University of Alabama Repository :: Browsing by Author "Lichstein, Kenneth L."

Browsing by Author "Lichstein, Kenneth L."

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Actigraphy Reliability with Normal Sleepers
(Routledge, 2012-12) Ustinov, Yuriy; Lichstein, Kenneth L.; University of Alabama Tuscaloosa
Introduction: Actigraphy has gained popularity as an objective method for measuring sleep in a home setting. We evaluated whether missing data affects the utility of actigraphy for the measurement of sleep parameters in normal sleepers. Methods: We evaluated actigraphy data from 60 normal sleepers who participated in a study of the effects of changes in setting on sleep. Participants were asked to wear a Mini Mitter Actiwatch actigraph for 35 days and to use event markers to record bedtime and arising time. Counts of nights on which participants failed to supply usable data were computed using the following criteria: missing nights, missing bedtime markers, missing arising time markers, and multiple markers supplied at bedtime or arising time. A night on which any of these problems occurred was counted as unscorable. Results: We evaluated a total of 2,100 nights, of which 559 (27%) nights were deemed unscorable due to missing data. Missing markers at bedtime (206) and arising time (172) accounted for the majority of missing data. Trends over the five weeks indicated that incidence of missing data increased over the assessment period. Conclusion: We found that missing data was a significant problem for long-term assessment of sleep using actigraphy. We suggest that researchers consider compensatory strategies, such as extending the assessment period and using adjunctive measures, in order to obtain sufficient data for analysis. We also recommend that future improvements in actigraphy instruments should aim to address the sources of missing data.
Affective mediators of the association between pleasant events and global sleep quality in community-dwelling adults
(Springer, 2016) Tighe, Caitlan A.; Shoji, Kristy D.; Dautovich, Natalie D.; Lichstein, Kenneth L.; Scogin, Forrest; University of Alabama Tuscaloosa
This study explored the association of engagement in pleasant events and global sleep quality, as well as examined the intermediary roles of positive affect and depressive symptoms in this association. Data were derived from the Midlife in the United States-II study. The sample consisted of 1054 community-dwelling adults. Participants completed the Pittsburgh Sleep Quality Index and indicated the frequency and enjoyableness of experiences on a positive events scale. Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression Scale. Positive affect was measured using the Mood and Symptoms Questionnaire. Regression analyses indicated more frequent engagement in pleasant events was associated with better global sleep quality. Depressive symptoms, but not positive affect, partially mediated the association between pleasant events and global sleep quality. The findings suggest that behavioral engagement in pleasant events may be related to global sleep quality via depressive symptoms, but not positive affect. These findings highlight the potential for engagement in pleasant activities to influence both mood and sleep.
Appraisals of Insomnia Identity in a Clinical Sample
(University of Alabama Libraries, 2020) Emert, Sarah Elizabeth; Lichstein, Kenneth L.; Gunn, Heather E.; University of Alabama Tuscaloosa
Difficulties falling asleep, staying asleep, waking too early, and daytime dysfunction are prevalent in insomnia disorder. Insomnia-related complaint crossed with sleep data yields complaining good sleepers (CG) and complaining poor sleepers (CP). Many theories relate to the development and maintenance of insomnia disorder. Little is known about factors influencing an insomnia identity, the self-ascribed belief that one has insomnia, or that differentiate these groups. We evaluated insomnia identity severity and differences between treatment-seeking groups on factors related to one’s sleep experience and sleep parameters. An insomnia complaint was considered evidence for an insomnia identity; however, the final sample yielded an unexpected group who did not endorse insomnia identity. Therefore, participants were also classified via insomnia identity yielding insomnia identifying good sleepers (IIG), insomnia identifying poor sleepers (IIP), and participants without insomnia identity (WOII). Participants provided demographic information, medical and psychiatric diagnoses, information related to their insomnia complaint, and two weeks of daily sleep diaries. CG and CP were evaluated on differences between perceived sleep comparisons, restorative sleep, daytime impairment, and insomnia-related catastrophizing. There were no significant differences on any factors for ? < .05. IIG, IIP, and WOII were evaluated on differences for the same four variables. A statistically significant difference emerged among groups on restorative sleep, F (2, 60) = 3.83, p = .03. Post hoc testing revealed that restorative sleep ratings were significantly higher in IIG compared to IIP, but not WOII (p = .02). Multiple linear regression tested the four sleep variables and self-reported sleep parameters as predictors of insomnia identity severity. The overall model was significant, F (1, 61) = 5.21, p = .03, R2 = .08. The analysis was conducted again substituting the three subfactors of catastrophic thinking to determine the effect of each subscale. The overall model was significant, F (1, 61) = 7.55, p = .008. R2 = .11. Negative sleep comparisons and increased helplessness predicted a stronger conviction of insomnia identity. Restorative sleep significantly differentiated IIG, IIP, and WOII, perhaps reflecting differences in sleep status rather than insomnia identity. Implications of results and further study directions on insomnia identity are discussed.
The association between chronotype and nonrestorative sleep
(University of Alabama Libraries, 2016) Tutek, Joshua; Lichstein, Kenneth L.; University of Alabama Tuscaloosa
Nonrestorative sleep (NRS), characterized by a lack of refreshment upon awakening, has received little attention in the sleep literature even though it can occur and cause impairment apart from other sleep difficulties associated with insomnia. The Restorative Sleep Questionnaire (RSQ; Drake et al., 2014) is one of the first validated self-report instruments for investigating NRS severity, presenting new opportunities to explore what factors predict and perhaps contribute to unrefreshing sleep. The present study sought to determine whether inherent circadian preference for morning or evening activity, known as chronotype, predicted restorative sleep in 164 college undergraduates who completed daily RSQs over two weeks. Participants who endorsed greater orientation to evening activity on the morningness-eveningness questionnaire (Terman, Rifkin, Jacobs, & White, 2001) reported significantly less average restorative sleep across their full sampling period, and this association was maintained after accounting for demographic factors, number of sleep-relevant psychiatric and medical diagnoses, sleep diary parameters, self-reported status as an insomniac, and ratings of sleep quality. Furthermore, when analyses were conducted separately for weekday and weekend RSQ scores, eveningness significantly predicted NRS above extraneous variables only during the workweek, not during Saturday and Sunday. These findings have implications for the developing conceptualization of NRS, and continue the work of elucidating the interconnections between common sleep disturbances and the circadian system.
Associations between sleep disturbances, personality, and trait emotional intelligence
(University of Alabama Libraries, 2016) Emert, Sarah E.; Lichstein, Kenneth L.; University of Alabama Tuscaloosa
Insomnia is defined by difficulty falling asleep, staying asleep, or waking earlier than desired with inability to return to sleep. Complaints of nonrestorative sleep (NRS) are often associated with insomnia but can occur independently. Fragmented sleep and NRS have been shown to relate to one’s mood, one’s ability to process their own or others’ emotions, and can lead to changes in cognitions and behaviors. Personality traits related to increases in anxiousness may play a role in the development and maintenance of sleep disorders and associated daytime impairment of NRS. The relations between sleep disturbance, personality traits, and trait emotional intelligence are underrepresented in the current literature and findings have been mixed. This study addressed some inconsistencies by identifying associations between the Big Five personality traits, trait emotional intelligence (TEI), complaints of NRS, and disrupted sleep associated with insomnia. We predicted that neuroticism would relate to poorer sleep and that conscientiousness and TEI would be associated with better sleep. Openness to experience, extraversion, and agreeableness are not often discussed in the literature, but were expected to associate similarly as conscientiousness. Results provided support for the idea that trait characteristics are associated with insomnia severity and restorative sleep quality. These findings indicated that personality and TEI may play a role in development and maintenance of sleep disorders and daytime impairment of NRS; higher conscientiousness, lower neuroticism, and higher TEI possibly demonstrate a protective role to experiencing negative effects of poor sleep.
Barriers and facilitators to yoga practice in adults with chronic low back pain
(University of Alabama Libraries, 2015) Combs, Martha Anne; Thorn, Beverly E.; University of Alabama Tuscaloosa
Given the high prevalence of chronic low back pain in the United States and the potential beneficial effects that integrative yoga interventions may have on this condition, the current study sought to examine barriers and facilitators to trying yoga in a population of adults with chronic low back pain. Participants self-reporting chronic low back pain were recruited from community sites in a collegiate town in western Alabama. Primary analyses utilized hierarchical regression and traditional 4-step mediational analyses to examine the predictive influence of catastrophizing and fear of movement on yoga attitudes. Results indicate that fear of movement serves a mediating role between catastrophizing and yoga attitudes. Originally proposed analyses included measurement of "intent to try yoga" as a primary outcome of interest. However, relationships between predictor variables and the unstandardized intent measure were, in general, extremely weak and execution of analyses was not indicated. Measurement of intention is discussed in Appendix A. Participants also responded to items asking them about perceptions of potential barriers and facilitators to trying yoga. Responses were subjected to qualitative thematic analysis and several common themes emerged for both barriers and facilitators: physical issues, cognitive/affective issues, motivational issues, informational issues, practical issues, and social issues. Qualitative analyses are discussed in Appendix B. Identifying cognitive barriers to consideration of yoga as a potential beneficial treatment for chronic low back pain conditions has great importance for clinical treatment of pain, especially as health care focus in the U.S. shifts to be more preventative and emphasizing self-management.
Behavioral and psychological treatments for chronic insomnia disorder in adults: an American Academy of Sleep Medicine clinical practice guideline
(American Academy of Sleep Medicine, 2021) Edinger, Jack D.; Arnedt, J. Todd; Bertisch, Suzanne M.; Carney, Colleen E.; Harrington, John J.; Lichstein, Kenneth L.; Sateia, Michael J.; Troxel, Wendy M.; Zhou, Eric S.; Kazmi, Uzma; Heald, Jonathan L.; Martin, Jennifer L.; National Jewish Health; Duke University; University of Michigan; Harvard University; Harvard Medical School; Brigham & Women's Hospital; Toronto Metropolitan University; University of Nebraska Medical Center; University of Alabama Tuscaloosa; Dartmouth College; RAND Corporation; Dana-Farber Cancer Institute; Boston Children's Hospital; University of California Los Angeles; University of California Los Angeles Medical Center; David Geffen School of Medicine at UCLA; US Department of Veterans Affairs; Veterans Health Administration (VHA); VA Greater Los Angeles Healthcare System; Geriatric Research Education & Clinical Center
Introduction: This guideline establishes clinical practice recommendations for the use of behavioral and psychological treatments for chronic insomnia disorder in adults. Methods: The American Academy of Sleep Medicine (AASM) commissioned a task force of experts in sleep medicine and sleep psychology to develop recommendations and assign strengths based on a systematic review of the literature and an assessment of the evidence using Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. The task force evaluated a summary of the relevant literature and the quality of evidence, the balance of clinically relevant benefits and harms, patient values and preferences, and resource use considerations that underpin the recommendations. The AASM Board of Directors approved the final recommendations. Recommendations: The following recommendations are intended as a guide for clinicians in choosing a specific behavioral and psychological therapy for the treatment of chronic insomnia disorder in adult patients. Each recommendation statement is assigned a strength ("strong" or "conditional"). A "strong" recommendation (ie, "We recommend...") is one that clinicians should follow under most circumstances. A "conditional" recommendation is one that requires that the clinician use clinical knowledge and experience, and to strongly consider the patient's values and preferences to determine the best course of action. 1. We recommend that clinicians use multicomponent cognitive behavioral therapy for insomnia for the treatment of chronic insomnia disorder in adults. (STRONG) 2. We suggest that clinicians use multicomponent brief therapies for insomnia for the treatment of chronic insomnia disorder in adults. (CONDITIONAL) 3. We suggest that clinicians use stimulus control as a single-component therapy for the treatment of chronic insomnia disorder in adults. (CONDITIONAL) 4. We suggest that clinicians use sleep restriction therapy as a single-component therapy for the treatment of chronic insomnia disorder in adults. (CONDITIONAL) 5. We suggest that clinicians use relaxation therapy as a single-component therapy for the treatment of chronic insomnia disorder in adults. (CONDITIONAL) 6. We suggest that clinicians not use sleep hygiene as a single-component therapy for the treatment of chronic insomnia disorder in adults. (CONDITIONAL)
Behavioral and psychological treatments for chronic insomnia disorder in adults: an American Academy of Sleep Medicine systematic review, meta-analysis, and GRADE assessment
(American Academy of Sleep Medicine, 2021) Edinger, Jack D.; Arnedt, J. Todd; Bertisch, Suzanne M.; Carney, Colleen E.; Harrington, John J.; Lichstein, Kenneth L.; Sateia, Michael J.; Troxel, Wendy M.; Zhou, Eric S.; Kazmi, Uzma; Heald, Jonathan L.; Martin, Jennifer L.; National Jewish Health; Duke University; University of Michigan; Harvard University; Brigham & Women's Hospital; Harvard Medical School; Toronto Metropolitan University; University of Nebraska Medical Center; University of Alabama Tuscaloosa; Dartmouth College; RAND Corporation; Boston Children's Hospital; Dana-Farber Cancer Institute; University of California Los Angeles; University of California Los Angeles Medical Center; David Geffen School of Medicine at UCLA; Geriatric Research Education & Clinical Center; US Department of Veterans Affairs; Veterans Health Administration (VHA); VA Greater Los Angeles Healthcare System
Introduction: The purpose of this systematic review is to provide supporting evidence for a clinical practice guideline on the use of behavioral and psychological treatments for chronic insomnia disorder in adult populations. Methods: The American Academy of Sleep Medicine commissioned a task force of 9 experts in sleep medicine and sleep psychology. A systematic review was conducted to identify randomized controlled trials that addressed behavioral and psychological interventions for the treatment of chronic insomnia disorder in adults. Statistical analyses were performed to determine if the treatments produced clinically significant improvements in a range of critical and important outcomes. Finally, the Grading of Recommendations Assessment, Development, and Evaluation process was used to evaluate the evidence for making specific treatment recommendations. Results: The literature search identified 1,244 studies; 124 studies met the inclusion criteria, and 89 studies provided data suitable for statistical analyses. Evidence for the following interventions is presented in this review: cognitive-behavioral therapy for insomnia, brief therapies for insomnia, stimulus control, sleep restriction therapy, relaxation training, sleep hygiene, biofeedback, paradoxical intention, intensive sleep retraining, and mindfulness. This review provides a detailed summary of the evidence along with the quality of evidence, the balance of benefits vs harms, patient values and preferences, and resource use considerations.
Cognitive mechanisms in comorbid insomnia and chronic pain
(University of Alabama Libraries, 2011) Dillon, Haley Rebecca; Lichstein, Kenneth L.; University of Alabama Tuscaloosa
The present study examined the relation between pain catastrophizing, pre-sleep arousal (PSA), and insomnia severity in chronic pain patients. Forty-eight outpatients with chronic pain (duration of 6 months or more) completed self-report measures of health, mood, pain, and sleep. A hierarchical regression analysis was conducted to determine the relative contributions of pain catastrophizing, cognitive PSA, and somatic PSA to the prediction of scores on the Insomnia Severity Index, while controlling for age, sex, education level, depression severity, symptoms of Restless Legs Syndrome (RLS), and pain intensity. Results showed that pain catastrophizing accounted for unique variance in insomnia severity, independent of pain intensity and other control variables. However, when cognitive and somatic PSA were taken into account, the significance of cognitive PSA rendered pain catastrophizing non-significant. Research and clinical work should explore how cognitive variables (such as pain catastrophizing) may be linked to the pre-sleep arousal in comorbid insomnia.
The Consensus Sleep Diary: Standardizing Prospective Sleep Self-Monitoring
(Oxford University Press, 2012) Carney, Colleen E.; Buysse, Daniel J.; Ancoli-Israel, Sonia; Edinger, Jack D.; Krystal, Andrew D.; Lichstein, Kenneth L.; Morin, Charles M.; Toronto Metropolitan University; University of Pittsburgh; University of California San Diego; Duke University; University of Alabama Tuscaloosa; Laval University
Study Objectives: To present an expert consensus, standardized, patient-informed sleep diary. Methods and Results: Sleep diaries from the original expert panel of 25 attendees of the Pittsburgh Assessment Conference(1) were collected and reviewed. A smaller subset of experts formed a committee and reviewed the compiled diaries. Items deemed essential were included in a Core sleep diary, and those deemed optional were retained for an expanded diary. Secondly, optional items would be available in other versions. A draft of the Core and optional versions along with a feedback questionnaire were sent to members of the Pittsburgh Assessment Conference. The feedback from the group was integrated and the diary drafts were subjected to 6 focus groups composed of good sleepers, people with insomnia, and people with sleep apnea. The data were summarized into themes and changes to the drafts were made in response to the focus groups. The resultant draft was evaluated by another focus group and subjected to lexile analyses. The lexile analyses suggested that the Core diary instructions are at a sixth-grade reading level and the Core diary was written at a third-grade reading level. Conclusions: The Consensus Sleep Diary was the result of collaborations with insomnia experts and potential users. The adoption of a standard sleep diary for insomnia will facilitate comparisons across studies and advance the field. The proposed diary is intended as a living document which still needs to be tested, refined, and validated.
Correlation of Disturbed Sleep and Cancer Stress
(Routledge, 2015-12) Vander Wal, Gregory S.; Lichstein, Kenneth L.; Perkins, Cynthia K.; University of Alabama Tuscaloosa
To illuminate the course of insomnia in the presence of an acute comorbidity, we examined the association between insomnia severity and breast cancer symptom severity over time and determined if this association varies with insomnia history and presleep arousal. Twenty-nine newly diagnosed breast cancer patients, who also exhibited insomnia, completed sleep diary and cancer symptom severity questionnaires every other week (total of 28 days) over 7 weeks, as well as baseline and postobservation measures. Participants were defined as having insomnia prior to cancer (IPC) or insomnia secondary to cancer (ISC) based on precancer sleep status. Insomnia and cancer symptom severity were strongly correlated at baseline but significantly declined over the evaluation period. Among ISC individuals, there was an association between sleep severity and cancer severity at baseline but not 7 weeks later. IPC individuals showed a consistent pattern of no significant association between sleep severity and cancer symptom severity. IPC had higher levels of cognitive presleep arousal than ISC. The current study documented the evolution of the relation between insomnia and breast cancer symptom severity over time and identified factors (premorbid insomnia and presleep hyperarousal) that may influence this association.
Differences in Weeknight Versus Weekend Self-Reported Sleep Parameters Across Sleep Subgroups
(University of Alabama Libraries, 2020) Molzof, Hylton Elisabeth; Lichstein, Kenneth L.; Gunn, Heather E.; University of Alabama Tuscaloosa
Insomnia identity refers to the conviction that one has insomnia, which can occur independently of poor sleep. The present study explored weeknight-weekend differences in sleep as a commonly overlooked factor contributing to night-to-night sleep variability as well as the discordance often documented between sleep and sleep appraisal. Multilevel modeling was used to explore sources of variability (within-person/between-person) and weeknight-weekend differences in outcomes of sleep duration (total sleep time, TST), sleep disturbance (sleep onset latency, SOL; wake after sleep onset, WASO), and sleep timing (bedtime, BT; arising time, AT; mid-sleep time, MST) among four sleep subgroups: noncomplaining good sleepers (NG), complaining poor sleepers (CP), complaining good sleepers (CG), and noncomplaining poor sleepers (NP). Analyses were conducted using an archival dataset of 528 community-dwelling adults who completed 14 days of sleep diaries. Participants were classified according to the presence/absence of a sleep complaint and presence/absence of poor sleep. First, sources of variability (within-person/between-person) were characterized for each sleep parameter among the sleep subgroups, separately. Second, weeknight-weekend differences in sleep were examined among the sleep subgroups by crossing sleep complaint with quantitative sleep status and day-type. Pervasive differences in weeknight versus weekend sleep were not observed among the sleep subgroups; nonetheless, findings did identify a few notable subgroup differences in certain sleep parameters that may contribute to sleep complaint and poor sleep. Specifically, CG exhibited significantly greater WASO than NG on weeknights only. WASO and SOL were each greater among CP than NP across weeknights and weekends. Earlier AT and MST – but not BT– were observed among good sleepers relative to poor sleepers on weeknights only. Within-person differences were greater than between-person differences for TST, SOL, and WASO across sleep subgroups; however, between-person differences exceeded within-person differences for sleep timing outcomes (BT, AT, MST). Findings from this study suggest that (1) differences in certain sleep parameters (WASO, SOL) may contribute to sleep complaint among good and poor sleepers, (2) delayed weekday sleep timing may be an important factor distinguishing between poor and good sleep subgroups, and (3) sources of variability (within-person/between-person) vary depending on both the sleep subgroup and sleep parameter being examined.
Efficacy of an audio-based cognitive behavioral therapy for older adults with depression
(University of Alabama Libraries, 2010) Shah, Avani; Scogin, Forrest Ray; University of Alabama Tuscaloosa
The purpose of this study was to develop and assess the efficacy of an audio-based cognitive behavioral therapy (ACBT) intervention for older adults with depressive symptoms. The process of developing this program included: 1) adaptation of a client and therapist manual developed for older adult caregivers (Dick, Gallagher-Thompson, Coon, Powers, & Thompson, 1996); 2) review of the ACBT program by older adults and cognitive behavioral therapists for acceptability; and 3) program revision. The revised program consists of 8 compact discs (CDs) and a workbook on the following topics: 1) introduction to CBT; 2) identifying and changing unhelpful thoughts; 3) addressing feelings; 4) relaxation; 5) engaging in pleasant events; 6) assertiveness; and 7) problem-solving. The next phase of this study entailed testing the efficacy of the ACBT program. Eligible participants (N = 34) were recruited from mainly medical settings and rural communities (e.g. above age 54 with a score greater than 9 on the Geriatric Depression Scale; GDS). Participants were randomly assigned to an immediate treatment group or a minimal contact delayed treatment group. The delayed treatment group waited four weeks to begin treatment while the immediate treatment group received a brief training session and 4 weeks to complete the ACBT program. Both groups received brief weekly contact calls to monitor mood. Outcome analyses assessed change in depression with the Hamilton Rating Scale for Depression (HRSD; Hamilton, 1967) and GDS. Intent-to-treat carry forward analyses revealed significant differences on only the HRSD by group and time. Analyses assessing change on the Somatization subscale of the Brief Symptom Inventory (Derogatis & Spencer, 1983) and GDS by group and time were not significant.
Epidemiology of bedtime, arising time, and time in bed: analysis of age, gender, and ethnicity
(University of Alabama Libraries, 2011) Thomas, Stephen Justin; Lichstein, Kenneth L.; University of Alabama Tuscaloosa
This study investigated the epidemiology of subjective behavioral sleep variables (i.e., bedtime, arising time, and time in bed) as a function of age, gender, and ethnicity. Sleep diaries were analyzed for 756 participants. Regression analysis showed a main effect of age on subjective bedtime, arising time, and time in bed, but not for gender or ethnicity. Younger adults had later bedtimes and arising times than other age groups. Older adults had earlier bedtimes and later arising times, which resulted in greater time spent in bed than any age group. These results suggest that there are distinct behavioral sleep patterns based on age but not gender or ethnicity and may have significant clinical implications, particularly for older adults.
Epidemiology of naps: association with sleep, ethnicity, and age
(University of Alabama Libraries, 2010) Soeffing, James Patrick; Lichstein, Kenneth L.; University of Alabama Tuscaloosa
Common knowledge supports the belief that occasional napping is a ubiquitous human behavior, yet epidemiological reports on napping vary in methodological quality and tend to focus on specific sub-groups of the lifespan. A notable weakness in the napping literature is a lack of data on African Americans, and an ongoing question is whether daytime napping has a negative impact on nighttime sleep. Given these limitations in the literature another study seemed warranted. The present study uses a high quality epidemiological data set collected via random digit dialing that includes 50 men and women in each age decade ranging from 20 to 80+, and a substantial proportion of African Americans, to answer the following questions. What is typical napping Behavior? Are there ethnic or gender differences in napping behavior? How does napping behavior change across the adult lifespan? Do persons with insomnia nap more than normal sleepers? Is there a relation between daytime napping and quality of nighttime sleep? The results suggested that a majority of people nap and naps are more frequent in African Americans and persons with insomnia, with older adults napping more frequently, but taking briefer naps. A significant relation was also found between daytime napping and nighttime sleep with daytime napping relating to increased onset latency and decreased total sleep time on the following night but with daytime napping also relating to increased wake time in the middle of the night and decreased total sleep time on the previous night.
The evolution of secondary insomnia in women with breast cancer
(University of Alabama Libraries, 2012) Vander Wal, Gregory Scott; Lichstein, Kenneth L.; University of Alabama Tuscaloosa
Secondary insomnia resulting from the onset of a health problem often persists beyond the course of the instigating stressor, suggesting that secondary insomnia evolves into a self-sustaining primary disorder. However, the course of secondary insomnia and how it relates to a primary medical or psychological disorder is poorly understood. Newly diagnosed breast cancer provides an opportunity to study secondary insomnia at the onset of an instigating stressor. The current study explored the feasibility of a methodology to examine the relationship between insomnia and breast cancer over a 2 month period in 29 women newly diagnosed (< 6 weeks) with breast cancer. Primary analyses included exploratory descriptive techniques. A multilevel modeling framework was also applied to the data to examine changes in sleep and cancer symptoms over time. The results show a significant relationship between insomnia severity and breast cancer symptom severity. Evidence is also presented regarding differences in the experience of this relationship for individuals with primary and secondary insomnia. Further evidence is presented supporting a change in the relationship between sleep and stress over time for individuals with secondary insomnia. Implications for timing of intervention and future research are discussed.
Hopelessness Mediates the Relation between Insomnia and Suicidal Ideation
(American Academy of Sleep Medicine, 2014) Woosley, Julie A.; Lichstein, Kenneth L.; Taylor, Daniel J.; Riedel, Brant W.; Bush, Andrew J.; University of Alabama Tuscaloosa; University of North Texas Denton; University of Memphis; University of Tennessee Health Science Center
Introduction: A growing body of literature indicates that insomnia is related to suicidality. However, the mechanism through which insomnia correlates with suicide risk is unclear. The goal of the present research was to determine whether hopelessness, a robust predictor of suicidality, mediates the relation between insomnia and suicidal ideation (SI). Methods: The present study used archival data from community-dwelling adults. Participants (n = 766) completed a Health Survey, two weeks of daily sleep diaries, and five measures of daytime functioning, including the Beck Depression Inventory (BDI). BDI item 2 was used to assess hopelessness, and BDI item 9 was used to assess SI. Criteria from the DSM-5 as well as quantitative criteria were used to identify participants with insomnia (n = 135). Results: The analyses revealed that hopelessness is a significant mediator of the relation between insomnia and SI. After adding depression as an additional mediator, hopelessness remained a significant predictor of SI. Conclusion: The present research suggests the need for clinicians to routinely screen clients who have insomnia for hopelessness and SI, and to treat hopelessness when it is present. Further research should address the limitations in this sample and should also consider other potential mediators of the insomnia-SI link.
Insomnia and suicide risk
(University of Alabama Libraries, 2015) Woosley, Julie; Lichstein, Kenneth L.; University of Alabama Tuscaloosa
A growing body of literature supports the notion that sleep disturbances, including insomnia, are related to suicidality. However, the mechanism through which insomnia correlates with suicide risk is unclear. The primary goal of the present research was to determine whether hopelessness, a robust predictor of suicidality, mediates the relation between insomnia and suicidal ideation (SI). Additionally, analyses were conducted to determine which demographic, health, sleep, and daytime functioning variables best predict hopelessness. Finally, this research will address gaps in the literature by determining which types of insomnia best predict suicide risk (i.e., hopelessness and SI), and whether a complaint of insomnia, poor sleep (as defined by quantitative criteria), or the combination of these factors best predicts suicide risk. The present study used an existing data set consisting of self-report data from a community-dwelling epidemiological sample. Participants (n = 766) completed a Health Survey, two weeks of daily sleep diaries, and five measures of daytime functioning, including the Beck Depression Inventory (BDI). BDI item 2 was used to assess hopelessness, and BDI item 9 was used to assess SI. Criteria from the Diagnostic and statistical manual of mental disorders (4th ed., text rev.) as well as quantitative criteria were used to identify participants with insomnia (n = 135). The analyses revealed that hopelessness is a significant mediator of the relation between insomnia and SI (Percentile 95% CI [0.24, 0.71]). Additionally, stepwise logistic regression revealed that, of a large pool of candidate variables, depression, anxiety, mean sleep efficiency, and intra-individual variability in sleep quality ratings are the best predictors of hopelessness. Finally, stepwise logistic regression revealed that a complaint of insomnia is a better predictor of suicide risk than quantitatively-defined poor sleep or the combination of these factors. Recommendations for future research include determining whether cognitive behavioral therapy for insomnia decreases hopelessness, which could ultimately decrease suicide risk. Additionally, the present research suggests the need for clinicians to routinely screen clients who report insomnia for hopelessness and SI.
Insomnia identity
(Pergamon, 2017-10) Lichstein, Kenneth L.; University of Alabama Tuscaloosa
Insomnia identity refers to the conviction that one has insomnia, and this sleep complaint can be measured independently of sleep. Conventional wisdom predicts that sleep complaints are synchronous with poor sleep, but crossing the presence or absence of poor sleep with the presence or absence of insomnia identity reveals incongruity with expected patterns. This review of existing research on insomnia identity processes and influence finds that about one-fourth of the population are uncoupled sleepers, meaning there is an uncoupling of sleep and sleep appraisal, and daytime impairment accrues more strongly to those who endorse an insomnia identity. Research supports the conclusion that there is a cost to pathologizing sleep. IndividudIs claiming an insomnia identity, regardless of sleep status, are at greater risk for a range of sequelae including self-stigma, depression, suicidal ideation, anxiety, hypertension, and fatigue. A broad research agenda is proposed with hypotheses about the sources, clinical mechanisms, and clinical management of insomnia identity. (C) 2017 Elsevier Ltd. All rights reserved.
Intraindividual sleep variability and its association with insomnia identity and poor sleep
(Elsevier, 2018) Molzof, Hylton E.; Emert, Sarah E.; Tutek, Joshua; Mulla, Mazheruddin M.; Lichstein, Kenneth L.; Taylor, Daniel J.; Riedel, Brant W.; University of Alabama Tuscaloosa; University of North Texas Denton
Objective: Insomnia identity refers to the conviction that one has insomnia, which can occur independently of poor sleep. Night-to-night variability in sleep (termed intraindividual variability [IIV]) may contribute to insomnia identity yet remain undetected via conventional mean analyses. This study compared sleep IIV across four subgroups: noncomplaining good sleepers (NG), complaining poor sleepers (CP), complaining good sleepers (CG), and noncomplaining poor sleepers (NP). Methods: This study analyzed 14 days of sleep diary data from 723 adults. Participants were classified according to presence/absence of a sleep complaint and presence/absence of poor sleep. A 2 x 2 multivariate analysis of covariance (MANCOVA) was performed to explore differences on five measures of sleep IIV: intraindividual standard deviation in total sleep time (iSD TST), sleep onset latency (iSD SOL), wake after sleep onset (iSD WASO), number of nightly awakenings (iSD NWAK), and sleep efficiency (iSD SE). Results: MANCOVA revealed significant main effects of poor sleep, sleep complaint, and their interaction on sleep IIV. Poor sleepers exhibited greater IIV across all sleep parameters compared to good sleepers. Similarly, individuals with a sleep complaint exhibited greater IIV compared to individuals with no complaint. The interaction revealed that iSD SOL was significantly greater among CP than NP, and iSD NWAK was significantly greater among CG than NG. Conclusions: Greater night-to-night variability in specific sleep parameters was present among complaining versus noncomplaining sleepers in good and poor sleep subgroups. These findings suggest certain aspects of sleep consistency may be salient for treatment-seeking individuals based on their quantitative sleep status. (c) 2018 Elsevier B.V. All rights reserved.

Browsing by Author "Lichstein, Kenneth L."

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