Does physiological hyperarousal enhance error rates among insomnia sufferers?

Objective: To examine the association between physiological hyperarousal and response accuracy on reaction time tasks among individuals with insomnia.

Design And Setting: This study was conducted at affiliated Veterans Administration (VA) and academic medical centers using a matched-group, cross-sectional research design.

Participants: Eighty-nine individuals (48 women) with primary insomnia, PI (MAge = 49.

Sensitivity and specificity of polysomnographic criteria for defining insomnia.

Study Objectives: In recent years, polysomnography-based eligibility criteria have been increasingly used to identify candidates for insomnia research, and this has been particularly true of studies evaluating pharmacologic therapy for primary insomnia. However, the sensitivity and specificity of PSG for identifying individuals with insomnia is unknown, and there is no consensus on the criteria sets which should be used for participant selection. In the current study, an archival data set was used to test the sensitivity and specificity of PSG measures for identifying individuals with primary insomnia in both home and lab settings.

Testing the reliability and validity of DSM-IV-TR and ICSD-2 insomnia diagnoses. Results of a multitrait-multimethod analysis.

Context: Distinctive diagnostic classification schemes for insomnia diagnoses are available, but the optimal insomnia nosology has yet to be determined.

Objectives: To test the reliability and validity of insomnia diagnoses listed in the American Psychiatric Association's DSM-IV-TR and the International Classification of Sleep Disorders, second edition (ICSD-2).

Design: Multitrait-multimethod correlation design.

Nightmare reduction in a Vietnam veteran using imagery rehearsal therapy.

Following exposure to traumatic events, approximately 19% of combat veterans develop posttraumatic stress disorder. One of the main symptoms of this mental illness is reexperiencing the trauma, which is commonly expressed in the form of chronic trauma-related nightmares. In these patients, nightmares can fragment sleep, decrease sleep quality, and even cause fear about going to sleep.

Ethnic differences in continuous positive airway pressure (CPAP) adherence in veterans with and without psychiatric disorders.

Continuous positive airway pressure (CPAP) is a safe, effective treatment for sleep apnea, yet adherence is notoriously problematic. Vulnerable populations that may be at increased risk of sleep apnea include African Americans (AAs) and individuals with psychiatric disorders, yet little is known about whether such individuals are at increased risk of CPAP non-adherence. This study examined rates of CPAP adherence in a large sample of AA and Caucasian American (CA) military veterans with and without comorbid mental health disorders.

Home is where sleep is: an ecological approach to test the validity of actigraphy for the assessment of insomnia.

Study Objectives: This study tested the ecological validity of actigraphy (ACT) for estimating objective sleep parameters in participants' homes. We also examined how well ACT and polysomnography (PSG) measures discriminated (1) individuals with and without insomnia; and (2) nights participants rated worse, the same as, or better than average.

Methods: Thirty-one primary insomnia sufferers and 31 normal sleepers completed up to 3 consecutive monitoring nights with wrist ACT and PSG in their homes.

Cognitive behavioral therapy for patients with primary insomnia or insomnia associated predominantly with mixed psychiatric disorders: a randomized clinical trial.

Objective: This study was conducted to evaluate the efficacy of cognitive behavioral therapy (CBT) against a sleep hygiene education control therapy in patients with primary or comorbid insomnia.

Design And Setting: Randomized, parallel-group, clinical trial conducted at a single Veterans Affairs medical center, with recruitment from March 2001 to June 2005.

Participants: Eighty-one adults (n = 11 women; mean age, 54.

Nonpharmacologic treatment of insomnia.

Insomnia is a widespread and debilitating disorder. Regardless of the initial cause, it may assume a chronic course perpetuated by psychological and behavioral factors. Although sedative-hypnotic medications are the most common treatment for insomnia, they pose certain risks such as adverse effects and dependence.

Psychomotor performance deficits and their relation to prior nights' sleep among individuals with primary insomnia.

Objective: To examine psychomotor (reaction time) performance deficits and their relation to subjective and objective sleep measures among individuals with primary insomnia (PI).

Design And Setting: This study was conducted at affiliated VA and academic medical centers using a matched-groups, cross-sectional research design.

Participants: Seventy-nine (43 women) individuals with PI (MAge = 50.

Objective evidence of sleep disturbance in women with posttraumatic stress disorder.

Although sleep disturbance is considered a hallmark of posttraumatic stress disorder (PTSD), objective evidence for sleep disturbance in patients with PTSD has been equivocal. The goal of the current investigation was to objectively examine sleep disturbance among women with PTSD in their home environment. Women with PTSD (n = 30) and a control group (n = 22) completed three nights of actigraphy monitoring.

Graded exposure therapy for addressing claustrophobic reactions to continuous positive airway pressure: a case series report.

Continuous positive airway pressure (CPAP) is a safe, effective treatment for obstructive sleep apnea, and yet many patients develop claustrophobic reactions to the CPAP nasal mask and cannot tolerate this treatment. We examined the efficacy of a graded in-vivo exposure therapy for enhancing CPAP adherence using a retrospective, case series design. Objective CPAP adherence data were obtained on clinical patients who attended 1 or more sessions of exposure therapy with a behavioral sleep psychologist.

Defining insomnia: quantitative criteria for insomnia severity and frequency.

Study Objective: Recent efforts have been made to develop quantitative frequency, duration, and severity criteria for insomnia. The current study was conducted to test a range of frequency and severity criteria sets for discriminating primary insomnia sufferers from normal sleepers.

Participants: Seventy-two adults with primary insomnia and 88 age-matched normal sleepers.

Cognitive-behavioral therapy for primary insomnia.

Primary insomnia (PI) is a prevalent form of sleep difficulty that impairs diurnal functioning, reduces quality of life and enhances health care utilization/costs for millions worldwide. Whereas the underlying pathophysiology of PI remains poorly understood, it is widely accepted that a host of cognitive and behavioral factors play important roles in perpetuating this condition. As such, a multi-factorial, cognitive-behavioral therapy (CBT) has emerged as a "treatment of choice" for managing the sleep/wake complaints of PI sufferers.

A pilot study of inexpensive sleep-assessment devices.

Polysomnography (PSG), the gold standard sleep-assessment methodology, is impractical for many applications. Although alternative assessment methodologies are available, it is not clear which most correlates with PSG measures. This study compared sleep log (SL), actigraphy (ACT), and the REMview (RV) device for estimating PSG sleep measures.

CPAP compliance in sleep apnea patients with and without laboratory CPAP titration.

Advances in auto-adjusting positive airway pressure technology for obstructive sleep apnea now permit this treatment to be initiated outside of the sleep laboratory environment, bypassing the need for laboratory-based titration studies. Thus far, little research has addressed how such developments may affect compliance to continuous positive airway pressure (CPAP). We tested the effect of laboratory CPAP exposure and technologist support in a retrospective chart review of 98 veterans with obstructive sleep apnea to determine whether patients who received standard laboratory CPAP titration complied better with CPAP than did patients who received no laboratory CPAP titration.

Accuracy of sleep perceptions among insomnia sufferers and normal sleepers.

Objective: To examine the distribution, consistency, and correlates of sleep time perceptions in primary insomnia sufferers and normal sleepers across settings (laboratory and home).

Methods: Fifty-two middle-aged and older insomnia sufferers and 49 matched normal sleepers underwent multiple nights of laboratory and home polysomnography (PSG) and provided concurrent subjective estimates of their sleep. Descriptive statistics, cluster analyses, and inferential tests were used to examine the nature of sleep time perceptions, identify subgroups with distinctive patterns such as perceptions, and explore factors that may contribute to these subgroups' distinctive sleep perceptions.

Changes in depressive symptoms after continuous positive airway pressure treatment for obstructive sleep apnea.

It is generally believed that obstructive sleep apnea (OSA) causes depression in some patients, yet it is unknown whether this depression is an actual clinical phenomenon or purely a result of overlapping somatic/physical symptoms shared by both disorders. The present study investigated changes in both somatic and affective/cognitive symptoms of depression associated with the introduction of continuous positive airway pressure (CPAP) treatment for OSA. Participants were 39 outpatients (35 males, 4 females) with no current or past mental health problems, diagnosed with OSA in a hospital sleep disorders clinic.

Behavioral treatment of insomnia.

Insomnia is a prevalent and potentially serious condition that compromises the functioning, health status and quality of lives of millions of individuals worldwide. Chronic insomnia is often perpetuated by psychological and behavioral factors, such as dysfunctional beliefs about sleep, heightened anxiety and sleep-disruptive compensatory practices. Whereas sedative hypnotic medications are often prescribed for this condition, such treatment is symptom-focused and fails to address underlying factors sustaining the sleep problems.