Faculty Bibliography

Maggie is a 16-year-old girl who came to see me because she wanted help with her longstanding difficulties falling asleep at night and waking up in the morning. She goes to bed between midnight and 3 am and usually lies awake worrying until falling asleep at 3 to 4 am. She often video-calls or texts her boyfriend before sleep. Her wakeup time is 8 am; she typically wakes exhausted, having slept 4 to 5 hours. Although a good student, she is often late for classes. On weekends, she wakes around noon. She is tired, anxious, and demoralized. She cannot concentrate as well as she did prior to the onset of her sleep symptoms at age 10 to 11 years. Her psychiatric history includes a diagnosis of anxiety and depression, both in remission, treated with fluoxetine 30 mg daily for several years. Difficulties falling asleep and waking in the morning are common complaints among adolescents and young adults. Before my additional year of training in sleep medicine, I would have misdiagnosed Maggie as having insomnia rather than delayed sleep phase disorder (DSPD), a circadian rhythm disorder.

OBJECTIVE: To examine the impact of a sleep course on sleep-related behaviors, mood, and anxiety in college students. PARTICIPANTS: Participants were 145 students enrolled in either the sleep course (n = 70) or a psychology course (n = 75); data were collected in September 2014, November 2014, and February 2015. METHODS: Sleep characteristics and symptoms of depression and anxiety were assessed using validated questionnaires and sleep logs. Linear, logistic and proportional odds regression models were used to test course effects. RESULTS: In November, sleep course students reported significant differences in sleep hygiene (SHI; p<0.001), perceived sleep latency (PSQI; p<0.05), and circadian sleep phase (MEQ; p<0.05), compared to controls. In February, the sleep course students maintained most of the aforementioned gains and reported fewer symptoms of depression (CES-D; p = 0.05) and anxiety (BAI; p<0.05). CONCLUSIONS: These positive preliminary results indicate that focused education has potential to improve sleep among college students.

Objectives: It is estimated that 25 percent of children and adolescents suffer from a sleep problem at some point before entering adulthood. Research shows that over 95 percent of child and adolescent psychiatrists prescribe at least one sleep medication monthly, yet numerous studies show that cognitive behavioral therapy for insomnia (CBT-I) works just as well as medication, is extremely cost effective, and has longer-lasting benefits. Unfortunately, however, most child and adolescent psychiatrists are not trained in CBT-I. This workshop will teach participants when and for whom CBT-I is an appropriate form of treatment intervention; the six primary components of CBT-I; and how to design CBT-I treatment plans for a variety of child, adolescent, and young adult patients diagnosed with insomnia. Methods: This workshop will be based upon a comprehensive literature review and the clinical expertise of the instructors. In advance of the workshop, registered participants will be sent a variety of standardized rating scales so that they may begin to assess their own sleep and that of select patients in preparation for learning CBT-I in the workshop. Results: CBT-I consists of an easily taught series of evidence-based skills that are portable and time and cost effective. The goals of CBT-I are to alter the factors that perpetuate insomnia and include: 1) behavioral training in stimulus control, sleep restriction, and sleep hygiene; 2) cognitive training in managing dysfunctional thoughts and maladaptive behaviors related to sleep, such as unrealistic expectations and rumination over the consequences of insomnia; and 3) physiological factors, such as hyperarousal and somatic and mental tension. Conclusions: This workshop will provide instruction in the use of CBT-I for children, adolescents, and adults, and practitioners will be guided through a series of applied exercises to enhance and practice their therapeutic skills

Objectives: It is estimated that 25 percent of children and adolescents suffer from a sleep problem at some point before entering adulthood. Research shows that over 95 percent of CAPs prescribe at least one sleep medication monthly, yet numerous studies show that CBT-I works just as well as medication, is extremely cost effective, and has longer-lasting benefits. However, unfortunately, most CAPs are not trained in CBT-I. This workshop will teach participants when and for whom CBT-I is an appropriate treatment intervention; the six primary components of CBT-I; and how to design CBT-I treatment plans for a variety of adolescent and young adult patients diagnosed with insomnia. Methods: This workshop will be based upon a comprehensive literature review and the clinical expertise of the instructors. In advance of the workshop, registered participants will be sent a variety of standardized rating scales so that they may begin to assess their own sleep in preparation for learning how to improve the sleep of their patients. Results: CBT-I consists of an easily taught series of evidence-based skills that are portable and time and cost effective. The goals of CBT-I are to alter the factors that perpetuate insomnia and include the following: 1) behavioral training in stimulus control, sleep restriction, and sleep hygiene; 2) cognitive training in managing dysfunctional thoughts and maladaptive behaviors related to sleep, such as unrealistic expectations and rumination over the consequences of insomnia; and 3) physiological factors, such as hyperarousal and somatic and mental tension. Conclusions: This workshop will provide instruction on the use of CBT-I for adolescents and adults, and practitioners will be guided through a series of applied exercises to enhance their therapeutic skills

BACKGROUND: Distinguishing pediatric bipolar disorder (BD) from attention-deficit hyperactivity disorder (ADHD) can be challenging. Hyperactivity is a core feature of both disorders, but severely disturbed sleep and circadian dysregulation are more characteristic of BD, at least in adults. We tested the hypothesis that objective measures of activity, sleep, and circadian rhythms would help differentiate pediatric subjects with BD from ADHD and typically developing controls. METHODS: Unmedicated youths (N = 155, 97 males, age 5-18) were diagnosed using DSM-IV criteria with Kiddie-SADS PL/E. BD youths (n = 48) were compared to typically developing controls (n = 42) and children with ADHD (n = 44) or ADHD plus comorbid depressive disorders (n = 21). Three-to-five days of minute-to-minute belt-worn actigraph data (Ambulatory Monitoring Inc.), collected during the school week, were processed to yield 28 metrics per subject, and assessed for group differences with analysis of covariance. Cross-validated machine learning algorithms were used to determine the predictive accuracy of a four-parameter model, with measures reflecting sleep, hyperactivity, and circadian dysregulation, plus Indic's bipolar vulnerability index (VI). RESULTS: There were prominent group differences in several activity measures, notably mean 5 lowest hours of activity, skewness of diurnal activity, relative circadian amplitude, and VI. A predictive support vector machine model discriminated bipolar from non-bipolar with mean accuracy of 83.1 +/- 5.4%, ROC area of 0.781 +/- 0.071, kappa of 0.587 +/- 0.136, specificity of 91.7 +/- 5.3%, and sensitivity of 64.4 +/- 13.6%. CONCLUSIONS: Objective measures of sleep, circadian rhythmicity, and hyperactivity were abnormal in BD. Wearable sensor technology may provide bio-behavioral markers that can help differentiate children with BD from ADHD and healthy controls.