattle WHI Clinical Center, Biobehavioral Nursing, University of Washington. · Department of Epidemiology, University of California San Diego School of Medicine. · Mid-Atlantic Mental Illness Research, Education, and Clinical Center (MIRECC), Durham VA Medical Center, North Carolina. Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, North Carolina. · Stanford Prevention Research Center, Department of Medicine and Obstetrics and Gynecology, Stanford University, California. · VA Palo Alto Health Care System, Sierra Pacific MIRECC and Center for Innovation to Implementation, California. Department of Psychiatry & Behavioral Sciences and Stanford Cancer Institute, Stanford University, California. ·Gerontologist · Pubmed #26768391.

ABSTRACT: PURPOSE OF THE STUDY: To compare the prevalence and cardiometabolic health impact of sleep disturbance among postmenopausal Veteran and non-Veteran participants in the Women's Health Initiative (WHI). DESIGN AND METHODS: The prevalence of five categories of sleep disturbance--medication/alcohol use for sleep; risk for insomnia; risk for sleep disordered breathing [SDB]; risk for comorbid insomnia and SDB (insomnia + SDB); and aberrant sleep duration [SLD]--was compared in 3,707 Veterans and 141,354 non-Veterans using logistic or multinomial regression. Cox proportional hazards models were used to evaluate the association of sleep disturbance and incident cardiovascular disease (CVD) and Type 2 diabetes in Veterans and non-Veterans. RESULTS: Women Veterans were more likely to have high risk for insomnia + SDB relative to non-Veteran participants. However, prevalence of other forms of sleep disturbance was similar across groups. Baseline sleep disturbance was not differentially associated with cardiometabolic health outcomes in Veteran versus non-Veteran women. Risks for SDB and insomnia + SDB were both linked to heightened risk of CVD and diabetes; SLD was consistently linked with greater risk of CVD and diabetes in non-Veterans but less strongly and consistently in Veterans. IMPLICATIONS: Efforts to identify and treat sleep disturbances in postmenopausal women are needed and may positively contribute to the attenuation of cardiometabolic morbidity risk. Increased awareness of women Veterans' vulnerability to postmenopausal insomnia + SDB may be particularly important for health care providers who treat this population.

9 Article Insomnia symptoms and behavioural health symptoms in veterans 1 year after traumatic brain injury. 2015

Farrell-Carnahan, Leah / Barnett, Scott / Lamberty, Gregory / Hammond, Flora M / Kretzmer, Tracy S / Franke, Laura M / Geiss, Meghan / Howe, Laura / Nakase-Richardson, Risa. ·a Hunter Holmes McGuire Veterans Affairs Medical Center , Richmond , VA , USA . · b Virginia Commonwealth University , Richmond , VA , USA . · c James A. Haley Veterans Hospital , Tampa , FL , USA . · d Minneapolis Veterans Affairs Health Care System , Minneapolis , MN , USA . · e University of Minnesota Medical School , Minneapolis , MN , USA . · f Indiana University School of Medicine , Indianapolis , IN , USA . · g Defense and Veterans Brain Injury Center , Richmond , VA , USA , and. · h VA Palo Alto Health Care System , Palo Alto , CA , USA. ·Brain Inj · Pubmed #26287761.

ABSTRACT: OBJECTIVE: Insomnia and behavioural health symptoms 1 year after traumatic brain injury (TBI) were examined in a clinical sample representative of veterans who received inpatient treatment for TBI-related issues within the Veterans Health Administration. METHODS: This was a cross-sectional sub-study (n = 112) of the Polytrauma Rehabilitation Centres' traumatic brain injury model system programme. Prevalence estimates of insomnia, depression, general anxiety, nightmares, headache and substance use, stratified by injury severity, were derived. Univariate logistic regression was used to examine unadjusted effects for each behavioural health problem and insomnia by injury severity. RESULTS: Participants were primarily male, < 30 years old and high school educated. Twenty-nine per cent met study criteria for insomnia; those with mild TBI were significantly more likely to meet criteria (43%) than those with moderate/severe TBI (22%), χ(2)(1, n = 112) = 5.088, p ≤ 0.05. Univariable logistic regression analyses revealed depressive symptoms and general anxiety were significantly associated with insomnia symptoms after TBI of any severity. Headache and binge drinking were significantly inversely related to insomnia symptoms after moderate/severe TBI, but not MTBI. CONCLUSIONS: Veterans with history of TBI, of any severity, and current insomnia symptoms may be at increased risk for depression and anxiety 1 year after TBI.

10 Article Cannabis species and cannabinoid concentration preference among sleep-disturbed medicinal cannabis users. 2015

Belendiuk, Katherine A / Babson, Kimberly A / Vandrey, Ryan / Bonn-Miller, Marcel O. ·University of California at Berkeley Institute of Human Development, 1127 Tolman Hall, Berkeley, CA, 94720-1690, USA. Electronic address: kab@berkeley.edu. · National Center for PTSD, VA Palo Alto Health Care System, 795 Willow Road (152-MPD), Menlo Park, CA, 94025, USA. Electronic address: Kimberly.Babson@va.gov. · Behavioral Pharmacology Research Unit, Johns Hopkins University School of Medicine5510 Nathan Shock Drive, Baltimore, MD, 21224,USA. Electronic address: rvandrey@jhmi.edu. · National Center for PTSD, VA Palo Alto Health Care System, 795 Willow Road (152-MPD), Menlo Park, CA, 94025, USA; Center for Innovation to Implementation, VA Palo Alto Health Care System, 795 Willow Road (152-MPD), Menlo Park, CA 94025, USA; Center of Excellence in Substance Abuse Treatment and Education, Philadelphia VAMC, Philadelphia, PA, 19104, USA; Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, 19104, USA. Electronic address: Marcel.Bonn-Miller@va.gov. ·Addict Behav · Pubmed #26151582.

ABSTRACT: INTRODUCTION: Individuals report using cannabis for the promotion of sleep, and the effects of cannabis on sleep may vary by cannabis species. Little research has documented preferences for particular cannabis types or cannabinoid concentrations as a function of use for sleep disturbances. METHODS: 163 adults purchasing medical cannabis for a physical or mental health condition at a cannabis dispensary were recruited. They provided self-report of (a) whether cannabis use was intended to help with sleep problems (e.g. insomnia, nightmares), (b) sleep quality (PSQI), (c) cannabis use (including preferred type), and (d) symptoms of DSM-5 cannabis dependence. RESULTS: 81 participants reported using cannabis for the management of insomnia and 14 participants reported using cannabis to reduce nightmares. Individuals using cannabis to manage nightmares preferred sativa to indica strains (Fisher's exact test (2) = 6.83, p < 0.05), and sativa users were less likely to endorse DSM-5 cannabis dependence compared with those who preferred indica strains (χ(2)(2) = 4.09, p < 0.05). Individuals with current insomnia (t(9) = 3.30, p < 0.01) and greater sleep latency (F(3,6) = 46.7, p < 0.001) were more likely to report using strains of cannabis with significantly higher concentrations of CBD. Individuals who reported at least weekly use of hypnotic medications used cannabis with lower THC concentrations compared to those who used sleep medications less frequently than weekly (t(17) = 2.40, p < 0.05). CONCLUSIONS: Associations between sleep characteristics and the type of cannabis used were observed in this convenience sample of individuals using cannabis for the management of sleep disturbances. Controlled prospective studies are needed to better characterize the impact that specific components of cannabis have on sleep.

11 Article Effects of cognitive behavioral therapy for insomnia on suicidal ideation in veterans. 2015

Trockel, Mickey / Karlin, Bradley E / Taylor, C Barr / Brown, Gregory K / Manber, Rachel. ·Sierra-Pacific Mental Illness Research, Education, and Clinical Center, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA. · Stanford University School of Medicine, Palo Alto, CA. · Mental Health Services, U.S. Department of Veterans Affairs Central Office, Washington, DC. · Education Development Center, Inc., New York, NY. · Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. · Mental Illness Research, Education, and Clinical Center, Philadelphia Veterans Affairs Medical Center, Philadelphia, PA. · Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA. ·Sleep · Pubmed #25515115.

ABSTRACT: OBJECTIVE: To examine the effects of cognitive behavioral therapy for insomnia (CBT-I) on suicidal ideation among Veterans with insomnia. DESIGN: Longitudinal data collected in the course of an uncontrolled evaluation of a large-scale CBT-I training program. SETTING: Outpatient and residential treatment facilities. PARTICIPANTS: Four hundred five Veterans presenting for treatment of insomnia. INTERVENTIONS: Cognitive behavioral therapy for insomnia (CBT-I). MEASUREMENT AND RESULTS: At baseline, 32% of patients, compared with 21% at final assessment, endorsed some level of suicidal ideation [χ(2)(df = 1) = 125; P < 0.001]. After adjusting for demographic variables and baseline insomnia severity, each 7-point decrease in Insomnia Severity Index (ISI) score achieved during CBT-I treatment was associated with a 65% (OR = 0.35; 95% CI = 0.24 to 0.52) reduction in odds of suicidal ideation. The effect of change in insomnia severity on change in depression severity was also significant. After controlling for change in depression severity and other variables in the model, the effect of change in insomnia severity on change in suicidal ideation remained significant. CONCLUSION: This evaluation of the largest dissemination of CBT-I in the United States found a clinically meaningful reduction in suicidal ideation among Veterans receiving CBT-I. The mechanisms by which effective treatment of insomnia with CBT-I reduces suicide risk are unknown and warrant investigation. The current results may have significant public health implications for preventing suicide among Veterans.

12 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.

13 Article Cognitive Behavioral Therapy for insomnia with Veterans: evaluation of effectiveness and correlates of treatment outcomes. 2014

Trockel, Mickey / Karlin, Bradley E / Taylor, C Barr / Manber, Rachel. ·Sierra-Pacific Mental Illness Research, Education, and Clinical Center, Veterans Affairs Palo Alto Health Care System, USA; Stanford University School of Medicine, USA. · Mental Health Services, U.S. Department of Veterans Affairs Central Office, USA; Bloomberg School of Public Health, Johns Hopkins University, USA. Electronic address: Bradley.Karlin2@va.gov. ·Behav Res Ther · Pubmed #24412462.

ABSTRACT: This paper examines the effectiveness of Cognitive Behavioral Therapy for insomnia (CBT-I) in Veterans and the effects of two process measures on CBT-I outcomes: 1) therapist ratings of patient adherence and 2) patient ratings of therapeutic alliance. Data are from 316 therapists in the Department of Veterans Affairs CBT-I Training Program and 696 patients receiving CBT-I from therapists undergoing training. Mixed effects model results indicate Insomnia Severity Index scores decreased from 20.7 at baseline to 10.9 (d = 2.3) during a typical course of CBT-I. Patients with highest tercile compared to those with lowest tercile adherence achieved, on average, 4.1 points greater reduction in ISI scores (d = 0.95). The effect of therapeutic alliance on change in insomnia severity was not significant after adjusting for adherence to CBT-I. These results support the effectiveness and feasibility of large-scale training in and implementation of CBT-I and indicate that greater focus on patient adherence may lead to enhanced outcomes. The current findings suggest that CBT-I therapists and training programs place greater emphasis on attending to and increasing patient adherence.

14 Article Sleep quality moderates the relation between depression symptoms and problematic cannabis use among medical cannabis users. 2013

Babson, Kimberly A / Boden, Matthew Tyler / Bonn-Miller, Marcel O. ·Center for Health Care Evaluation, VA Palo Alto Health Care System, Menlo Park, CA 94025, USA. Kimberly.Babson@va.gov ·Am J Drug Alcohol Abuse · Pubmed #23721537.

ABSTRACT: OBJECTIVES: This study sought to extend research on the relation between depression symptoms and problematic cannabis use by evaluating the potential moderating role of perceived sleep quality among medical cannabis users. METHODS: This employed a cross-sectional design. The sample consisted of 162 adults (mean age = 42.05 years, SD = 14.8; 22% female), with current recommendations from a doctor for medical cannabis, recruited from a medical cannabis dispensary. RESULTS: Consistent with previous research, individuals with heightened depression symptoms had greater problematic cannabis use. In addition, perceived sleep quality moderated this relation, such that depression symptoms differentially related to problematic cannabis use as a function of perceived quality of sleep (ΔR(2) = .03, p = .02). Participants with higher levels of depression and good perceived sleep quality had the greatest rates of problematic cannabis use. CONCLUSIONS: These results suggest that individuals with heightened depression may have higher rates of problematic cannabis use, in part, because of the beneficial effects of cannabis in terms of perceived sleep quality.