How openness and inquisitiveness led to a career as a sleep researcher and a broad contribution to sleep science.

After describing my serendipitous discovery of sleep research as a potential career, I note how my openness and inquisitiveness led to a broad contribution to sleep science. After a PhD in biological psychology, I completed a postdoctoral fellowship in alcoholism and drug abuse. This led to my first studies on rebound insomnia.

Anhedonia modulates benzodiazepine and opioid demand among persons in treatment for opioid use disorder.

Background: Benzodiazepine (BZD) misuse is a significant public health problem, particularly in conjunction with opioid use, due to increased risks of overdose and death. One putative mechanism underlying BZD misuse is affective dysregulation, exaggerated negative affect (e.g.

Catching up on sleep: Recent evidence on the role of sleep in substance use disorders.

The objective of this editorial is to summarize the findings published in the special issue on "Sleep and Drug Abuse". The manuscripts in this issue include review articles as well as original investigations, and cover topics ranging from pre-clinical investigation to epidemiological-based clinical studies. Together, these papers provide evidence that sleep and drug abuse share a bidirectional relationship, with sleep playing a prominent role in substance use disorders.

At the intersection of sleep deficiency and opioid use: mechanisms and therapeutic opportunities.

Due to the ongoing opioid epidemic, innovative scientific perspectives and approaches are urgently needed to reduce the unprecedented personal and societal burdens of nonmedical and recreational opioid use. One promising opportunity is to focus on the relationship between sleep deficiency and opioid use. In this review, we examine empirical evidence: (1) at the interface of sleep deficiency and opioid use, including hypothesized bidirectional associations between sleep efficiency and opioid abstinence; (2) as to whether normalization of sleep deficiency might directly or indirectly improve opioid abstinence (and vice versa); and (3) regarding mechanisms that could link improvements in sleep to opioid abstinence.

Sleep and alertness disturbance and substance use disorders: A bi-directional relation.

The majority of the literature describing the relation of sleep/alertness disturbance and substance use disorders (SUD) has focused on the disruptive effects of substances with abuse liability on sleep and alertness. Rarely have studies or literature reviews assessed or discussed how sleep/alertness disturbance affects substance use. This paper focuses on the sleep/alertness disturbance side of the relation.

Current and potential pharmacological treatment options for insomnia in patients with alcohol use disorder in recovery.

Alcohol use disorder (AUD) is characterized by dysfunction in motivational, mood-stress regulation, and sleep systems that interact in complex ways to heighten the risk of relapse during abstinence. Emerging data suggest that excessive and chronic alcohol use disrupts sleep homeostasis and, in abstinence, subjects with AUD are known to experience insomnia that may persist for weeks to years, which we propose to refer to as insomnia associated with alcohol cessation (IAAC). The purpose of this review is to provide an update of pharmacological approaches to therapy including compounds in development, to raise awareness of the prevalence of and unmet need in IAAC and highlight differences in treatment consideration for IAAC as compared to insomnia disorder.

Sleep and pain in humans with fibromyalgia and comorbid insomnia: double-blind, crossover study of suvorexant 20 mg versus placebo.

Study Objectives: The chronic pain disorder, fibromyalgia, is associated with sleep disturbance, typically sleep maintenance. No studies have evaluated the effect of sleep medication on pain sensitivity in this population. Suvorexant, an orexin antagonist approved for treatment of insomnia, was evaluated for effects on both sleep and the pain of fibromyalgia.

Shift Work: A Perspective on Shift Work Disorder-Is Prevention the Answer?

The prevalence of shift work in the United States is nearly 20%, but recognition of shift work disorder (SWD) among shift workers is still a challenge. The health care sector is no exception. While a substantial portion of shift workers are physicians and nurses, expertise in identifying SWD is lacking.

Improving Daytime Functioning, Work Performance, and Quality of Life in Postmenopausal Women With Insomnia: Comparing Cognitive Behavioral Therapy for Insomnia, Sleep Restriction Therapy, and Sleep Hygiene Education.

Study Objectives: Insomnia is a chief complaint among postmenopausal women, and insomnia impairs daytime functioning and reduces quality of life. Recent evidence supports the efficacy of cognitive behavioral therapy for insomnia (CBTI) for menopausal insomnia, but it remains unclear whether treating insomnia improves daytime function in this population. This study evaluated whether CBTI improves daytime fatigue, energy, self-reported sleepiness, work productivity, and quality of life in postmenopausal women with insomnia, and whether sleep restriction therapy (SRT)-a single component of CBTI-is equally efficacious.

Hyperarousal in insomnia: pre-sleep and diurnal cortisol levels in response to chronic zolpidem treatment.

Objectives: To determine whether cortisol levels, both diurnal and pre-sleep, would vary as a function of MSLT and would be reduced by nightly placebo versus zolpidem 10 mg.

Methods: DSM-IVR diagnosed subjects with insomnia (N = 95), aged 32-70 yrs, having no other sleep disorder, unstable medical or psychiatric diseases or drug dependency served. On a screening MSLT 27 had MSLTs <10 min (Lo) and 42 > 15 min (Hi).

Relation between ambulatory actigraphy and laboratory polysomnography in insomnia practice and research.

Actigraphy is increasingly used in practice and research studies because of its relative low cost and decreased subject burden. How multiple nights of at-home actigraphy compare to one independent night of in-laboratory polysomnography (PSG) has not been examined in people with insomnia. Using event markers (MARK) to set time in bed (TIB) compared to automatic program analysis (AUTO) has not been systematically evaluated.

Tachypnea Seen During Positive Airway Pressure Titration Studies: A Case Series of Four Patients.

We report a case series of four patients where tachypnea was observed during positive airway titration studies, double the baseline breathing rate (tachypnea range 46-68 breaths/min). It happened mainly during non-rapid eye movement to rapid eye movement sleep transitions without significant changes in oxygen saturation or signs of autonomic hyperactivity such as an increased heart rate. The increased respiratory rate may be a normal physiological extreme outlier seen during phasic rapid eye movement sleep triggered by high pressure ventilation and it may also indicate underlying ventilatory instability, making patients predisposed to central sleep apnea.

Inclusion and Exclusion Criteria of Clinical Trials for Insomnia.

Randomized controlled trials (RCTs) have eligibility criteria for the inclusion of participants. Ideally, the RCT sample would be representative for the patient population that will use the drug under investigation. However, external validity may be at stake when applying too many or too restrictive eligibility criteria.

Efficacy of digital CBT for insomnia to reduce depression across demographic groups: a randomized trial.

Background: Insomnia and depression are highly comorbid and mutually exacerbate clinical trajectories and outcomes. Cognitive behavioral therapy for insomnia (CBT-I) effectively reduces both insomnia and depression severity, and can be delivered digitally. This could substantially increase the accessibility to CBT-I, which could reduce the health disparities related to insomnia; however, the efficacy of digital CBT-I (dCBT-I) across a range of demographic groups has not yet been adequately examined.

Insomnia as a path to alcoholism: tolerance development and dose escalation.

Study Objectives: To assess the risks associated with the use of alcohol as a "sleep aid," we evaluated tolerance development to pre-sleep ethanol's sedative-hypnotic effects, and subsequent ethanol dose escalation.

Methods: Volunteers, 21-55 years old, with insomnia in otherwise good medical and psychiatric health and no history of alcoholism or drug abuse participated. In experiment 1 (n = 24) 0.

Increasing presurgery sleep reduces postsurgery pain and analgesic use following joint replacement: a feasibility study.

Study Objectives: To determine whether presurgery sleep extension in short-sleeping volunteers scheduled for total knee/hip replacement surgery would reduce postsurgery pain and analgesic use.

Methods: Eighteen short sleepers, defined by sleep times below the national mean (ie, ≤7 h) nightly, were randomized to one week of a 2-h nightly extension of their time in bed (EXT) or maintenance of their habitual time in bed (HAB) prior to knee or hip replacement surgery. Compliance was monitored by wrist actigraphy.

Effectiveness of Benzodiazepine Receptor Agonists in the Treatment of Insomnia: An Examination of Response and Remission Rates.

Study Objectives: To examine the real-world effectiveness of benzodiazepine receptor agonists (BzRAs) by quantifying response and remission rates in a clinical sample receiving chronic BzRA treatment for insomnia.

Methods: Participants were outpatients (N = 193; 72% female; 55.2 ± 11.

Prevalence and Predictors of Prescription Sleep Aid Use among Individuals with DSM-5 Insomnia: The Role of Hyperarousal.

Study Objectives: Despite mounting evidence for the overuse of prescription sleep aids (PSA), reliable data on PSA use among insomniacs are unavailable. Current studies focus on trends in PSA use at the general population level, and thus do not distinguish between transient sleep disturbance and insomnia disorder. Therefore, we prospectively examined the prevalence and predictors of baseline and chronic PSA use in a well-defined sample of individuals with insomnia.

Sleep Disturbance in Substance Use Disorders.

This article discusses the role sleep and alertness disturbance plays in the initiation, maintenance and relapse of substance use disorders.

Gender Differences in the Efficacy and Safety of Chronic Nightly Zolpidem.

Study Objectives: Studies have shown pharmacokinetic differences for hypnotics in women compared to men, but few studies have assessed either short-or long-term differences in efficacy and safety.

Methods: To evaluate gender differences in the efficacy and safety of chronic nightly zolpidem (10 mg), we did a post hoc assessment of a large clinical trial. In the trial, participants with primary insomnia (n = 89), ages 23-70, meeting DSM-IV-TR criteria for primary insomnia were randomized, double blind, to nightly zolpidem, 10 mg (n = 47) or placebo (n = 42) 30 minutes before bedtime nightly for 12 months.

Characteristics of Disturbed Sleep in Patients With Fibromyalgia Compared With Insomnia or With Pain-Free Volunteers.

Objective: To investigate the differential nature of disturbed sleep in patients with fibromyalgia (FM) reporting sleep difficulties versus patients with primary insomnia (PI) and patients who do not report disturbed sleep (pain-free controls).

Materials And Methods: Patients (FM: n=132; PI: n=109; normals: n=52) were recruited for different studies. FM and PI patients were preselected to meet the sleep disturbance criteria.

Effects of reduced time in bed on daytime sleepiness and recovery sleep in fibromyalgia and rheumatoid arthritis.

Objectives: Fibromyalgia (FM) and rheumatoid arthritis (RA) are associated with sleep disturbance and daytime sleepiness. We sought to determine whether sleep homeostatic mechanisms are blunted in FM by assessing the effects of reduced time in bed (4h) on next day sleepiness and recovery sleep.

Methods: Fifty women (18 with FM, 16 with RA, and 16 HC) had a baseline 8h time-in-bed (TIB) and Multiple Sleep Latency Test (MSLT) the following day, and 3-7 days later bedtime was reduced (4h) followed by MSLT and an 8h TIB recovery night.

Correlation between sleep disruption on postoperative pain.

Objectives: To identify the amount of sleep disruption that occurs in the postoperative inpatient hospital setting, determine the relationship between sleep disruption and the quantity of narcotics taken for postoperative pain, and determine if hospital length of stay is related to sleep disruption.

Study Design: Prospective cohort study.

Setting: Single tertiary care academic institution.

Physiological correlates of insomnia.

Insomnia is a prevalent sleep disorder that is typically comorbid with medical, psychiatric, and other sleep disorders. Yet, it is a disorder with its own course and morbidity that can persist if untreated. This chapter describes the physiological correlates of insomnia expressed during sleep and during the daytime.