Pick Topic
Review Topic
List Experts
Examine Expert
Save Expert
  Site Guide ··   
Sleep Initiation and Maintenance Disorders: HELP
Articles from University of Sydney
Based on 71 articles published since 2009
||||

These are the 71 published articles about Sleep Initiation and Maintenance Disorders that originated from University of Sydney during 2009-2019.
 
+ Citations + Abstracts
Pages: 1 · 2 · 3
1 Guideline Guidelines for sleep studies in adults - a position statement of the Australasian Sleep Association. 2017

Douglas, James A / Chai-Coetzer, Ching Li / McEvoy, David / Naughton, Matthew T / Neill, Alister M / Rochford, Peter / Wheatley, John / Worsnop, Christopher. ·The Prince Charles Hospital, Brisbane, Queensland, Australia. Electronic address: n.shillabeer@elsevier.com. · Adelaide Institute for Sleep Health, Flinders Centre of Research Excellence, Flinders University, Adelaide, South Australia, Australia; Sleep Health Service, Repatriation General Hospital, Southern Adelaide Local Health Network, Adelaide, South Australia, Australia. · Mater Medical Centre, Brisbane, Queensland, Australia. · The Alfred Hospital, Melbourne, Victoria, Australia; Monash University, Melbourne, Victoria, Australia. · WellSleep Sleep Investigation Centre, University of Otago, New Zealand. · Institute of Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia. · Ludwig Engel Centre for Respiratory Research, The Westmead Institute for Medical Research, Sydney, NSW, Australia; University of Sydney at Westmead Hospital, Sydney, NSW, Australia. ·Sleep Med · Pubmed #28648224.

ABSTRACT: -- No abstract --

2 Review Cognitive Behavioral Therapies for Insomnia and Hypnotic Medications: Considerations and Controversies. 2019

Cheung, Janet M Y / Ji, Xiao-Wen / Morin, Charles M. ·School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Room S303, Pharmacy and Bank Building (A15), Science Road, Camperdown Campus, Sydney, NSW 2006, Australia; École de psychologie, Université Laval, Pavillon Félix-Antoine-Savard, local 1036, Québec, QC G1V 0A6, Canada; Centre d'étude des troubles du sommeil, Institut universitaire en santé mentale de Québec, Québec, QC, Canada. · École de psychologie, Université Laval, Pavillon Félix-Antoine-Savard, local 1036, Québec, QC G1V 0A6, Canada; Centre d'étude des troubles du sommeil, Institut universitaire en santé mentale de Québec, Québec, QC, Canada. · École de psychologie, Université Laval, Pavillon Félix-Antoine-Savard, local 1036, Québec, QC G1V 0A6, Canada; Centre d'étude des troubles du sommeil, Institut universitaire en santé mentale de Québec, Québec, QC, Canada. Electronic address: cmorin@psy.ulaval.ca. ·Sleep Med Clin · Pubmed #31029191.

ABSTRACT: Insomnia is a costly health problem, where management has remained suboptimal despite advances in the understanding and treatment of the condition. This article provides an overview of the evidence-based treatment options of insomnia, looking at short-term and long-term therapeutic outcomes for cognitive behavioral therapies and pharmacologic therapies. Key issues of treatment delivery and implementation are highlighted at the patient and health system levels, and novel approaches for combining and sequencing treatment to maximize therapeutic outcomes for insomnia are discussed. The impact of recent updates of major clinical guidelines and future research directions for the field are discussed.

3 Review Early intervention for bipolar disorder in adolescents: A psychosocial perspective. 2018

McAulay, Claire / Mond, Jonathan / Touyz, Stephen. ·Clinical Psychology Unit, School of Psychology, University of Sydney, Sydney, New South Wales, Australia. · Centre for Rural Health, School of Health Sciences, University of Tasmania, Launceston, Tasmania, Australia. · Translational Health Research Institute, School of Medicine, Western Sydney University, Sydney, New South Wales, Australia. ·Early Interv Psychiatry · Pubmed #28836352.

ABSTRACT: AIM: Early intervention in bipolar disorder (BD) has received increasing attention in recent years. The identification of risk factors has improved, but researchers continue to struggle to find an effective treatment once the illness has become established. The aetiology of BD and feasibility of early intervention present a challenge, making it difficult to decide who to target, as well as how. METHODS: This essay seeks to address the lack of guidance for managing patients with a possible emerging bipolar illness, by presenting a rough roadmap to psychological care. The psychological techniques currently showing the most potential for this challenging group are reviewed. Markers of risk and supplementary clinical targets, such as anxiety and sleep disruption, are also discussed. RESULTS: While research in this group remains in its infancy, various avenues of enquiry show promise, such as family-based approaches, CBT that targets features beyond the core illness, psychoeducation, and interventions that consider physical health. However, clearer pathways for establishing the course and stage of the illness are required to inform the intensity and type of treatment. CONCLUSION: It is argued that treating early, indistinct symptoms of psychological distress, that may or may not signify prodromal BD, is valuable beyond its utility as an early intervention tool, as it has the capacity to improve help-seeking behaviour, quality of life and the likelihood of functional recovery in those who go on to develop the illness as adults.

4 Review A systematic review and meta-analysis of placebo versus no treatment for insomnia symptoms. 2018

Yeung, Valerie / Sharpe, Louise / Glozier, Nick / Hackett, Maree L / Colagiuri, Ben. ·University of Sydney, School of Psychology, Sydney, Australia. · University of Sydney, Brain and Mind Centre, Sydney Medical School, Sydney, Australia. · University of Sydney, The George Institute for Global Health, Sydney, Australia; Faculty of Health and Wellbeing, The University of Central Lancashire, Preston, United Kingdom. · University of Sydney, School of Psychology, Sydney, Australia. Electronic address: ben.colagiuri@sydney.edu.au. ·Sleep Med Rev · Pubmed #28554719.

ABSTRACT: This systematic review and meta-analysis aimed to determine the size of the placebo effect for insomnia symptoms when comparing placebo treatment with no treatment. PsycINFO, MEDLINE, and CINAHL databases were systematically searched for studies allocating participants with insomnia symptoms (diagnosed or self-reported) to receive a placebo that they were led to believe was an active treatment or to a no treatment control group. Thirteen independent studies (n = 566) met inclusion criteria. Meta-analysis indicated a reliable placebo effect whereby placebo treatment led to improved perceived sleep onset latency (SOL; Hedges g = 0.272), total sleep time (TST; Hedges g = 0.322), and global sleep quality (GSQ; Hedges' g = 0.581), when compared with no treatment. There was no effect on objective assessment of SOL, however only a few studies reported this outcome and there were insufficient sample sizes to meta-analyse other objective outcomes. Moderator analysis indicated that the placebo effect for perceived insomnia symptoms was quite consistent across different variables. The present findings provide strong evidence for placebo effects for perceived insomnia symptoms, but not on the only objective measurement with sufficient sample size to meta-analyse, namely objective SOL. This has important implications for the treatment of insomnia symptoms and the design and interpretation of clinical trials for insomnia symptoms.

5 Review Gender differences in obstructive sleep apnoea, insomnia and restless legs syndrome in adults - What do we know? A clinical update. 2018

Theorell-Haglöw, Jenny / Miller, Christopher B / Bartlett, Delwyn J / Yee, Brendon J / Openshaw, Hannah D / Grunstein, Ronald R. ·CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, University of Sydney, Australia; Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Sweden. Electronic address: jenny.theorell-haglow@medsci.uu.se. · CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, University of Sydney, Australia. ·Sleep Med Rev · Pubmed #28495359.

ABSTRACT: Research in sleep medicine over the last decades has involved a broad variety of sleep disorders in both men and women. Gender differences have been identified in sleep physiology as well as in the three most common sleep disorders: obstructive sleep apnoea (OSA), insomnia and restless legs syndrome (RLS). However, research on gender differences in sleep medicine appears limited. This clinical review aims to give an updated overview of gender differences, in relation to prevalence, clinical presentation, treatment and quality of life in OSA, insomnia and RLS. Future research directions in the adult population will also be discussed.

6 Review A systematic review of interventions to deprescribe benzodiazepines and other hypnotics among older people. 2017

Reeve, Emily / Ong, Magdalene / Wu, Angela / Jansen, Jesse / Petrovic, Mirko / Gnjidic, Danijela. ·Cognitive Decline Partnership Centre, Kolling Institute of Medical Research, Sydney Medical School, University of Sydney, Sydney, Australia. emily.reeve@sydney.edu.au. · Aging and Pharmacology, Royal North Shore Hospital, Level 12 Kolling Building, St Leonards, NSW, Australia. emily.reeve@sydney.edu.au. · Faculty of Pharmacy and Charles Perkins Centre, University of Sydney, Sydney, Australia. · Wiser Healthcare, Sydney School of Public Health, The University of Sydney, Sydney, NSW, 2006, Australia. · Centre for Medical Psychology and Evidence-Based Decision-Making (CeMPED), The University of Sydney, Sydney, NSW, 2006, Australia. · Department of Internal Medicine, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium. ·Eur J Clin Pharmacol · Pubmed #28456823.

ABSTRACT: PURPOSE: Benzodiazepines are effective medicines for insomnia and anxiety but are commonly used beyond recommended treatment time frames, which may lead to adverse drug events. The aim of this systematic review was to critically evaluate the success of interventions used to reduce benzodiazepines and 'Z-drug' use, and the impact of these interventions on clinical outcomes in older adults. METHODS: A search was conducted in PubMed, Embase, Informit, International Pharmaceutical Abstracts, Scopus, PsychINFO, Cochrane Central Register of Controlled Trials (CENTRAL) and CINAHL. Studies conducted in older adults (≥65 years) and published between January 1995 and July 2015 were included. Two authors independently reviewed all articles for eligibility and extracted the data. RESULTS: Seven studies of benzodiazepines and Z-drug withdrawal were identified. Benzodiazepine discontinuation rates were 64.3% in one study that employed pharmacological substitution with melatonin and 65.0% in a study that employed general practitioner-targeted intervention. Mixed interventions including patient education and tapering (n = 2), pharmacological substitution with psychological support (n = 1) and tapering with psychological support (n = 1) yielded discontinuation rates between 27.0 and 80.0%. Five studies measured clinical outcomes following benzodiazepine discontinuation. Most (n = 4) observed no difference in prevalence of withdrawal symptoms or sleep quality, while one study reported decline in quality of life in those who continued taking benzodiazepine vs. those who discontinued over 8 months. CONCLUSIONS: Current evidence shows that benzodiazepine withdrawal is feasible in the older population, but withdrawal rates vary according to the type of intervention. As the benefits and sustainability of these interventions are unclear, further studies should be conducted to assess this.

7 Review Heart rate variability in insomnia patients: A critical review of the literature. 2017

Dodds, Kirsty L / Miller, Christopher B / Kyle, Simon D / Marshall, Nathaniel S / Gordon, Christopher J. ·Sydney Nursing School, University of Sydney, Australia; CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, University of Sydney, NSW, Australia. · CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, University of Sydney, NSW, Australia; Sydney Medical School, University of Sydney, Australia. · Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, England, UK. · Sydney Nursing School, University of Sydney, Australia; CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, University of Sydney, NSW, Australia. Electronic address: christopher.gordon@sydney.edu.au. ·Sleep Med Rev · Pubmed #28187954.

ABSTRACT: Heart rate variability (HRV) is an objective marker that provides insight into autonomic nervous system dynamics. There is conflicting evidence regarding the presence of HRV impairment in insomnia patients. Web-based databases were used to systematically search the literature for all studies that compared the HRV of insomnia patients to controls or reported the HRV of insomnia patients before and after an intervention. 22 relevant papers were identified. Study characteristics were summarised, HRV measures were extracted and a risk of bias assessment for each study was performed. We were limited in our ability to synthesise outcome measures and perform meta-analyses due to considerable differences in patient (and control) selection, study protocols, measurement and processing techniques and outcome reporting. Risk of bias was deemed to be high in the majority of studies. As such, we cannot confirm that HRV is reliably impaired in insomnia patients nor determine the HRV response to interventions. Whilst HRV impairment in insomnia is a widely accepted concept, it is not supported by empirical evidence. Large longitudinal studies incorporating 24-hour recordings are required to elucidate the precise nature of HRV dynamics in insomnia patients.

8 Review Exercise as an alternative treatment for chronic insomnia (PEDro synthesis). 2017

Milne, Stephen / Elkins, Mark R. ·Woolcock Institute of Medical Research, University of Sydney, Sydney, Australia. · Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia. · Centre for Evidence-Based Physiotherapy, The George Institute for Global Health, Sydney, New South Wales, Australia. ·Br J Sports Med · Pubmed #27198542.

ABSTRACT: -- No abstract --

9 Review Towards standardisation and improved understanding of sleep restriction therapy for insomnia disorder: A systematic examination of CBT-I trial content. 2015

Kyle, Simon D / Aquino, Maria Raisa Jessica / Miller, Christopher B / Henry, Alasdair L / Crawford, Megan R / Espie, Colin A / Spielman, Arthur J. ·School of Psychological Sciences, University of Manchester, UK. Electronic address: simon.kyle@manchester.ac.uk. · School of Health Sciences, City University London, UK. · Woolcock Institute of Medical Research, University of Sydney, Australia. · Institute of Inflammation & Repair, University of Manchester, UK. · Rush University Medical Center, Chicago, USA. · Sleep & Circadian Neuroscience Institute, University of Oxford, UK. · Weill Cornell Medical College, Center for Sleep Medicine, NY, USA. ·Sleep Med Rev · Pubmed #25771293.

ABSTRACT: Sleep restriction therapy is a core element of contemporary cognitive-behavioural therapy for insomnia and is also effective as a single-component therapeutic strategy. Since its original description, sleep restriction therapy has been applied in several different ways, potentially limiting understanding of key therapeutic ingredients, mode of action, evidence synthesis, and clinical implementation. We sought to examine the quality of reporting and variability in the application of sleep restriction therapy within the context of insomnia intervention trials. Systematic literature searches revealed 88 trials of cognitive-behavioural therapy/sleep restriction therapy that met pre-defined inclusion/exclusion criteria. All papers were coded in relation to their description of sleep restriction therapy procedures. Findings indicate that a large proportion of papers (39%) do not report any details regarding sleep restriction therapy parameters and, for those papers that do, variability in implementation is present at every level (sleep window generation, minimum time-in-bed, sleep efficiency titration criteria, and positioning of sleep window). Only 7% of papers reported all parameters of sleep restriction treatment. Poor reporting and variability in the application of sleep restriction therapy may hinder progress in relation to evidence synthesis, specification of mechanistic components, and refinement of therapeutic procedures for patient benefit. We set out guidelines for the reporting of sleep restriction therapy as well as a research agenda aimed at advancing understanding of sleep restriction therapy.

10 Review Bidirectional interactions between the baroreceptor reflex and arousal: an update. 2015

Silvani, Alessandro / Calandra-Buonaura, Giovanna / Benarroch, Eduardo E / Dampney, Roger A L / Cortelli, Pietro. ·PRISM lab, Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy. · Autonomic Unit, Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy; IRCCS Bologna Institute of Neurological Sciences, Bologna, Italy. · Department of Neurology, Mayo Clinic, Rochester, MN, USA. · School of Medical Sciences (Physiology) and Bosch Institute for Biomedical Research, University of Sydney, Australia. · Autonomic Unit, Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy; IRCCS Bologna Institute of Neurological Sciences, Bologna, Italy. Electronic address: pietro.cortelli@unibo.it. ·Sleep Med · Pubmed #25616389.

ABSTRACT: Studies involving genetic engineering on animal models and mathematical analysis of cardiovascular signals on humans are shedding new light on the interactions between the arterial baroreceptor reflex (baroreflex) and arousal. Baroreceptor stimulation, if very mild or performed under anaesthesia, may inhibit cortical arousal. However, substantial increases or decreases in baroreflex activation cause arousal in animal models and human subjects in physiological conditions. On the other hand, cardiovascular changes during autonomic arousals and between the states of wakefulness and sleep involve changes in the baroreflex set point and balance with central autonomic commands. Neural connectivity and functional data suggest that the nucleus of the solitary tract, adrenergic C1 neurons of the medulla, and the parabrachial nucleus of the pons mediate the bidirectional interactions between the baroreflex and arousal. These interactions may constitute a positive feedback loop that facilitates sharp and coordinated brain state and autonomic transitions upon arousal: upon arousal, central autonomic commands may increase blood pressure, thereby loading baroreceptors and further increasing arousal. Anomalies of this feedback loop may play a role in the pathophysiology of disease conditions associated with cardiovascular and sleep-wake cycle alterations. These conditions include: obstructive sleep apnoea syndrome, with its association with excessive daytime sleepiness and baroreflex impairment; and insomnia, with its association with autonomic hyperarousal and hypertension. When faced with disorders associated with cardiovascular and sleep-wake cycle alterations, clinical reasoning should entertain the possibility that both conditions are strongly influenced by anomalies of baroreflex function.

11 Review A review of sleep-promoting medications used in pregnancy. 2015

Okun, Michele L / Ebert, Rebecca / Saini, Bandana. ·University of Pittsburgh, Pittsburgh, PA; University of Colorado at Colorado Springs, Colorado Springs, CO. Electronic address: mokun@uccs.edu. · University of Pittsburgh, Pittsburgh, PA. · University of Sydney, Sydney, Australia. ·Am J Obstet Gynecol · Pubmed #25448509.

ABSTRACT: Approximately 4% of adults who have symptoms of insomnia resort to various hypnotic or sedating medications for acute symptom relief. Although typically a common practice for nonpregnant adults, this is not the case for the thousands of pregnant women who also report substantial sleep issues. Unfortunately, a paucity of randomized controlled trials in this population, scant empiric evidence regarding the appropriateness of prescribing options, and the concern of subsequent teratogenicity restricts the ability of clinicians to make informed decisions. We synthesized the current research regarding hypnotics and sedating medications used (both on- and off-label) during pregnancy and their association with adverse outcomes. Medications that we investigated included benzodiazepines, hypnotic benzodiazepine receptor agonists, antidepressants, and antihistamines. Overall, the examined studies showed no correlation of increased risk of congenital malformations. However, benzodiazepines and hypnotic benzodiazepine receptor agonists may increase rates of preterm birth, low birthweight, and/or small-for-gestational-age infants. The small number of studies and the small number of subjects prohibit any definitive interpretation regarding the consequences of the use of hypnotic or sedating medications in pregnancy. Additional case reports, randomized clinical trials, and epidemiologic studies are needed urgently.

12 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.

13 Review Circadian rhythm disorders among adolescents: assessment and treatment options. 2013

Bartlett, Delwyn J / Biggs, Sarah N / Armstrong, Stuart M. ·Sleep and Circadian Group, Woolcock Institute of Medical Research, Sydney, NSW, Australia. delwyn.bartlett@sydney.edu.au. ·Med J Aust · Pubmed #24138360.

ABSTRACT: Delayed sleep phase disorder (DSPD) - a circadian rhythm sleep disorder - is most commonly seen in adolescents. The differential diagnosis between DSPD and conventional psychophysiological insomnia is important for correct therapeutic intervention. Adolescent DSPD sleep duration is commonly 9 hours or more. Depression may be comorbid with DSPD. DSPD has a negative impact on adolescent academic performance. DSPD treatments include bright light therapy, chronotherapeutic regimens, and administration of melatonin as a chronobiotic (as distinct from a soporific). Attention to non-photic and extrinsic factors including healthy sleep parameters is also important to enable better sleep and mood outcomes in adolescents.

14 Review The insomnia patient perspective, a narrative review. 2013

Cheung, Janet M Y / Bartlett, Delwyn J / Armour, Carol L / Saini, Bandana. ·a Faculty of Pharmacy , The University of Sydney , Australia. ·Behav Sleep Med · Pubmed #23402684.

ABSTRACT: Insomnia is a common sleep disorder associated with substantial direct and indirect costs, yet there is a strong propensity among patients to self-medicate which often delays professional help. Understanding the process which underpins the initiation, engagement and adherence to insomnia treatment(s) is a vital step for understanding this phenomenon. The current paper explores how the patient perspective has been conceptualized in the research literature and its implications for insomnia treatment and health care delivery. A literature search was conducted using Embase, Medline and PsycINFO databases. Articles have been thematically organized into patient correlates of health behaviors, patient experiences and treatment attitudes. Deferral of professional help among insomnia patients is partially related to barriers embedded in the health care system and patient health beliefs.

15 Review Sleep disturbances in Parkinson disease and their potential role in heterogeneity. 2010

Gunn, David G / Naismith, Sharon L / Lewis, Simon J G. ·Parkinson's Disease Research Clinic, Ageing Brain Centre, Brain & Mind Research Institute, University of Sydney, Camperdown, New South Wales, Australia. ·J Geriatr Psychiatry Neurol · Pubmed #20101072.

ABSTRACT: Parkinson disease (PD) is commonly conceptualized as a movement disorder. Most previous attempts to define the heterogeneity of the condition have used prospective methods based on arbitrary features such as motor symptoms or age of disease onset. However, nonmotor symptoms including neuropsychological, neuropsychiatric, and behavioral impairments have received less attention. Sleep disturbances are extremely common in PD and appear to be associated with cognitive and psychiatric problems. Recent research has begun to elucidate the links between these variables, but the origin and extent of these relationships are not clearly understood. This review outlines the importance of sleep for healthy cognition and mood, highlighting the possible implications that disturbed sleep may have with regard to patients with PD. It also emphasizes the need for further studies that explore the heterogeneity of all disease features in PD.

16 Clinical Trial Clusters of Insomnia Disorder: An Exploratory Cluster Analysis of Objective Sleep Parameters Reveals Differences in Neurocognitive Functioning, Quantitative EEG, and Heart Rate Variability. 2016

Miller, Christopher B / Bartlett, Delwyn J / Mullins, Anna E / Dodds, Kirsty L / Gordon, Christopher J / Kyle, Simon D / Kim, Jong Won / D'Rozario, Angela L / Lee, Rico S C / Comas, Maria / Marshall, Nathaniel S / Yee, Brendon J / Espie, Colin A / Grunstein, Ronald R. ·CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, University of Sydney, Australia. · Sydney Medical School, University of Sydney, Australia. · Sydney Nursing School, University of Sydney, Australia. · Nuffield Department of Clinical Neurosciences and Sleep & Circadian Neuroscience Institute, University of Oxford, UK. · Department of Respiratory and Sleep Medicine, RPAH, Sydney Local Health District, Sydney, NSW, Australia. · Clinical Research Unit, Brain & Mind Centre, University of Sydney, Australia. ·Sleep · Pubmed #27568796.

ABSTRACT: STUDY OBJECTIVES: To empirically derive and evaluate potential clusters of Insomnia Disorder through cluster analysis from polysomnography (PSG). We hypothesized that clusters would differ on neurocognitive performance, sleep-onset measures of quantitative ( METHODS: Research volunteers with Insomnia Disorder (DSM-5) completed a neurocognitive assessment and overnight PSG measures of total sleep time (TST), wake time after sleep onset (WASO), and sleep onset latency (SOL) were used to determine clusters. RESULTS: From 96 volunteers with Insomnia Disorder, cluster analysis derived at least two clusters from objective sleep parameters: Insomnia with normal objective sleep duration (I-NSD: n = 53) and Insomnia with short sleep duration (I-SSD: n = 43). At sleep onset, differences in HRV between I-NSD and I-SSD clusters suggest attenuated parasympathetic activity in I-SSD (P < 0.05). Preliminary work suggested three clusters by retaining the I-NSD and splitting the I-SSD cluster into two: I-SSD A (n = 29): defined by high WASO and I-SSD B (n = 14): a second I-SSD cluster with high SOL and medium WASO. The I-SSD B cluster performed worse than I-SSD A and I-NSD for sustained attention (P ≤ 0.05). In an exploratory analysis, CONCLUSIONS: Two insomnia clusters derived from cluster analysis differ in sleep onset HRV. Preliminary data suggest evidence for three clusters in insomnia with differences for sustained attention and sleep-onset CLINICAL TRIAL REGISTRATION: Insomnia 100 sleep study: Australia New Zealand Clinical Trials Registry (ANZCTR) identification number 12612000049875. URL: https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=347742.

17 Clinical Trial Physiological Markers of Arousal Change with Psychological Treatment for Insomnia: A Preliminary Investigation. 2015

Miller, Christopher B / Kyle, Simon D / Gordon, Christopher J / Espie, Colin A / Grunstein, Ronald R / Mullins, Anna E / Postnova, Svetlana / Bartlett, Delwyn J. ·Centre for Integrated Research and Understanding of Sleep (CIRUS), NeuroSleep and Woolcock Institute of Medical Research, University of Sydney, Sydney, Australia. · Sleep & Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom. · Sydney Nursing School, University of Sydney, Sydney, Australia. · Department of Respiratory and Sleep Medicine, RPAH, Sydney Local Health District, Sydney, Australia. · School of Physics, University of Sydney, Sydney, Australia. ·PLoS One · Pubmed #26683607.

ABSTRACT: OBJECTIVES: The aim of this preliminary study was to evaluate if Sleep Restriction Therapy for insomnia is associated with modifications to physiological arousal, indexed through overnight measures of plasma cortisol concentrations and core body temperature. METHODS: In a pre-to-post open label study design, eleven patients with chronic and severe Psychophysiological Insomnia underwent 5 weeks of Sleep Restriction Therapy. RESULTS: Eight (73%) patients out of 11 consented completed therapy and showed a decrease in insomnia severity pre-to-post treatment (mean (SD): 18.1 (2.8) versus 8.4 (4.8); p = .001). Six patients were analyzed with pre-to-post overnight measures of temperature and cortisol. Contrary to our hypothesis, significantly higher levels of plasma cortisol concentrations were found during the early morning at post-treatment compared to baseline (p < .01), while no change was observed in the pre-sleep phase or early part of the night. Core body temperature during sleep was however reduced significantly (overall mean [95% CI]: 36.54 (°C) [36.3, 36.8] versus 36.45 [36.2, 36.7]; p < .05). CONCLUSIONS: Sleep Restriction Therapy therefore was associated with increased early morning cortisol concentrations and decreased core body temperature, supporting the premise of physiological changes in functioning after effective therapy. Future work should evaluate change in physiological variables associated with clinical treatment response. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ANZCTR 12612000049875.

18 Clinical Trial Sleep restriction therapy for insomnia is associated with reduced objective total sleep time, increased daytime somnolence, and objectively impaired vigilance: implications for the clinical management of insomnia disorder. 2014

Kyle, Simon D / Miller, Christopher B / Rogers, Zoe / Siriwardena, A Niroshan / Macmahon, Kenneth M / Espie, Colin A. ·School of Psychological Sciences, University of Manchester, Manchester, UK. · Woolcock Institute of Medical Research, University of Sydney, Sydney, Australia. · Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, UK. · School of Health and Social Care, University of Lincoln, Lincoln, UK. · Institute of Neuroscience and Psychology, University of Glasgow, Glasgow, UK. · Sleep and Circadian Neuroscience Institute, University of Oxford, Oxford, UK. ·Sleep · Pubmed #24497651.

ABSTRACT: STUDY OBJECTIVES: To investigate whether sleep restriction therapy (SRT) is associated with reduced objective total sleep time (TST), increased daytime somnolence, and impaired vigilance. DESIGN: Within-subject, noncontrolled treatment investigation. SETTING: Sleep research laboratory. PARTICIPANTS: Sixteen patients [10 female, mean age = 47.1 (10.8) y] with well-defined psychophysiological insomnia (PI), reporting TST ≤ 6 h. INTERVENTIONS: Patients were treated with single-component SRT over a 4-w protocol, sleeping in the laboratory for 2 nights prior to treatment initiation and for 3 nights (SRT night 1, 8, 22) during the acute interventional phase. The psychomotor vigilance task (PVT) was completed at seven defined time points [day 0 (baseline), day 1,7,8,21,22 (acute treatment) and day 84 (3 mo)]. The Epworth Sleepiness Scale (ESS) was completed at baseline, w 1-4, and 3 mo. MEASUREMENT AND RESULTS: Subjective sleep outcomes and global insomnia severity significantly improved before and after SRT. There was, however, a robust decrease in PSG-defined TST during acute implementation of SRT, by an average of 91 min on night 1, 78 min on night 8, and 69 min on night 22, relative to baseline (P < 0.001; effect size range = 1.60-1.80). During SRT, PVT lapses were significantly increased from baseline (at three of five assessment points, all P < 0.05; effect size range = 0.69-0.78), returning to baseline levels by 3 mo (P = 0.43). A similar pattern was observed for RT, with RTs slowing during acute treatment (at four of five assessment points, all P < 0.05; effect size range = 0.57-0.89) and returning to pretreatment levels at 3 mo (P = 0.78). ESS scores were increased at w 1, 2, and 3 (relative to baseline; all P < 0.05); by 3 mo, sleepiness had returned to baseline (normative) levels (P = 0.65). CONCLUSION: For the first time we show that acute sleep restriction therapy is associated with reduced objective total sleep time, increased daytime sleepiness, and objective performance impairment. Our data have important implications for implementation guidelines around the safe and effective delivery of cognitive behavioral therapy for insomnia.

19 Article Health concerns of cancer survivors after primary anti-cancer treatment. 2019

Tan, S Y / Turner, J / Kerin-Ayres, K / Butler, S / Deguchi, C / Khatri, S / Mo, C / Warby, A / Cunningham, I / Malalasekera, A / Dhillon, H M / Vardy, Janette L. ·Concord Cancer Centre, Concord Repatriation General Hospital, Hospital Rd, Concord, NSW, 2137, Australia. · Sydney Medical School, University of Sydney, Sydney, Australia. · Centre for Medical Psychology and Evidence-Based Decision-making, University of Sydney, Sydney, Australia. · Concord Cancer Centre, Concord Repatriation General Hospital, Hospital Rd, Concord, NSW, 2137, Australia. janette.vardy@sydney.edu.au. · Sydney Medical School, University of Sydney, Sydney, Australia. janette.vardy@sydney.edu.au. · Centre for Medical Psychology and Evidence-Based Decision-making, University of Sydney, Sydney, Australia. janette.vardy@sydney.edu.au. ·Support Care Cancer · Pubmed #30710242.

ABSTRACT: PURPOSE: Cancer survivors experience significant health concerns compared to the general population. Sydney Survivorship Clinic (SSC) is a multi-disciplinary clinic aiming to help survivors treated with curative intent manage side effects, and establish a healthy lifestyle. Here, we determine the health concerns of survivors post-primary treatment. METHODS: Survivors completed questionnaires assessing symptoms, quality of life (QOL), distress, diet, and exercise before attending SSC, and a satisfaction survey after. Body mass index (BMI), clinical findings and recommendations were reviewed. Descriptive statistical methods were used. RESULTS: Overall, 410 new patients attended SSC between September 2013 and April 2018, with 385 survivors included in analysis: median age 57 years (range 18-86); 69% female; 43% breast, 31% colorectal and 19% haematological cancers. Median time from diagnosis, 12 months. Common symptoms of at least moderate severity: fatigue (45%), insomnia (37%), pain (34%), anxiety (31%) and with 56% having > 5 moderate-severe symptoms. Overall, 45% scored distress ≥ 4/10 and 62% were rated by clinical psychologist as having 'fear of cancer recurrence'. Compared to population mean of 50, mean global QOL T-score was 47.2, with physical and emotional well-being domains most affected. Average BMI was 28.2 kg/m CONCLUSION: Distress, fear of cancer recurrence, fatigue, obesity and sedentary lifestyle are common in cancer survivors attending SSC and may best be addressed in a multi-disciplinary Survivorship Clinic to minimise longer-term effects. This model is well-rated by survivors.

20 Article Insomnia disorder subtypes derived from life history and traits of affect and personality. 2019

Blanken, Tessa F / Benjamins, Jeroen S / Borsboom, Denny / Vermunt, Jeroen K / Paquola, Casey / Ramautar, Jennifer / Dekker, Kim / Stoffers, Diederick / Wassing, Rick / Wei, Yishul / Van Someren, Eus J W. ·Department of Sleep and Cognition, Netherlands Institute for Neuroscience, Amsterdam, Netherlands; Department of Integrative Neurophysiology and Department of Psychiatry, Amsterdam Neuroscience, Vrije Universiteit, Amsterdam University Medical Centre, Amsterdam, Netherlands. Electronic address: t.blanken@nin.knaw.nl. · Department of Sleep and Cognition, Netherlands Institute for Neuroscience, Amsterdam, Netherlands; Department of Social, Health and Organizational Psychology and Department of Experimental Psychology, Utrecht University, Utrecht, Netherlands. · Department of Psychological Methods, University of Amsterdam, Amsterdam, Netherlands. · Department of Methodology and Statistics, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, Netherlands. · Department of Sleep and Cognition, Netherlands Institute for Neuroscience, Amsterdam, Netherlands; Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia. · Department of Sleep and Cognition, Netherlands Institute for Neuroscience, Amsterdam, Netherlands. · Department of Sleep and Cognition, Netherlands Institute for Neuroscience, Amsterdam, Netherlands; Spinoza Centre for Neuroimaging, Amsterdam, Netherlands. · Department of Sleep and Cognition, Netherlands Institute for Neuroscience, Amsterdam, Netherlands; Department of Integrative Neurophysiology and Department of Psychiatry, Amsterdam Neuroscience, Vrije Universiteit, Amsterdam University Medical Centre, Amsterdam, Netherlands. ·Lancet Psychiatry · Pubmed #30630691.

ABSTRACT: BACKGROUND: Insomnia disorder is the second most prevalent mental disorder, and it is a primary risk factor for depression. Inconsistent clinical and biomarker findings in patients with insomnia disorder suggest that heterogeneity exists and that subtypes of this disease remain unrecognised. Previous top-down proposed subtypes in nosologies have had insufficient validity. In this large-scale study, we aimed to reveal robust subtypes of insomnia disorder by use of data-driven analyses on a multidimensional set of biologically based traits. METHODS: In this series of studies, we recruited participants from the Netherlands Sleep Registry, a database of volunteers aged 18 years or older, who we followed up online to survey traits, sleep, life events, and health history with 34 selected questionnaires of which participants completed at least one. We identified insomnia disorder subtypes by use of latent class analyses. We evaluated the value of our identified subtypes of insomnia disorder by use of a second, non-overlapping cohort who were recruited through a newsletter that was emailed to a new sample of Netherlands Sleep Registry participants, and by assessment of within-subject stability over several years of follow-up. We extensively tested the clinical validity of these subtypes for the development of sleep complaints, comorbidities (including depression), and response to benzodiazepines; in two subtypes of insomnia disorder, we also assessed the clinical relevance of these subtypes by use of an electroencephalogram biomarker and the effectiveness of cognitive behavioural therapy. To facilitate implementation, we subsequently constructed a concise subtype questionnaire and we validated this questionnaire in the second, non-overlapping cohort. FINDINGS: 4322 Netherlands Sleep Registry participants completed at least one of the selected questionnaires, a demographic questionnaire, and an assessment of their Insomnia Severity Index (ISI) between March 2, 2010, and Oct 28, 2016. 2224 (51%) participants had probable insomnia disorder, defined as an ISI score of at least 10, and 2098 (49%) participants with a lower ISI score served as a control group. With a latent class analysis of the questionnaire responses of 2224 participants, we identified five novel insomnia disorder subtypes: highly distressed, moderately distressed but reward sensitive (ie, with intact responses to pleasurable emotions), moderately distressed and reward insensitive, slightly distressed with high reactivity (to their environment and life events), and slightly distressed with low reactivity. In a second, non-overlapping replication sample of 251 new participants who were assessed between June 12, 2017, and Nov 26, 2017, five subtypes were also identified to be optimal. In both the development sample and replication sample, each participant was classified as having only one subtype with high posterior probability (0·91-1·00). In 215 of the original sample of 2224 participants with insomnia who were reassessed 4·8 (SD 1·6) years later (between April 13, 2017, and June 21, 2017), the probability of maintaining their original subtype was 0·87, indicating a high stability of the classification. We found differences between the identified subtypes in developmental trajectories, response to treatment, the presence of an electroencephalogram biomarker, and the risk of depression that was up to five times different between groups, which indicated a clinical relevance of these subtypes. INTERPRETATION: High-dimensional data-driven subtyping of people with insomnia has addressed an unmet need to reduce the heterogeneity of insomnia disorder. Subtyping facilitates identification of the underlying causes of insomnia, development of personalised treatments, and selection of patients with the highest risk of depression for inclusion in trials regarding prevention of depression. FUNDING: European Research Council and Netherlands Organization for Scientific Research.

21 Article A systematic review of cognitive behavioral therapy for insomnia implemented in primary care and community settings. 2019

Cheung, Janet M Y / Jarrin, Denise C / Ballot, Orlane / Bharwani, Annika A / Morin, Charles M. ·School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; École de psychologie, Université Laval, Québec, QC, Canada; Centre d'étude des troubles du sommeil, Institut universitaire en santé mentale de Québec, Québec, QC, Canada. Electronic address: janet.cheung@sydney.edu.au. · École de psychologie, Université Laval, Québec, QC, Canada; Centre d'étude des troubles du sommeil, Institut universitaire en santé mentale de Québec, Québec, QC, Canada. · Faculty of Medicine, Chinese University of Hong Kong, New Territories, Hong Kong. ·Sleep Med Rev · Pubmed #30612061.

ABSTRACT: The advent of stepped-care and the need to disseminate cognitive behavioral therapy for insomnia (CBT-I) has led to novel interventions, which capitalize on non-specialist venues and/or health personnel. However, the translatability of these CBT-I programs into practice is unknown. This review evaluates the current state of CBT-I programs that are directly implemented in primary care and/or community settings. A literature search was conducted through major electronic databases (N = 840) and through snowballing (n = 8). After removing duplicates, 104 full-texts were extracted and evaluated against our initial inclusion criteria. Twelve studies including data from 1625 participants were subsequently evaluated for its study design and methodological quality. CBT-I program components varied across studies and included cognitive therapy (n = 6), relaxation (n = 7), sleep restriction therapy (n = 9), stimulus control therapy (n = 11) and sleep psychoeducation (n = 12). The respective interventions produced small to moderate post-treatment weighted effect sizes for the Insomnia Severity Index (0.40), Pittsburgh Sleep Quality Index (0.37), sleep efficiency (0.38), sleep onset latency (0.38), and wake time after sleep onset (0.46) but total sleep time (0.10) did not reach statistical significance. While non-specialist community settings can potentially address the demands for CBT-I across clinical contexts, intervention heterogeneity precluded the full impact of the 12 CBT-I programs to be evaluated.

22 Article The added value of cognitive behavioral therapy for insomnia to current best evidence physical therapy for chronic spinal pain: protocol of a randomized controlled clinical trial. 2019

Malfliet, Anneleen / Bilterys, Thomas / Van Looveren, Eveline / Meeus, Mira / Danneels, Lieven / Ickmans, Kelly / Cagnie, Barbara / Mairesse, Olivier / Neu, Daniel / Moens, Maarten / Goubert, Dorien / Kamper, Steven J / Nijs, Jo. ·Research Foundation - Flanders (FWO), Brussels, Belgium; Pain in Motion International Research Group(1); Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Brussel, Belgium; Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Brussels Belgium; Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Campus Heymans, Ghent, Belgium. Electronic address: Anneleen.Malfliet@vub.be. · Pain in Motion International Research Group(1); Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Brussel, Belgium. · Pain in Motion International Research Group(1); Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Campus Heymans, Ghent, Belgium. · Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Campus Heymans, Ghent, Belgium. · Pain in Motion International Research Group(1); Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Brussel, Belgium; Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Brussels Belgium. · Department of Experimental and Applied Psychology, Vrije Universiteit Brussel, Brussels, Belgium; Sleep Laboratory and Unit for Chronobiology U78, Brugmann University Hospital, Université Libre de Bruxelles (U.L.B.), Brussels, Belgium. · Sleep Laboratory and Unit for Chronobiology U78, Brugmann University Hospital, Université Libre de Bruxelles (U.L.B.), Brussels, Belgium. · Department of Neurosurgery, Universitair Ziekenhuis Brussel, Brussels, Belgium; Department of Radiology, Universitair Ziekenhuis Brussel, Brussels, Belgium; Center for Neurosciences (C4N), Vrije Universiteit Brussel (VUB), Brussels, Belgium. · School of Public Health, University of Sydney, Camperdown, Australia; Centre for Pain, Health and Lifestyle, Sydney, Australia(2). ·Braz J Phys Ther · Pubmed #30389347.

ABSTRACT: BACKGROUND: Insomnia is a highly prevalent and debilitating comorbidity that is often not addressed in therapy for chronic spinal pain (CSP). Given the close interaction between insomnia and CSP severity and related disability, targeting sleep problems during therapy could improve treatment outcomes in these patients. OBJECTIVE: Can cognitive behavioral therapy for insomnia (CBT-I) combined with the modern neuroscience approach (i.e. pain neuroscience education and cognition-targeted exercise therapy) reduce pain and improve sleep, physical activity and function in people with CSP and comorbid insomnia? METHODS: Participants: One-hundred-twenty participants with chronic spinal pain and comorbid insomnia Intervention: CBT-I combined with the modern neuroscience approach (experimental) compared to the modern neuroscience approach alone (control). Both interventions start with three sessions of pain neuroscience education, followed by six sessions of CBT-I and nine sessions of cognition-targeted exercise therapy in the experimental group, or 15 sessions of cognition-targeted exercise therapy in the control group. MEASUREMENTS: Primary outcome measure: self-reported pain severity (Brief Pain Inventory). SECONDARY OUTCOME MEASURES: pain sensitivity (pressure pain thresholds, and online questionnaires), sleep-related outcomes (home-based polysomnography and online questionnaires), physical activity (actigraphy), and function (online questionnaires). Online questionnaires will be completed at baseline, directly post-treatment, and at 3, 6 and 12 months post-treatment. Polysomnography, pressure pain thresholds and actigraphy will be carried out at baseline, post-treatment and at 12 months follow-up. DISCUSSION: Findings may provide (1) a novel therapeutic approach for people with CSP and comorbid insomnia to improve pain, sleep, physical activity and function, and (2) new treatment guidelines for professionals. TRIAL REGISTRATION: Clinicaltrials.gov NCT03482856 (https://clinicaltrials.gov/ct2/show/NCT03482856).

23 Article Patient Perceptions of Treatment Delivery Platforms for Cognitive Behavioral Therapy for Insomnia. 2019

Cheung, Janet M Y / Bartlett, Delwyn J / Armour, Carol L / Laba, Tracey-Lea / Saini, Bandana. ·a Faculty of Pharmacy , University of Sydney , Sydney, Australia. · b CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, University of Sydney , Sydney , Australia. · c Clinical Management Group, Woolcock Institute of Medical Research, University of Sydney , Sydney , Australia. · d Sydney Local Health District , New South Wales Health, Sydney , Australia. · e The George Institute for Global Health, University of Sydney , Sydney , Australia. ·Behav Sleep Med · Pubmed #28323439.

ABSTRACT: OBJECTIVE: Stepped care has given rise to the proliferation of abbreviated CBT-I programs and delivery formats. This includes interventions delivered by allied health professionals and those delivered electronically through the Internet. This article aims to explore patient perceptions between electronic and face-to-face (FTF) delivery platforms for (abbreviated) CBT-I. PARTICIPANTS: Patients with insomnia from specialist sleep or psychology clinics and those from the general community in Sydney, Australia. METHOD: Semistructured interviews were conducted with patients with insomnia, guided by a schedule of questions and a choice task to explore patient perceptions of the different CBT-I treatment delivery platforms (e.g., perceived advantages and disadvantages or willingness to engage with either platform). Interviews were transcribed verbatim and analyzed using Framework Analysis. Participants also completed a battery of clinical mood and insomnia measures. RESULTS: Fifty-one interviews were conducted with patients with insomnia from specialist sleep or psychology clinics (n = 22) and the general community (n = 29). Synthesis of the qualitative data set revealed three themes pertinent to the patients' perspective toward electronic and FTF CBT-I delivery: Concepts of Efficacy, Concerns About Treatment, and Treatment on My Terms. Participants' choice to engage with either platform was also informed by diverse factors including perceived efficacy of treatment, personal commitments, lifestyle, and beliefs about sleep and insomnia. CONCLUSION: Clarifying patient treatment priorities and allaying potential concerns about engaging with an electronic treatment platform represent important steps for disseminating eCBT-I into mainstream practice.

24 Article Insomnia Management in the Australian Primary Care Setting. 2019

Sake, Fatema-Tun-Naher / Wong, Keith / Bartlett, Delwyn J / Saini, Bandana. ·a Faculty of Pharmacy , The University of Sydney , Sydney , Australia. · b Faculty of Medicine , Woolcock Institute of Medical Research, The University of Sydney , Sydney , Australia. · c Department of Respiratory and Sleep Medicine , Royal Prince Alfred Hospital , Camperdown , Australia. ·Behav Sleep Med · Pubmed #28098492.

ABSTRACT: BACKGROUND AND OBJECTIVE: Insomnia is one of the most prevalent and costly sleep disorders presenting in general practice, and when left untreated, has major health consequences. However, studies are limited on how general practitioners respond to this health issue, especially since the reconceptualization of insomnia in DSM 5. Therefore, the aim of this study was to explore how insomnia is diagnosed and treated in Australian general practices. PARTICIPANTS: Twenty-four (54% male) general practitioners were recruited throughout the greater Sydney metropolitan area in New South Wales using the professional network of research team members and snowballing technique. METHODS: Participants were interviewed using a semi-structured interview guide. The audio-taped interviews were transcribed verbatim and a framework approach was used for analysis of transcribed data. RESULTS: Participant's responses highlighted that despite being a frequent presentation, insomnia is often trivialized with a low recognition rate in general practices. Lack of support and clear and effective management guidelines for general practitioners are the perceived barriers to early recognition of insomnia in general practices. Treating the underlying causes and initiating the treatment with general practitioners to manage insomnia. Medications including off-label antidepressants are often prescribed based on perceived patient expectation for a prescription. CONCLUSION: Findings of this exploratory study suggest the need for clearly contextualized guidelines that include information about a patient's insomnia experience and treatment expectations. Another significant implication of this study is the need to develop and evaluate a model of collaborative sleep health services in general practice.

25 Article Greater sleep disturbance and longer sleep onset latency facilitate SCR-specific fear reinstatement in PTSD. 2018

Zuj, Daniel V / Palmer, Matthew A / Malhi, Gin S / Bryant, Richard A / Felmingham, Kim L. ·Division of Psychology, School of Medicine, University of Tasmania, TAS, Australia; Department of Psychology, Swansea University, Wales, United Kingdom. Electronic address: d.v.zuj@swansea.ac.uk. · Division of Psychology, School of Medicine, University of Tasmania, TAS, Australia. · Department of Psychiatry, Royal North Shore Hospital, St Leonards, NSW, Australia; Sydney Medical School, University of Sydney, NSW, Australia. · School of Psychology, University of New South Wales, NSW, Australia. · School of Psychological Sciences, University of Melbourne, VIC, Australia. ·Behav Res Ther · Pubmed #30145363.

ABSTRACT: Fear reinstatement is one of several paradigms designed to measure fear return following extinction, as a laboratory model for the relapse of Posttraumatic Stress Disorder (PTSD) symptoms. Sleep is a key factor in emotional memory consolidation, and here we examined the relationship between sleep quality and fear reinstatement in PTSD, relative to trauma-exposed and non-exposed controls. The Pittsburgh Sleep Quality Index (PSQI) was used as a subjective measure of sleep quality, and skin conductance responses (SCR) and unconditioned stimulus (US)-expectancy ratings were used to index threat responses during a differential fear conditioning, extinction, and reinstatement paradigm. There were no significant between-group differences in the reinstatement of conditioned responding. Sleep disturbance and sleep onset latency were significant moderators between reinstatement of fear and PTSD symptom severity, such that there was a positive relationship between PTSD symptoms and fear reinstatement for higher levels - but not lower levels - of sleep disturbance and sleep onset latency. To our knowledge, this is the first study to investigate PTSD-specific reinstatement patterns and sleep as a boundary condition of reinstatement. Future research using polysomnographic measures of sleep-wave architecture may further clarify the relationship between fear reinstatement and sleep quality in clinical samples with PTSD relative to controls.

Next