38 results on '"Deirdre A. Conroy"'
Search Results
2. Relationships between insomnia and alcohol and cocaine use frequency with aggression among veterans engaged in substance use treatment
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Minden B. Sexton, Erin E. Bonar, Jaclyn Reckow, Robert J. Spencer, Stephen T. Chermack, Spencer Dawson, Deirdre A. Conroy, Jamie J. Winters, and David Phillips
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Substance-Related Disorders ,media_common.quotation_subject ,Population ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Cocaine ,Randomized controlled trial ,law ,Sleep Initiation and Maintenance Disorders ,Insomnia ,Humans ,Medicine ,education ,Veterans Affairs ,health care economics and organizations ,Veterans ,media_common ,Sleep disorder ,education.field_of_study ,business.industry ,Aggression ,Addiction ,General Medicine ,medicine.disease ,Mental health ,030228 respiratory system ,medicine.symptom ,business ,030217 neurology & neurosurgery ,Clinical psychology - Abstract
Background Veterans with substance use problems have rates of partner and non-partner violence that typically exceed the general population. Sleep problems may exacerbate violence and maintain addictive behaviors in non-veterans, but requires study in veterans. Therefore, we examine the interrelationships between substance use, insomnia, and violence in veterans. Methods Veterans (N = 762) screened for a randomized controlled trial at veterans affairs mental health and substance use clinics. Participants completed modified Conflict Tactics Scales to quantify past-year violence and the Insomnia Symptom Questionnaire to assess sleep disturbance. We evaluated associations between substance use and sleep in predicting the target of aggression (partner or non-partner) and degree of violence (aggression or injury) using binomial logistic regressions. Results Half of participants endorsed symptoms suggestive of insomnia, 23.2% endorsed physical aggression toward partners (PA-P) and 33.9% non-partners (PA-NP), and 9.7% endorsed physical injury of partners (PI-P) and 17.6% of non-partners (PI-NP). Regressions revealed significant models for PA-P, PA-NP, and PI-NP, whereas the PI-P model was not significant. PA-P was higher among non-Caucasian race and older veterans. PA-NP was more common in those with insomnia and increased with frequency of cocaine use. Insomnia moderated the relationship between cocaine use and PA-NP; there was a weaker relationship between cocaine use and PA-NP in those with insomnia. PI-NP was more common with higher frequency of alcohol and cocaine use, and in those with insomnia. Conclusions This study finds sleep disturbances are meaningful predictors of violence among veterans with differential relationships with aggression severity, victims, and substance use concurrence.
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- 2021
3. The prevalence and impact of pre-existing sleep disorder diagnoses and objective sleep parameters in patients hospitalized for COVID-19
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Pratima Sharma, Cathy Goldstein, Jonathan P. Troost, Emily C. Somers, Gita Gupta, Louise M. O'Brien, Helen J Burgess, Muneer Rizvydeen, Jonathan L. Golob, and Deirdre A. Conroy
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Adult ,Sleep Wake Disorders ,Pulmonary and Respiratory Medicine ,Michigan ,Pediatrics ,medicine.medical_specialty ,Coronavirus disease 2019 (COVID-19) ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,medicine.medical_treatment ,Cohort Studies ,Hospitals, University ,Prevalence ,medicine ,Humans ,In patient ,Medical diagnosis ,Mechanical ventilation ,Sleep disorder ,business.industry ,COVID-19 ,medicine.disease ,Scientific Investigations ,Sleep in non-human animals ,Hospitalization ,Obstructive sleep apnea ,Treatment Outcome ,Neurology ,Neurology (clinical) ,business - Abstract
STUDY OBJECTIVES: Obstructive sleep apnea and other sleep disorders overlap with comorbidities associated with poor outcomes related to severe acute respiratory syndrome coronavirus 2 infection. However, the prevalence of obstructive sleep apnea among patients hospitalized for COVID-19 and relationship to outcomes is poorly characterized, and the relevance of other sleep disorders remains unknown. The objective of this study was to identify the prevalence of pre-existing sleep disorders and association with outcomes related to severe COVID-19 illness. METHODS: Patients with severe acute respiratory syndrome coronavirus 2 infection admitted to the University of Michigan Hospital System were included. Electronic medical records were queried for sleep disorders diagnostic codes. Data were extracted from polysomnography and home sleep testing in a subgroup with previous diagnostic testing at our center. Logistic regression was used to examine the association of sleep disorders with mechanical ventilation requirement, treatment with vasopressors, and death and Cox proportional hazards regression for time to discharge. RESULTS: Among n = 572 adult patients hospitalized for COVID-19, 113 (19.8%) patients had obstructive sleep apnea, 4 patients had central sleep apnea (0.7%), 5 had hypoventilation (0.9%), 63 had insomnia (11.0%), and 22 had restless legs syndrome or periodic limb movements disorder (3.9%). After adjusting for age, sex, body mass index, and race, no significant relationship was apparent between sleep disorders diagnoses or indices of sleep-disordered breathing severity and outcomes. CONCLUSIONS: This is the first study to determine the prevalence of obstructive sleep apnea and other sleep disorders in a well-characterized cohort of patients hospitalized for COVID-19. Once hospitalized, a significant contribution of sleep disorders to outcomes was not identified. Therefore, future evaluations should focus on earlier outcomes, such as infection or clinical manifestations after exposure to severe acute respiratory syndrome coronavirus 2. CITATION: Goldstein CA, Rizvydeen M, Conroy DA, et al. The prevalence and impact of pre-existing sleep disorder diagnoses and objective sleep parameters in patients hospitalized for COVID-19. J Clin Sleep Med. 2021;17(5):1039–1050.
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- 2021
4. Skipping breakfast and mood: The role of sleep
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Erica C. Jansen, Tom Dunietz, Zon-Shuan Chang, Deirdre A. Conroy, and Ali Boolani
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Adult ,Male ,medicine.medical_specialty ,Time Factors ,Medicine (miscellaneous) ,03 medical and health sciences ,0302 clinical medicine ,Surveys and Questionnaires ,Humans ,Medicine ,030212 general & internal medicine ,Circadian rhythm ,Psychiatry ,Breakfast ,Meal patterns ,Nutrition and Dietetics ,Sleep quality ,business.industry ,digestive, oral, and skin physiology ,food and beverages ,Breakfast skipping ,Feeding Behavior ,General Medicine ,Sleep in non-human animals ,Mental health ,Affect ,Mood ,Female ,Sleep ,business ,030217 neurology & neurosurgery - Abstract
Background: Breakfast skipping has been related to poor mood, but the role of sleep in this relationship remains unclear. Aim: To evaluate whether breakfast skipping associated with mood independently of sleep, and whether sleep interacted with breakfast skipping. Methods: During an in-person research visit, a sample of 329 adults completed questionnaires regarding last night’s sleep, current morning breakfast intake, and mid-morning mood states. Sex-stratified linear regression models examined associations between breakfast skipping and mood and interactions with sleep. Results: Among males, those who did not consume breakfast had less vigor independent of sleep (β=−2.72 with 95% CI −4.91, −0.53). Among females, those who did not consume breakfast had higher feelings of anxiety (β=1.21 with 95% CI −0.04, 2.47). Interaction analyses revealed that males with longer time to fall asleep and longer night-time awake time had higher depression scores in the presence of breakfast skipping, and females with more night-time awake time and shorter duration had higher fatigue and less vigor if they were also breakfast skippers. Conclusion: Breakfast skipping and poor sleep may jointly affect mood.
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- 2021
5. Plasma DHA Is Related to Sleep Timing and Duration in a Cohort of Mexican Adolescents
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Louise M. O'Brien, Erica C. Jansen, Martha María Téllez-Rojo, Helen J Burgess, Alejandra Cantoral, Deirdre A. Conroy, Karen E. Peterson, and Ana Baylin
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Male ,Adolescent ,Docosahexaenoic Acids ,Medicine (miscellaneous) ,Physiology ,030209 endocrinology & metabolism ,Cohort Studies ,03 medical and health sciences ,0302 clinical medicine ,Humans ,Nutritional Epidemiology ,Medicine ,Child ,Mexico ,chemistry.chemical_classification ,Nutrition and Dietetics ,business.industry ,Fatty acid ,Actigraphy ,Sleep in non-human animals ,Cross-Sectional Studies ,chemistry ,Quartile ,Docosahexaenoic acid ,Cohort ,Population study ,Female ,Sleep ,business ,030217 neurology & neurosurgery ,Cohort study - Abstract
Background Delayed sleep timing and short sleep duration represent a significant public health burden in adolescents. Whether intake of nutrients affects the pineal gland, where sleep/wake cycles are regulated, remains unclear. Objectives In a cross-sectional analysis, we investigated whether plasma concentrations of DHA and arachidonic acid (AA), long-chain fatty acids that can be obtained through diet, were related to sleep timing and duration in adolescents. Methods The study population included 405 Mexico City adolescents (mean age ± SD = 14.2 ± 2.1 y; 48% males) who took part in a 2015-2016 follow-up visit as a part of an ongoing cohort study. Fatty acid concentrations were measured in plasma using GLC, as a percentage of total fatty acids. Sleep midpoint and duration were assessed with 7-d wrist actigraphy. We categorized DHA and AA plasma concentrations into quartiles (Q1-Q4; Q4 = highest fatty acids). We conducted cross-sectional linear regression analysis with sleep characteristics as separate outcomes and quartiles of DHA and AA as exposures, adjusting for sex, age, and BMI z-scores. Results Mean ± SD plasma DHA (as percentage of total fatty acids) was 1.2 ± 0.4%, whereas mean ± SD plasma AA was 6.2 ± 1.5%. In adjusted analysis, higher plasma DHA was linearly associated with longer sleep duration on the weekends; to illustrate, those in Q4 compared with Q1 had 32 min longer duration (95% CI: 7, 57; P trend = 0.005). Higher DHA was also associated with earlier sleep timing during weekdays and weekends, although in a nonlinear fashion. The largest difference was a 0.75-h (45-min) later sleep midpoint in Q2 compared with Q4 (95% CI: 0.36, 1.14). Conclusions Plasma DHA was associated with earlier sleep timing and longer weekend sleep duration in Mexican adolescents. Whether DHA supplementation improves sleep in adolescent populations deserves consideration in randomized trials.
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- 2020
6. CBT-I in patients with alcohol use and cannabis use disorders
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Deirdre A. Conroy, Trevor M. Brooks, and Gabrielle E. Bowyer
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chemistry.chemical_compound ,medicine.medical_specialty ,chemistry ,business.industry ,Medicine ,In patient ,Alcohol ,Cannabis use ,business ,Psychiatry - Published
- 2022
7. The effects of COVID-19 stay-at-home order on sleep, health, and working patterns: a survey study of US health care workers
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Deirdre A. Conroy, Chamisa MacKenzie, Aliya Moreira, Helen J. Burgess, Nicole Hadler, J. Todd Arnedt, Echelle Cho, Leslie M. Swanson, and Cathy Goldstein
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Pulmonary and Respiratory Medicine ,Adult ,Male ,medicine.medical_specialty ,Work ,Cross-sectional study ,Social Determinants of Health ,Attitude of Health Personnel ,Health Personnel ,Health Status ,Disease ,03 medical and health sciences ,Screen time ,Young Adult ,0302 clinical medicine ,Surveys and Questionnaires ,Health care ,Medicine ,Humans ,Aged ,Aged, 80 and over ,business.industry ,SARS-CoV-2 ,COVID-19 ,Middle Aged ,Scientific Investigations ,United States ,Mood ,Cross-Sectional Studies ,030228 respiratory system ,Neurology ,Order (business) ,Family medicine ,Quarantine ,Commentary ,Anxiety ,Female ,Neurology (clinical) ,Sleep (system call) ,medicine.symptom ,business ,Sleep ,030217 neurology & neurosurgery - Abstract
STUDY OBJECTIVES: By March 2020, COVID-19 forced much of the world to stay at home to reduce the spread of the disease. Whereas some health care workers transitioned to working from home, many continued to report to work in person as essential employees. We sought to explore changes in sleep, health, work, and mood in health care workers during the stay-at-home orders. METHODS: We developed a cross-sectional online survey administered to health care workers. The survey assessed changes in sleep, work, screen time, media exposure, diet, exercise, substance use, and mood. The survey data were collected between March 28, 2020, and April 29, 2020. RESULTS: A total of 834 of 936 individuals completed the entire survey. Respondents were from 41 US states. Mood after the stay-at-home orders worsened, and screen time and substance use increased. Total sleep time shortened in those continuing to work in person (P < .001), whereas it was unchanged in those working from home (P = .73). Those working from home went to bed later, woke up later, and worked fewer hours. Reduced total sleep time and increased screen time before bed were associated with worse mood and screen time. Longer sleep time was associated with better mood. CONCLUSIONS: Health care workers’ mood worsened regardless of whether work was in person or remote, although total sleep time was shorter for those working in person. Those working from home may have shifted their sleep time to be more in line with their endogenous circadian phase. Peer or other support services may be indicated to address sleep, mood, and health behaviors among health care workers during these unprecedented times. CITATION: Conroy DA, Hadler NL, Cho E, et al. The effects of COVID-19 stay-at-home order on sleep, health, and working patterns: a survey study of US health workers. J Clin Sleep Med. 2021;17(2):185–191.
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- 2020
8. Telemedicine versus face-to-face delivery of cognitive behavioral therapy for insomnia: a randomized controlled noninferiority trial
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Ananda Sen, Deirdre A. Conroy, Daniel Eisenberg, Ann Mooney, J. Todd Arnedt, and Allison K.C. Furgal
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Adult ,Telemedicine ,medicine.medical_specialty ,medicine.medical_treatment ,Cognitive behavioral therapy for insomnia ,03 medical and health sciences ,Face-to-face ,0302 clinical medicine ,Sleep Initiation and Maintenance Disorders ,Physiology (medical) ,medicine ,Insomnia ,Humans ,030212 general & internal medicine ,Modalities ,Cognitive Behavioral Therapy ,business.industry ,Confounding ,Clinical trial ,Cognitive behavioral therapy ,Treatment Outcome ,Physical therapy ,Female ,Neurology (clinical) ,medicine.symptom ,Sleep ,business ,030217 neurology & neurosurgery - Abstract
Study Objectives In a randomized controlled noninferiority trial, we compared face-to-face and telemedicine delivery (via the AASM SleepTM platform) of cognitive-behavioral therapy (CBT) for insomnia for improving insomnia/sleep and daytime functioning at posttreatment and 3-month follow-up. A secondary objective compared the modalities on treatment credibility, satisfaction, and therapeutic alliance. Methods A total of 65 adults with chronic insomnia (46 women, 47.2 ± 16.3 years of age) were randomized to 6 sessions of CBT for insomnia delivered individually via AASM SleepTM (n = 33, CBT-TM) or face-to-face (n = 32, CBT-F2F). Participants completed sleep diaries, the Insomnia Severity Index (ISI), and daytime functioning measures at pretreatment, posttreatment, and 3-month follow-up. Treatment credibility, satisfaction, and therapeutic alliance were compared between treatment modalities. The ISI was the primary noninferiority outcome. Results Based on a noninferiority margin of four points on the ISI and, after adjusting for confounders, CBT-TM was noninferior to CBT-F2F at posttreatment (β = 0.54, SE = 1.10, 95% CI = 1.64 to 2.72) and follow-up (β = 0.34, SE = 1.10, 95% CI = 1.83 to 2.53). Daytime functioning measures, except the physical composite scale of the SF-12, were significantly improved at posttreatment and follow-up, with no difference between treatment formats. CBT-TM sessions were, on average, nearly 10 min shorter, yet participant ratings of therapeutic alliance were similar to CBT-F2F. Conclusions Telemedicine delivery of CBT for insomnia is not inferior to face-to-face for insomnia severity and yields similar improvements on other sleep and daytime functioning outcomes. Further, telemedicine allows for more efficient treatment delivery while not compromising therapeutic alliance. Clinical Trial Registration Number NCT03293745
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- 2020
9. Bright Light as a Preventive Intervention for Depression in Late-Life: A Pilot Study on Feasibility, Acceptability, and Symptom Improvement
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Deirdre A. Conroy, Amanda Leggett, Helen C. Kales, and Frederic C. Blow
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Male ,Sleep Wake Disorders ,Light therapy ,medicine.medical_specialty ,medicine.medical_treatment ,Pilot Projects ,Severity of Illness Index ,Article ,Pittsburgh Sleep Quality Index ,03 medical and health sciences ,Sleep Phase Chronotherapy ,0302 clinical medicine ,Intervention (counseling) ,medicine ,Humans ,Psychiatry ,Depression (differential diagnoses) ,Aged ,Aged, 80 and over ,Psychiatric Status Rating Scales ,Depressive Disorder ,Sleep disorder ,Depression ,business.industry ,Australia ,Actigraphy ,Phototherapy ,medicine.disease ,030227 psychiatry ,Patient Health Questionnaire ,Psychiatry and Mental health ,Distress ,Treatment Outcome ,Physical therapy ,Feasibility Studies ,Patient Compliance ,Female ,Self Report ,Geriatrics and Gerontology ,Sleep ,business ,030217 neurology & neurosurgery - Abstract
Objectives We examined the feasibility and acceptability of a portable bright light intervention and its impact on sleep disturbance and depressive symptoms in older adults. Methods One-arm prevention intervention pilot study of the Re-Timer (Re-Timer Pty Ltd, Adelaide, Australia) bright light device (worn 30 minutes daily for 2 weeks) in 1 older adults (age 65 + years) with subsyndromal symptoms of depression and poor sleep quality. Participants were assessed on intervention acceptability and adherence, depressive symptoms (Patient Health Questionnaire- 9), and sleep (Pittsburgh Sleep Quality Index, Insomnia Severity Index, actigraphy and daily diary reports). Results The Re-Timer device was rated positively by participants, and, on average, participants only missed 1 day of utilization. Although depressive symptoms declined and self-reported sleep improved, improvement was seen largely before the start of intervention. Conclusions An effective preventive intervention that is targeted towards a high risk group of older adults has the potential to reduce distress and costly health service use.
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- 2018
10. 0513 Comparison of Patient Satisfaction and Therapeutic Alliance for Telemedicine vs. Face-to-Face Delivered Cognitive Behavioral Therapy for Insomnia
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Deirdre A. Conroy, Allison K.C. Furgal, J Arnedt, Ann Mooney, Ananda Sen, K DuBuc, Sydney Balstad, Dari Pace, and Alexander Yang
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medicine.medical_specialty ,Telemedicine ,Evidence-based practice ,business.industry ,medicine.medical_treatment ,Cognitive behavioral therapy for insomnia ,Sleep medicine ,Cognitive behavioral therapy ,Face-to-face ,Patient satisfaction ,Physiology (medical) ,Insomnia ,Medicine ,Neurology (clinical) ,medicine.symptom ,business ,Clinical psychology - Abstract
Introduction CBT for insomnia (CBTI) is effective but a barrier to its widespread use is the lack of evidence-based delivery modalities other than face-to-face. The perception and acceptability of telemedicine for the delivery of CBTI is unknown. We conducted a randomized controlled non-inferiority trial comparing face-to-face (F2F) and telemedicine (via AASM SleepTM) delivery of CBTI. We compared measures of patient satisfaction with treatment and the perception of the therapist’s warmth and skills between F2F and SleepTM. Methods Adults with insomnia were recruited from insomnia clinics and the community and screened for sleep, medical, and mental health disorders. Eligible participants were randomized to receive CBTI either via AASM SleepTM or F2F in 6 weekly sessions of 45-60 minutes each. Participants completed the Client Satisfaction Questionnaire (CSQ-8) and The Therapy Evaluation Questionnaire (TEQ) after completing treatment. The CSQ-8 score ranges from 8-32 with high scores indicating greater satisfaction. We also analyzed the two items on the TEQ that assess participants’ perception of therapist’s warmth and skills. Item scores ranged from 1-7, with higher scores indicating greater warmth and skills. Results Sixty-five adults with chronic insomnia were recruited primarily from insomnia clinics. Sixty-two participants (41 women, mean age 48.9 ± 15.4 years) completed all 6 sessions of CBTI via F2F (n=32) or via AASM SleepTM (n=30). Independent samples t-tests revealed no significant differences between conditions on patient satisfaction (SleepTM, 28.5 +/-4.2 vs F2F 29.9 +/-2.4, t(-1.5), p=.14), therapist warmth (SleepTM, 6.0 ±1.1 vs F2F, 6.4±0.95, t(-1.4), p=.16), or therapist skills (Sleep TM 6.4 ±1.0 vs F2F, 6.7±0.59, t(-1.5), p=.15). Conclusion Our findings suggest no differences in patient satisfaction, perception of therapist’s warmth, or confidence in therapist’s skills between telemedicine (via the AASM SleepTM) and F2F delivery of CBTI. Telemedicine-delivered CBTI should be implemented more widely. Support Research supported by American Sleep Medicine Foundation Grant # 168-SR-17 (JT Arnedt)
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- 2020
11. 0532 Cognitive Behavioral Therapy Delivered Via Telemedicine vs. Face-to-Face: Results from a Randomized Controlled Non-Inferiority Trial
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Allison K.C. Furgal, Deirdre A. Conroy, Daniel Eisenberg, Dari Pace, K DuBuc, Alexander Yang, Ann Mooney, Ananda Sen, Sydney Balstad, and J Arnedt
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medicine.medical_specialty ,Telemedicine ,Evidence-based practice ,business.industry ,medicine.medical_treatment ,Sleep in non-human animals ,Sleep medicine ,Cognitive behavioral therapy ,Face-to-face ,Physiology (medical) ,Physical therapy ,medicine ,Insomnia ,Anxiety ,Neurology (clinical) ,medicine.symptom ,business - Abstract
Introduction Telemedicine is increasingly an option for delivery of healthcare services, but its efficacy and acceptability for delivering CBT for insomnia has not been adequately tested. In a randomized controlled non-inferiority trial, we compared face-to-face and telemedicine delivery (via the AASM SleepTM platform) of CBT for insomnia for improving sleep and daytime functioning at post-treatment and 12-week follow-up. Methods Sixty-five adults with chronic insomnia (46 women, mean age 47.2 ± 16.3 years) were recruited primarily from insomnia clinics and screened for disqualifying sleep, medical, and mental health disorders. Eligible participants were randomized to 6 sessions of CBT for insomnia delivered face-to-face (n=32) or via AASM SleepTM (n=33). Participants completed self-report measures of insomnia (Insomnia Severity Index, ISI) and daytime functioning (fatigue, depression, anxiety, and overall functioning) at pre-treatment, post-treatment, and 12-week follow-up. The ISI was the primary non-inferiority outcome. Results Telemedicine was non-inferior to face-to-face delivery of CBT for insomnia, based on a non-inferiority margin of 4 points on the ISI (β = -0.07, 95% CI -2.28 to 2.14). Compared to pre-treatment, ISI scores improved significantly at post-treatment (β = -9.02, 95% CI -10.56 to -7.47) and at 12-week follow-up (β = -9.34, 95% CI -10.89 to -7.79). Similarly, daytime functioning measures improved from pre- to post-treatment, with sustained improvements at 12-week follow-up. Scores on the fatigue scale were lower in the telemedicine group at both post-treatment (F=4.64, df=1,119, p Conclusion Insomnia and daytime functioning improve similarly whether CBT for insomnia is delivered via telemedicine or face-to-face. Telemedicine delivery of CBT for insomnia should be implemented more systematically to improve access to this evidence-based treatment. Support American Sleep Medicine Foundation Grant # 168-SR-17 (JT Arnedt, PhD)
- Published
- 2020
12. Predictors of Long-Term and High-Dose Use of Zolpidem in Veterans
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Tony Van, Deirdre A. Conroy, Matheos Yosef, Lauren B. Gerlach, Kara Zivin, and Hyungjin Myra Kim
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Adult ,Male ,0301 basic medicine ,Pediatrics ,medicine.medical_specialty ,Zolpidem ,Time Factors ,Databases, Factual ,Substance-Related Disorders ,medicine.drug_class ,Drug Administration Schedule ,Young Adult ,03 medical and health sciences ,Sex Factors ,0302 clinical medicine ,medicine ,Insomnia ,Humans ,Medical prescription ,Young adult ,Aged ,Veterans ,Aged, 80 and over ,Sleep disorder ,business.industry ,Age Factors ,Odds ratio ,Middle Aged ,medicine.disease ,United States ,Substance abuse ,Psychiatry and Mental health ,030104 developmental biology ,Sleep Aids, Pharmaceutical ,030220 oncology & carcinogenesis ,Sedative ,Female ,medicine.symptom ,business ,medicine.drug - Abstract
OBJECTIVE Prescriptions for sedative hypnotics are routinely initiated and renewed to treat insomnia, despite evidence supporting nonpharmacologic treatments as comparable and more favorable over time. We used national Veterans Health Administration data to assess patient characteristics associated with high-dose and long-term zolpidem use. METHOD The study included outpatients with new zolpidem prescriptions (January 1, 2013, to June 3, 2014). We defined high-dose use as use of doses above those recommended in the 2013 FDA safety warning (> 5 mg for women, > 10 mg for men) and defined long-term use as at least 180 days of continued supply. We fit separate logistic regression models by sex to evaluate how patient factors, adjusting for facilities, predicted high-dose and long-term use. RESULTS Of 139,525 new zolpidem users, < 1% of men and 41% of women used high doses within 180 days of initiation, and 20% continued to use zolpidem long-term. Prior-year use of other sleep medications was associated with both high-dose and long-term use. Substance abuse/dependence was associated with high-dose use in women (odds ratio = 1.20, P < .001). Although long-term use was less likely in those over the age of 85 years, about 1 in 5 users aged 65 to 85 continued long-term. In both sexes, individuals of Hispanic ethnicity and nonwhite races were less likely to use long-term, whereas those with ICD-9-CM-defined psychiatric and sleep disorder diagnoses were more likely to use long-term. CONCLUSIONS Zolpidem use at a higher-than-recommended dose was common in women who were new zolpidem users. In both sexes, 1 in 5 users continued to use zolpidem for at least 180 days. Efforts to improve access to effective nonpharmacologic treatment alternatives may benefit from attention to subpopulations with higher risk of high-dose and long-term use.
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- 2019
13. Poor sleep is linked to impeded recovery from traumatic brain injury
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David A. Kalmbach, Frederick K. Korley, Hayley Falk, Vani Rao, Deirdre A. Conroy, Matthew E. Peters, Durga Roy, and Timothy E. Van Meter
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Adult ,Male ,Sleep Wake Disorders ,Pediatrics ,medicine.medical_specialty ,Adolescent ,Traumatic brain injury ,03 medical and health sciences ,0302 clinical medicine ,Surveys and Questionnaires ,Physiology (medical) ,Brain Injuries, Traumatic ,medicine ,Insomnia ,Humans ,030212 general & internal medicine ,Brain Concussion ,Depression (differential diagnoses) ,Depression ,business.industry ,Head injury ,Emergency department ,Odds ratio ,Middle Aged ,medicine.disease ,Sleep in non-human animals ,Insomnia and Psychiatric Disorders ,Female ,Neurology (clinical) ,medicine.symptom ,Sleep onset ,Sleep ,business ,030217 neurology & neurosurgery - Abstract
Study ObjectivesWhile disruptions in sleep are common after mild traumatic brain injury (TBI), the longitudinal relationships between sleep problems and global functioning after injury are poorly understood. Here, we prospectively investigate risk for functional impairment during the first 6 months of TBI recovery based on sleep onset insomnia symptoms and short sleep.MethodsPatients presenting to the Emergency Department (ED) at Johns Hopkins Hospital within 24 hours of head injury and evaluated for TBI were eligible for our study. Demographic and injury-related information were collected in the ED. Patients then completed in-person surveys and phone interviews to provide follow-up data on global functioning, sleep, and depressive symptoms at 1, 3, and 6 months post-injury. A total of 238 patients provided sufficient data for analysis, and hypotheses were tested using mixed effects modeling.ResultsSleep quality and global functioning improved over the 6 months of TBI recovery, but patients were at increased risk for functional impairment when sleeping poorly (odds ratio [OR] = 7.69, p < .001). Sleep onset insomnia symptoms and short sleep both independently corresponded to poor global functioning. Functional impairment was highest among those with both insomnia and short sleep (43%–79%) compared to good sleepers (15%–25%) and those with short sleep (29%–33%) or insomnia alone (33%–64%). A bidirectional relationship between sleep quality and functioning was observed.ConclusionsFunctionally impaired patients diagnosed predominantly with mild TBI exhibit high rates of insomnia and short sleep, which may impede TBI recovery. Monitoring sleep after head injury may identify patients with poor prognoses and allow for early intervention to improve functional outcomes.
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- 2018
14. 0242 Consumption of the Long-Chain Fatty Acid Docosahexaenoic Acid In Relation To Sleep Timing And Duration In Adolescents: An Actigraphy-based Study In Mexico City
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Erica C. Jansen, Deirdre A. Conroy, Ana Baylin, O'Brien Louise, Martha María Téllez Rojo, Alejandra Cantoral, Karen E. Peterson, and Helen J. Burgess
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Consumption (economics) ,business.industry ,Duration (music) ,Docosahexaenoic acid ,Physiology (medical) ,Environmental health ,Mexico city ,Medicine ,Actigraphy ,Neurology (clinical) ,Long chain fatty acid ,business ,Sleep in non-human animals - Published
- 2019
15. Responsiveness of Veterans Affairs Health Care System to Zolpidem Safety Warnings
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Matheos Yosef, Marcia Valenstein, Anne E. Sales, Claire Stano, Deirdre A. Conroy, Kara Zivin, Paul N. Pfeiffer, Lauren B. Gerlach, and Hyungjin Myra Kim
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Pulmonary and Respiratory Medicine ,Male ,medicine.medical_specialty ,Zolpidem ,03 medical and health sciences ,0302 clinical medicine ,Sleep Initiation and Maintenance Disorders ,Sedative/hypnotic ,Health care ,Insomnia ,medicine ,Humans ,Practice Patterns, Physicians' ,Psychiatry ,Veterans Affairs ,Veterans ,business.industry ,United States Food and Drug Administration ,Middle Aged ,Scientific Investigations ,United States ,030227 psychiatry ,United States Department of Veterans Affairs ,Neurology ,Sleep Aids, Pharmaceutical ,Female ,Neurology (clinical) ,Guideline Adherence ,medicine.symptom ,business ,030217 neurology & neurosurgery ,medicine.drug - Abstract
Sedative hypnotic medications are routinely prescribed for insomnia treatment, but have been associated with significant risks of morning-after impairment. We evaluated responsiveness in the Veterans Health Administration (VHA) facilities to two drug safety warnings recommending against high-dose zolpidem use-a 2007 Veterans Administration Pharmacy Benefits Management Service warning and a 2013 Food and Drug Administration (FDA) warning.We used interrupted time-series design to assess how the two warnings influenced prescribing within the VHA in outpatients from 2005 to 2014. We assessed two outcomes: monthly outpatient use of (1) higher-than-recommended dose of zolpidem among zolpidem users and (2) any-dose zolpidem among all VHA users. In sensitivity analyses, we compared zolpidem prescribing to prescribing other sleep medications not subject to safety warnings.After the 2007 VHA warning, high-dose zolpidem use decreased significantly among both sexes from approximately 10% to 2%. Following the 2013 FDA warning, high-dose zolpidem use declined again; however, approximately half of women Veterans remained on high doses. Overall zolpidem use nearly quadrupled between the 2007 VHA and 2013 FDA warnings, but the overall use declined after the 2013 FDA warning. Increase in sedating antidepressant use was seen after the FDA warning, suggesting potential substitution.Higher than recommended dose use within the VHA decreased after each zolpidem high dose warning. Although overall use also decreased after the FDA warning, almost 50% of high-dose use among women Veterans is concerning. Different strategies to communicate the warnings should be examined.A commentary on this article appears in this issue on page 1093.
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- 2017
16. Using Sleep as a Window into Early Brain Recovery from Alcoholism
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Deirdre A. Conroy
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medicine.medical_specialty ,Sleep Stages ,Alcohol-related disorders ,medicine.diagnostic_test ,business.industry ,Medicine (miscellaneous) ,Brain recovery ,Window (computing) ,Audiology ,Electroencephalography ,Toxicology ,Sleep in non-human animals ,Psychiatry and Mental health ,Text mining ,Medicine ,business ,Psychiatry - Published
- 2015
17. Referral Practices for Cognitive Behavioral Therapy for Insomnia: A Survey Study
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Deirdre A. Conroy and Matthew R. Ebben
- Subjects
Michigan ,medicine.medical_specialty ,Article Subject ,Referral ,medicine.medical_treatment ,Neurosciences. Biological psychiatry. Neuropsychiatry ,Cognitive behavioral therapy for insomnia ,Hospitals, Urban ,Patient Load ,Sleep Initiation and Maintenance Disorders ,Insomnia ,medicine ,Humans ,Practice Patterns, Physicians' ,Psychiatry ,Referral and Consultation ,Sleep hygiene ,Cognitive Behavioral Therapy ,Sleep quality ,business.industry ,Survey research ,General Medicine ,Neuropsychology and Physiological Psychology ,Neurology ,Health Care Surveys ,Cognitive therapy ,New York City ,Neurology (clinical) ,medicine.symptom ,business ,RC321-571 ,Research Article - Abstract
This study examined referring practices for cognitive behavioral therapy for insomnia (CBTI) by physicians at University of Michigan Hospitals and Weill Cornell Medical College of Cornell University. A five-item questionnaire was sent via email that inquired about the physician’s patient load, number of patients complaining of insomnia, percent referred for CBTI, and impressions of what is the most effective method for improving sleep quality in their patients with insomnia. The questionnaire was completed by 239 physicians. More physicians believed a treatment other than CBTI and/or medication was most effective (N= 83). “Sleep hygiene” was recommended by a third of the sample. The smallest number of physicians felt that CBTI alone was the most effective treatment (N= 22). Additional physician education is needed.
- Published
- 2015
18. Prevalence and correlates of sleep-related problems in adults receiving medical cannabis for chronic pain
- Author
-
Carrie Bourque, Deirdre A. Conroy, Frederic C. Blow, J. Todd Arnedt, Kipling M. Bohnert, James A. Cranford, and Mark A. Ilgen
- Subjects
Adult ,Sleep Wake Disorders ,medicine.medical_specialty ,Michigan ,Substance-Related Disorders ,Medical Marijuana ,Toxicology ,Article ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Prevalence ,Humans ,Pharmacology (medical) ,Clinical significance ,030212 general & internal medicine ,Cannabis withdrawal ,Psychiatry ,Cannabis ,Pharmacology ,Sleep disorder ,biology ,business.industry ,Chronic pain ,medicine.disease ,biology.organism_classification ,Sleep in non-human animals ,Substance Withdrawal Syndrome ,Psychiatry and Mental health ,Medical cannabis ,Chronic Pain ,business ,030217 neurology & neurosurgery ,Sleep problem - Abstract
Purpose To examine the prevalence and correlates of sleep problems in a sample of medical cannabis patients. Procedures Adults ages 21 and older (N = 801, M age = 45.8) who were seeking medical cannabis certification (either for the first time or as a renewal) for chronic pain at medical cannabis clinics in southern Michigan completed baseline measures of cannabis use, sleep, pain, and other related constructs. Findings Over half of the sample (59%) met criteria for past 1-month sleep disturbance, defined as at least one sleep problem occurring on 15 or more nights in the past month. Most participants (86%) reported that sleep problems were due to their current pain. Approximately 80% of participants reported using cannabis in the past 6 months to improve sleep and, among these participants, cannabis was rated as helpful for improving sleep. Sleep-related cannabis side effects were rare (35%), but sleep-related cannabis withdrawal symptoms were relatively common (65%). Statistically significant correlates of past 1-month sleep disturbance included a) being female, b) being white, c) being on disability, d) not having a medical cannabis card, and e) frequency of using cannabis to help sleep. Conclusions Sleep problems are highly prevalent and frequent in medical cannabis patients and are closely tied to pain. Sleep-related cannabis withdrawal symptoms are relatively common but their clinical relevance is unknown. The association between frequency of cannabis use to help sleep with higher odds of sleep problems will need to be clarified by longitudinal studies.
- Published
- 2017
19. The Role of Sleep on the Pathway to Substance Abuse in Teens
- Author
-
Deirdre A. Conroy
- Subjects
medicine.medical_specialty ,Adolescent ,business.industry ,Substance-Related Disorders ,Public Health, Environmental and Occupational Health ,medicine.disease ,Sleep in non-human animals ,Article ,Substance abuse ,03 medical and health sciences ,Psychiatry and Mental health ,0302 clinical medicine ,Pediatrics, Perinatology and Child Health ,Medicine ,Humans ,030212 general & internal medicine ,Prospective Studies ,business ,Psychiatry ,Sleep ,030217 neurology & neurosurgery ,Clinical psychology - Published
- 2016
20. 0363 Efficacy of Cognitive Behavioral Therapy Delivered via Telemedicine vs. Face-to-Face: Preliminary Results from a Randomized Controlled Non-Inferiority Trial
- Author
-
Ann Mooney, Deirdre A. Conroy, Alexander Yang, Sydney Balstad, J. Todd Arnedt, Dari Pace, Daniel Eisenberg, Ananda Sen, and K DuBuc
- Subjects
medicine.medical_specialty ,Generalized anxiety disorder ,Evidence-based practice ,business.industry ,medicine.medical_treatment ,medicine.disease ,Sleep medicine ,Cognitive behavioral therapy ,Patient Health Questionnaire ,Physiology (medical) ,medicine ,Insomnia ,Physical therapy ,Anxiety ,Sleep diary ,Neurology (clinical) ,medicine.symptom ,business - Published
- 2019
21. Improve Sleep during Midlife: Address Mental Health Problems Early
- Author
-
Deirdre A. Conroy
- Subjects
Adult ,Male ,medicine.medical_specialty ,Adolescent ,Psychological intervention ,MEDLINE ,Child Behavior ,Comorbidity ,Anxiety ,Young Adult ,Child Rearing ,Prevalence of mental disorders ,Sleep Initiation and Maintenance Disorders ,Physiology (medical) ,Prevalence ,Humans ,Medicine ,Longitudinal Studies ,Prospective Studies ,Age of Onset ,Child ,Psychiatry ,Sex Characteristics ,Depression ,business.industry ,Mental Disorders ,Infant ,Confounding Factors, Epidemiologic ,medicine.disease ,Mental health ,Sleep in non-human animals ,Diagnostic and Statistical Manual of Mental Disorders ,Editorial ,Cross-Sectional Studies ,Mental Health ,Social Class ,Adolescent Behavior ,Child, Preschool ,Female ,Neurology (clinical) ,business ,New Zealand ,Clinical psychology - Abstract
Insomnia is a highly prevalent condition that constitutes a major public health and economic burden. However, little is known about the developmental etiology of adulthood insomnia.We examined whether indicators of psychological vulnerability across multiple developmental periods (psychiatric diagnoses in young adulthood and adolescence, childhood behavioral problems, and familial psychiatric history) predicted subsequent insomnia in adulthood.We used data from the ongoing Dunedin Multidisciplinary Health and Development Study, a population-representative birth cohort study of 1,037 children in New Zealand who were followed prospectively from birth (1972-1973) through their fourth decade of life with a 95% retention rate.Insomnia was diagnosed at age 38 according to DSM-IV criteria. Psychiatric diagnoses, behavioral problems, and family psychiatric histories were assessed between ages 5 and 38.In cross-sectional analyses, insomnia was highly comorbid with multiple psychiatric disorders. After controlling for this concurrent comorbidity, our results showed that individuals who have family histories of depression or anxiety, and who manifest lifelong depression and anxiety beginning in childhood, are at uniquely high risk for age-38 insomnia. Other disorders did not predict adulthood insomnia.The link between lifelong depression and anxiety symptoms and adulthood insomnia calls for further studies to clarify the neurophysiological systems or behavioral conditioning processes that may underlie this association.
- Published
- 2014
22. Substance Use as a Risk Factor for Sleep Problems Among Adolescents Presenting to the Emergency Department
- Author
-
Olena Zhabenko, Peter F. Ehrlich, Elizabeth A. Austic, Quyen Epstein-Ngo, Rebecca M. Cunningham, Vijay Singh, Maureen A. Walton, and Deirdre A. Conroy
- Subjects
Adult ,Male ,Sleep Wake Disorders ,medicine.medical_specialty ,Adolescent ,Substance-Related Disorders ,Article ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Informed consent ,Risk Factors ,medicine ,Humans ,Pharmacology (medical) ,030212 general & internal medicine ,Young adult ,Risk factor ,Medical prescription ,Psychiatry ,Depression (differential diagnoses) ,business.industry ,Emergency department ,Psychiatry and Mental health ,Adolescent Behavior ,Homicidal ideation ,Female ,medicine.symptom ,Brief intervention ,business ,Emergency Service, Hospital ,030217 neurology & neurosurgery - Abstract
Objectives: To determine correlates of sleep problems among adolescents. Specifically, to assess the relative strength of associations between sleep problems and dating victimization, reasons for emergency department (ED) visit, depression, unhealthy alcohol use, and other drug use (marijuana, nonmedical use of prescription opioids, stimulants, and tranquilizers). Methods: A total of 1852 adolescents aged 14 to 20 years presenting for care to the University of Michigan Emergency Department, Ann Arbor, Michigan, during 2011–2012, self-administered a computerized health survey. Sleep problems were identified if any of the 4 items on the Sleep Problems Questionnaire were rated by a patient as greater than 3 on a 0 to 5 scale. Adolescents who were too sick to be screened in the ED were eligible to participate in the study during their inpatient stay. Exclusion criteria for baseline included insufficient cognitive orientation precluding informed consent, not having parent/guardian present if younger than 18 years, medical severity precluding participation, active suicidal/homicidal ideation, non-English-speaking, deaf/visually impaired, or already participated in this study on a prior visit. Results: 23.5% of adolescents reported clinically significant sleep problems. Female gender, depression, dating victimization, tobacco use, nonmedical use of prescription medication, and an ED visit for medical reasons were each associated with sleep problems among adolescents, even while controlling for age, other types of drug use, receiving public assistance, and dropping out of school. Conclusions: These exploratory findings indicate that ED-based screening and brief intervention approaches addressing substance use and/or dating victimization may need to account for previously undiagnosed sleep problems.
- Published
- 2016
23. An Open Uncontrolled Pilot Trial of Online Cognitive-Behavioral Therapy for Insomnia for Ukrainian Alcohol-Dependent Patients
- Author
-
Iryna Frankova, Alexander Mazur, Kirk J. Brower, Robert A. Zucker, Anna Oliinyk, Nataliya Zhabenko, Deirdre A. Conroy, Olena Zhabenko, and Oleg S. Chaban
- Subjects
medicine.medical_specialty ,Heavy drinking ,business.industry ,Alcohol dependence ,Pilot trial ,Alcohol ,Cognitive behavioral therapy for insomnia ,030227 psychiatry ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,chemistry ,Alcohol and health ,Environmental health ,Unrecorded alcohol ,Medicine ,business ,Psychiatry ,030217 neurology & neurosurgery ,Harmful use - Abstract
Heavy drinking patterns among adults are common in Ukraine (Webb et al. in Alcohol Alcohol 40(4):327, 2005). According to the WHO Global Information System on Alcohol and Health, the total recorded and unrecorded alcohol per capita consumption among adults (15+) in Ukraine was 14.3 (in liters of pure alcohol) in 2003–2005 which decreased to 13.9 in 2008–2010, with spirits being the main beverage group (48 % of all the alcohol) followed by beer (40 %) and wine (9 %). The 12-month prevalence of alcohol use disorders (including alcohol dependence and harmful use of alcohol) and alcohol dependence estimates (15+) among males were 9.3 and 4.2 % and females 1.1 and 0.5 %, respectively (WHO 2014). The same report found that the highest patterns of drinking score, i.e., the most risky patters of drinking, have been found in Russia and Ukraine.
- Published
- 2016
24. Behavioral Management of Hypersomnia
- Author
-
Leslie M. Swanson, Danielle M. Novick, and Deirdre A. Conroy
- Subjects
Psychiatry and Mental health ,Clinical Psychology ,Neuropsychology and Physiological Psychology ,business.industry ,Medicine ,Behavior management ,Neurology (clinical) ,General Medicine ,business ,Clinical psychology - Published
- 2012
25. A Pilot Study on Adolescents With Depression and Insomnia: Qualitative Findings From Focus Groups
- Author
-
Timothy F. Hoban, J. T. Arnedt, Dawn M. Dore-Stites, Deirdre A. Conroy, Richard Dopp, Roseanne Armitage, and A. M. Czopp
- Subjects
Male ,medicine.medical_specialty ,Adolescent ,Neuroscience (miscellaneous) ,Medicine (miscellaneous) ,Pilot Projects ,Affect (psychology) ,Bedtime ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Sleep Initiation and Maintenance Disorders ,mental disorders ,medicine ,Insomnia ,Humans ,Young adult ,Psychiatry ,Depression (differential diagnoses) ,Qualitative Research ,Motivation ,business.industry ,Depression ,Patient Preference ,Focus Groups ,030227 psychiatry ,Affect ,Mood ,Rumination ,Patient Compliance ,Female ,Neurology (clinical) ,Psychology (miscellaneous) ,Thematic analysis ,medicine.symptom ,business ,Sleep ,030217 neurology & neurosurgery ,Clinical psychology - Abstract
Nonpharmacological treatments for insomnia in adolescents with depression are lacking. This qualitative study was a thematic analysis of the unique characteristics of and preferences for an insomnia treatment in a group of depressed adolescents. Fourteen adolescents with insomnia (age range = 14-19, mean = 17, SD ± 1.7; 71% female) and depression completed a 90-min focus group. Information was elicited about sleep disruptions, insomnia's impact on mood, and preferences for insomnia treatments. Themes included poor daytime functioning affecting sleep, lack of benefit from sleep medication, and bedtime rumination. Most identified sleep diaries as a barrier to treatment regardless of mode of delivery. Participants also preferred an in-person therapy. Insomnia therapy in adolescents should consider the unique characteristics of depression. Larger studies are warranted.
- Published
- 2015
26. Sa1096 - Therapeutic Effects of Cognitive Behavioral Therapy for Insomnia on Reflux Symptoms
- Author
-
Deirdre A. Conroy, Cathy Goldstein, and Joan W. Chen
- Subjects
Hepatology ,business.industry ,Therapeutic effect ,Gastroenterology ,Reflux ,Medicine ,business ,Cognitive behavioral therapy for insomnia ,Clinical psychology - Published
- 2018
27. Evaluation of the Insomnia Patient
- Author
-
Donn Posner, J. Todd Arnedt, Deirdre A. Conroy, and Mark S. Aloia
- Subjects
Psychiatry and Mental health ,Clinical Psychology ,medicine.medical_specialty ,Neuropsychology and Physiological Psychology ,business.industry ,Insomnia ,medicine ,Physical therapy ,Neurology (clinical) ,General Medicine ,medicine.symptom ,business - Published
- 2006
28. Sleep to Activate Mood Promotion (Stamp) in Older Adults: Initial Results From a Prevention Pilot Study
- Author
-
Deirdre A. Conroy, Helen C. Kales, Amanda Leggett, and Frederic C. Blow
- Subjects
Psychiatry and Mental health ,medicine.medical_specialty ,Promotion (rank) ,Mood ,business.industry ,media_common.quotation_subject ,Physical therapy ,medicine ,Sleep (system call) ,Geriatrics and Gerontology ,business ,Psychiatry ,media_common - Published
- 2016
29. Overlooking insomnia in a patient with alcohol abuse or dependence can increase risk of relapse
- Author
-
Deirdre A. Conroy
- Subjects
medicine.medical_specialty ,Eszopiclone ,business.industry ,Ramelteon ,Advanced sleep phase disorder ,Alcohol abuse ,medicine.disease ,Sleep medicine ,medicine ,Insomnia ,medicine.symptom ,Psychiatry ,business ,Depression (differential diagnoses) ,Slow-wave sleep ,medicine.drug - Published
- 2014
30. Patient education and motivational enhancement can make the difference between adherence and non-use of positive airway pressure
- Author
-
Jennifer R. Goldschmied and Deirdre A. Conroy
- Subjects
medicine.medical_specialty ,Psychotherapist ,business.industry ,Motivational enhancement ,Positive airway pressure ,Physical therapy ,Medicine ,Motivational enhancement therapy ,business ,Sleep medicine ,Patient education - Published
- 2014
31. Exploring the Acceptability of Sleep Monitoring and Bright Light Technologies for Intervention Use in Older Adults
- Author
-
Helen C. Kales, Deirdre A. Conroy, Amanda Leggett, and Frederic C. Blow
- Subjects
Psychiatry and Mental health ,medicine.medical_specialty ,Sleep monitoring ,business.industry ,Intervention (counseling) ,Medicine ,Geriatrics and Gerontology ,business ,Psychiatry ,Bright light - Published
- 2015
32. Treatment for Insomnia in Depressed Adolescents
- Author
-
Deirdre A. Conroy
- Subjects
Sleep disorder ,medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Motivational interviewing ,Sleep apnea ,medicine.disease ,Sleep in non-human animals ,Cognitive behavioral therapy ,Circadian rhythm sleep disorder ,Mood ,medicine ,Insomnia ,medicine.symptom ,Psychiatry ,business ,Clinical psychology - Abstract
Objective: Sleep undergoes dramatic changes during the adolescent years due to biological, circadian, and psychosocial influences. It is now known that sleep loss, both acute and chronic, can affect emotion regulation and can increase the likelihood of developing depression and risky behaviors. Method: The authors carried out a systematic review utilizing the PubMed database by using the search terms including: “adolescence, depression, sleep, and insomnia.” The present review covers manuscripts accepted up to the year 2013. The following review discusses findings on the bidirectional relationship between insomnia and depression and will cover current evaluation and treatment options. Results: Depression can be present in up to 20 percent of adolescents and most of these children will have some form of sleep disturbance. The etiology of sleep disturbances may reflect insomnia, circadian rhythm sleep disorder, sleep apnea, or other factors. Pharmacological and cognitive behavioral therapy approaches are common, but may result in limited gains due to persistent insomnia. Antidepressant medications may be lessened and relapse may be higher in those with insomnia. Treatment monitoring may be helped by motivational interviewing techniques and examining the teen’s self-report over parental sleep reports. Conclusion: Sleep disturbances that are identified, addressed, and appropriately monitored may result in improved sleep and mood. Active involvement of the teen in the therapy process may improve outcomes. Further research is needed to develop non-pharmacological strategies that are acceptable and sustainable for adolescents
- Published
- 2013
33. The influence of emerging low mood symptoms on sleep in children: a pilot study
- Author
-
Deirdre A. Conroy, Kirk J. Brower, Robert Hoffmann, Anameti Usoro, and Roseanne Armitage
- Subjects
Pediatrics ,medicine.medical_specialty ,pediatrics ,insomnia ,Rapid eye movement sleep ,Polysomnography ,03 medical and health sciences ,Behavioral Neuroscience ,0302 clinical medicine ,Rating scale ,Nature and Science of Sleep ,medicine ,Insomnia ,EEG ,Applied Psychology ,Original Research ,Sleep Stages ,Sleep disorder ,medicine.diagnostic_test ,business.industry ,medicine.disease ,Sleep in non-human animals ,030227 psychiatry ,Mood ,depression ,medicine.symptom ,business ,030217 neurology & neurosurgery - Abstract
Deirdre A Conroy, Anameti Usoro, Robert F Hoffmann, Kirk J Brower, Roseanne ArmitageUniversity of Michigan, Department of Psychiatry, Ann Arbor, MI, USAPurpose: Sleep disturbances can lead to the onset and relapse of psychiatric disorders. However, the age at which this relationship begins and the role of sleep disturbances in the trajectory to the onset of a psychiatric disorder are still not fully understood. The purpose of this study was to explore, based on self- and parental-reports of mood symptoms, subjective and objective sleep in young children who are at risk of developing a psychiatric disorder but who have not yet met diagnostic criteria.Patients and methods: Twenty-one children (eleven girls) between the ages of 8 and 11 (mean age = 9.7 years, standard deviation = 1.1 years) were dichotomized into low mood (LM) and not low mood (NLM) groups based on scoring below or above the median threshold score on at least two of the following questionnaires: the Child Depressive Rating Scale (CDRS), Weinberg Screening Affective Scale (WSAS), and Quick Inventory of Depressive Symptomatology (QIDS). The children completed sleep diaries and underwent two nights (for adaptation and baseline) of polysomnography. Sleep stages and sleep microarchitecture (alpha, sigma, beta, and delta) in the first half of the night, were analyzed.Results: Self-reported sleep disturbance accounted for 72% of the variance (F[3, 20] = 15, P < 0.005) of the Weinberg Screening Affective Scale in LM children. LM children had fewer arousals at night, but awakened earlier than NLM children. Regardless of mood, girls had more sleep disturbance, as well as lower alpha, beta, and delta power in the first half of the night, compared to boys. Girls with LM had shorter sleep times and a lower percentage of rapid eye movement sleep.Conclusions: Girls with and without LM, and without a clinical diagnosis of depression, showed more sleep disturbances than boys of the same age. Sleep disturbances evident early in life and in LM girls may reflect greater risk for future sleep or psychiatric disorders.Keywords: depression, insomnia, EEG, pediatrics
- Published
- 2012
34. Sleep and Substance Use Disorders
- Author
-
Deirdre A. Conroy, J. Todd Arnedt, and Kirk J. Brower
- Subjects
medicine.medical_specialty ,business.industry ,Insomnia ,Medicine ,Substance use ,medicine.symptom ,business ,Psychiatry ,Sleep in non-human animals ,Non pharmacological - Published
- 2012
35. Effects of a 3-hour sleep delay on sleep homeostasis in alcohol dependent adults
- Author
-
Roseanne Armitage, Kirk J. Brower, Robert Hoffmann, J. Todd Arnedt, and Deirdre A. Conroy
- Subjects
Adult ,Male ,medicine.medical_specialty ,Polysomnography ,Audiology ,Exponential regression ,Non-rapid eye movement sleep ,Time ,Young Adult ,Physiology (medical) ,Internal medicine ,Medicine ,Homeostasis ,Humans ,Analysis of Variance ,medicine.diagnostic_test ,business.industry ,Alcohol dependence ,Actigraphy ,Electroencephalography ,Middle Aged ,Sleep in non-human animals ,Alcoholism ,Endocrinology ,Sleep Deprivation ,Sleep Homeostasis in Alcohol-Dependent Adults ,Hour sleep ,Female ,Neurology (clinical) ,business ,Sleep - Abstract
Objectives This study evaluated slow wave activity homeostatic response to a mild sleep challenge in alcohol-dependent adults compared to healthy controls. Design Participants maintained a 23:00-06:00 schedule for 5 days verified by actigraphy and diary, followed by 3 nights in the lab: adaptation, baseline, and a sleep delay night with an 02:00-09:00 schedule. Setting Sleep ' Chronophysiology laboratory. Participants 48 alcohol-dependent adults (39 men, 9 women) who were abstinent for at least 3 weeks and 16 healthy control adults (13 men, 3 women), 21-55 years of age participated in study. Interventions N/A. Measurements and results Slow wave EEG activity (SWA) in consecutive NREM periods was compared between baseline and sleep delay nights and between AD and HC groups, using age and sex as statistical covariates. The AD group showed a blunted SWA response to sleep delay with significantly lower SWA power than the HC group. Exponential regression analyses confirmed lower asymptotic SWA with a slower decay rate over NREM sleep time in the AD group. Results were similar for raw SWA and %SWA on the delay night expressed relative to baseline SWA. Conclusions Alcohol dependence is associated with impaired SWA regulation and a blunted response to a mild homeostatic sleep challenge.
- Published
- 2012
36. Alcohol, toxins, and medications as a cause of sleep dysfunction
- Author
-
Kirk J. Brower and Deirdre A. Conroy
- Subjects
medicine.medical_specialty ,education.field_of_study ,medicine.diagnostic_test ,business.industry ,Population ,Disease ,Polysomnography ,Sleep in non-human animals ,Clinical research ,Pharmacokinetics ,medicine ,Over-the-counter ,Medical prescription ,Psychiatry ,Intensive care medicine ,education ,business - Abstract
Publisher Summary Numerous substances can result in sleep dysfunction by directly altering brain systems that regulate sleep. Substances can also cause sleep dysfunction indirectly by exacerbating an illness or disorder associated with sleep impairment (for example, caffeine can exacerbate reflux disease causing pain and discomfort that disturb sleep). Substances included in this chapter are drugs of abuse, prescription medications, substances obtained over the counter and off the shelf in stores, and toxic heavy metals. The chapter focuses on the clinical studies and observations. Substance-related, population related, and methodology-related factors influence the observed effects of a substance on sleep in clinical research. Substance related factors include dose, timing of dose, acute versus chronic use, withdrawal from use, pharmacokinetics, mechanism of action, and interactions with other drugs. Population-related factors include age, gender, weight, genetics, psychological traits and states, and health status. Methodological factors include sample size, study design, and type of outcome measures (e.g., nocturnal sleep versus daytime sleepiness; self-report versus polysomnography (PSG))
- Published
- 2011
37. Daily rhythm of cerebral blood flow velocity
- Author
-
Arthur J. Spielman, Deirdre A Conroy, and Rebecca Q Scott
- Subjects
medicine.medical_specialty ,Evening ,Endocrine and Autonomic Systems ,Physiology ,business.industry ,Research ,Poison control ,Surgery ,Time of day ,Rhythm ,lcsh:Biology (General) ,Cerebral blood flow ,Internal medicine ,medicine ,Cardiology ,Wakefulness ,sense organs ,Circadian rhythm ,skin and connective tissue diseases ,business ,lcsh:QH301-705.5 ,Morning - Abstract
Background CBFV (cerebral blood flow velocity) is lower in the morning than in the afternoon and evening. Two hypotheses have been proposed to explain the time of day changes in CBFV: 1) CBFV changes are due to sleep-associated processes or 2) time of day changes in CBFV are due to an endogenous circadian rhythm independent of sleep. The aim of this study was to examine CBFV over 30 hours of sustained wakefulness to determine whether CBFV exhibits fluctuations associated with time of day. Methods Eleven subjects underwent a modified constant routine protocol. CBFV from the middle cerebral artery was monitored by chronic recording of Transcranial Doppler (TCD) ultrasonography. Other variables included core body temperature (CBT), end-tidal carbon dioxide (EtCO2), blood pressure, and heart rate. Salivary dim light melatonin onset (DLMO) served as a measure of endogenous circadian phase position. Results A non-linear multiple regression, cosine fit analysis revealed that both the CBT and CBFV rhythm fit a 24 hour rhythm (R2 = 0.62 and R2 = 0.68, respectively). Circadian phase position of CBT occurred at 6:05 am while CBFV occurred at 12:02 pm, revealing a six hour, or 90 degree difference between these two rhythms (t = 4.9, df = 10, p < 0.01). Once aligned, the rhythm of CBFV closely tracked the rhythm of CBT as demonstrated by the substantial correlation between these two measures (r = 0.77, p < 0.01). Conclusion In conclusion, time of day variations in CBFV have an approximately 24 hour rhythm under constant conditions, suggesting regulation by a circadian oscillator. The 90 degree-phase angle difference between the CBT and CBFV rhythms may help explain previous findings of lower CBFV values in the morning. The phase difference occurs at a time period during which cognitive performance decrements have been observed and when both cardiovascular and cerebrovascular events occur more frequently. The mechanisms underlying this phase angle difference require further exploration.
- Published
- 2004
38. Erratum
- Author
-
Robert Hoffmann, Inga Landsmane, J. Todd Arnedt, Roseanne Armitage, Deirdre A. Conroy, and Kirk J. Brower
- Subjects
medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,Medicine (miscellaneous) ,Actigraphy ,Alcohol ,Polysomnography ,Psychiatry and Mental health ,Clinical Psychology ,chemistry.chemical_compound ,chemistry ,Physical therapy ,Medicine ,business - Published
- 2011
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