1988 |
Lichstein, Kenneth L |
R15Activity Code Description: Supports small-scale research projects at educational institutions that provide baccalaureate or advanced degrees for a significant number of the Nation’s research scientists but that have not been major recipients of NIH support. The goals of the program are to (1) support meritorious research, (2) expose students to research, and (3) strengthen the research environment of the institution. Awards provide limited Direct Costs, plus applicable F&A costs, for periods not to exceed 36 months. This activity code uses multi-year funding authority; however, OER approval is NOT needed prior to an IC using this activity code. |
Pupillometric Effects of Sleep in the Elderly
The proposed study examines normal and insomniac sleep patterns in the elderly from a novel perspective to shed light on mechanisms of disturbed sleep. The central hypothesis is that many elderly desire an amount of sleep that exceeds bodily need. This discrepancy motivates frustrating awake time in bed, i.e., an insomnia-appearing sleep pattern, but does not produce daytime sleepiness, the presumed result of insomnia. Therefore, daytime sleepiness emerges as a crucial dependent variable in verifying the presence of insomnia. This study will conduct a 4-point (early morning, noon, dinner time, and bedtime) pupillometric assessment of 60 elderly subjects characterized by normal sleep, medicated insomnia, or unmedicated insomnia. The extant literature recommends pupillometry as the sole physiological marker of daytime sleepiness, though methodological weaknesses, prevent firm conclusion. Nightime sleep pattern, against which daytime sleepiness will be matched, will be monitored objectively, in the natural environment with a response-demand device. The purposes of this study are to (a) assess the validity of pupillometry as a sleepiness index on a geriatric sample by tracking the natural course of sleepiness during the day, (b) assess the effects of nighttime sleep pattern on daytime sleepiness, and (c) identify an insomniac subset presenting with poor sleep, but no excessive daytime sleepiness. This last group, termed insomnoid, reflects individuals desiring more sleep than they physiologically need, a problem hypothesized to be most common in the elderly. Successful demonstrations that some elderly insomniacs have satisfied bodily sleep need, despite the persistence of a distrubed sleep pattern, raise conflicts with traditional conceptualizations of insomnia and with medical and psychological treatments that aim at helping people sleep longer. The treatment implications of this line of research recommend sleep education in place of treatments bearing higher cost and higher risk of negative side- effects.
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0.964 |
1995 — 1998 |
Lichstein, Kenneth L |
R01Activity Code Description: To support a discrete, specified, circumscribed project to be performed by the named investigator(s) in an area representing his or her specific interest and competencies. |
Biobehavioral Approach to Insomnia Treatment
Older adults suffer heightened prevalence of insomnia compared to middle- aged groups and increasingly turn to hypnotic medication in defiance of escalating health hazards. Further, there have been relatively few trials of psychological treatments with older insomniacs, and these have yielded moderate results. The present clinical outcome study will attempt to improve therapeutic efficacy by tailoring psychological treatments to geriatric insomnia subgroups that are distinguished by either behavioral or biological deficits. From a behavioral perspective, normal, but unfavorable, aging effects on sleep promote. the over diagnosis of insomnia among older adults. Seniors uninformed as to their changing sleep requirements and motivated to preserve a middle-aged sleep pattern may desire an amount and quality of sleep (sleep goals) that exceed biological need. This need/goal disparity may give rise to frustrating awake time in bed, i.e., an insomnia pattern, but not daytime impairment, a consequence of inadequate sleep. Such individuals, termed "insomnoid," would not be expected to benefit from conventional insomnia treatments aimed at extending sleep, but rather present a better fit with an intervention known as sleep restriction, which focuses on correcting sleep schedule behavior. It consists of revising sleep goals and shortening time in bed to match sleep need. Alternatively, individuals fitting traditional conceptions of insomnia present a disturbed sleep pattern and fail to satisfy biological sleep need due to worrisome thoughts, physical restlessness, and the like. These individuals are prone to exhibit residual daytime impairment characterized by sleepiness, cognitive and emotional deficits, etc., and would likely profit from a method such as relaxation that could surmount biological barriers to sleep. Daytime impairment emerges as a key factor in determining if disordered sleep reflects "true" insomnia or inappropriate sleep goals, and it also may predict differential treatment responsivity. The proposed investigation will compare three psychological treatments, sleep restriction, passive relaxation, and placebo desensitization with 120 subjects representing two older adult insomnia subgroups, high or low in daytime impairment as determined by a self-report questionnaire. An interaction is predicted, whereby high impaired subjects are expected to respond best to relaxation therapy and low impaired subjects best to sleep restriction. Assessments of sleep and daytime functioning will be conducted at baseline, posttreatment, and 8-month follow-up to determine clinical outcome. Additional assessments will monitor design variables and will screen for sleep-active medications.
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0.964 |
1999 — 2004 |
Lichstein, Kenneth L |
R01Activity Code Description: To support a discrete, specified, circumscribed project to be performed by the named investigator(s) in an area representing his or her specific interest and competencies. |
Treatment of Hypnotic Dependence in Older Adults
Hypnotic-dependent insomnia (HDI) refers to insomnia maintained by the chronic use of sleep medications (hypnotics) with associated tolerance and dependence. As disproportionately high users of hypnotics, older adults are most likely to develop HDI, and they are most vulnerable to the negative side-effects associated with chronic benzodiazepine use. The efficacy of psychological treatments for insomnia is well established, but there has been relatively little research on the use of these same treatments for people with insomnia who are also dependent on hypnotics. The planned study will treat 90 older adults diagnosed with HDI secondary to benzodiazepine use in a randomized experiment with three conditions: scheduled gradual hypnotic withdrawal supplemented by a placebo desensitization, and scheduled gradual hypnotic withdrawal only. Assessments at baseline, post-treatment/withdrawal, and 1-year follow-up will include monitoring of hypnotic consumption, self report and laboratory sleep evaluations, drug screens, and measures of psychological and global functioning. Side-effects during the drug withdrawal period will also be monitored by self-report. The study will attempt to determine if adding psychological treatments to gradual drug withdrawal will improve success of drug withdrawal, diminish withdrawal side-effects, improve sleep, or improve psychological and global functioning compared to gradual drug withdrawal alone in the management of HDI with older adults.
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0.964 |
2002 — 2008 |
Lichstein, Kenneth L |
R01Activity Code Description: To support a discrete, specified, circumscribed project to be performed by the named investigator(s) in an area representing his or her specific interest and competencies. |
Treating Addiction to Sleep Medication
DESCRIPTION (provided by applicant): Hypnotic-dependent insomnia (HDI) refers to insomnia maintained by the chronic use of sleep medications (hypnotics) with associated tolerance and dependence. Benzodiazepines, one class of commonly used sleep medications, are particularly prone to producing addiction and negative side effects. Similar, but often less severe negative effects, are associated with nonbenzodiazepine prescription sleep medications. The efficacy of psychological treatments for insomnia is well established, but there has been relatively little research on the use of these same treatments for people with insomnia who are also addicted to sleep medication. The planned study will treat 90 young and middle-aged adults, ages 21-59, diagnosed with HDI secondary to prescribed sleep medication in a randomized experiment with three conditions: scheduled gradual hypnotic withdrawal supplemented by stress management (relaxation, stimulus control, and sleep hygiene), scheduled gradual hypnotic withdrawal supplemented by placebo desensitization, and scheduled gradual hypnotic withdrawal only. Assessments at baseline, post-treatment/withdrawal, and 1-year follow-up will include monitoring of hypnotic consumption, self-report and laboratory sleep evaluations, drug screens, and measures of daytime functioning. Side effects during the drug withdrawal period will also be monitored by self-report. The study will attempt to determine if adding psychological treatments to gradual drug withdrawal will improve success of drug withdrawal, diminish withdrawal side-effects, improve sleep, or improve daytime functioning compared to gradual drug withdrawal alone in the management of HDI. This project fits within the guidelines of a Stage II clinical trial according to the Behavioral Therapies Development Program of the National Institute on Drug Abuse.
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0.987 |
2011 — 2013 |
Lichstein, Kenneth L Scogin, Forrest R (co-PI) [⬀] |
R34Activity Code Description: To provide support for the initial development of a clinical trial or research project, including the establishment of the research team; the development of tools for data management and oversight of the research; the development of a trial design or experimental research designs and other essential elements of the study or project, such as the protocol, recruitment strategies, procedure manuals and collection of feasibility data. |
Treatment of Insomnia and Depression in Elders (Tide) @ University of Alabama in Tuscaloosa
DESCRIPTION (provided by applicant): Insomnia and depression are two of the most prevalent mental health disorders and often co-occur. Health disparities in rural America and among African-Americans are well documented. We propose an R34 exploratory project to test the feasibility of delivering high-fidelity insomnia and depression psychological services to an underserved population. Treatment of Insomnia and Depression in Elders (TIDE) is a pilot study that will treat rural, predominantly African-American older adults who present to their primary care physician with co-occurring insomnia/depression. Stage 1 will be an uncontrolled case study series (n = 10) focusing on treatment development/refinement and patient acceptability. In stage 2, feasibility will be experimentally tested with 46 participants randomized to integrated cognitive-behavior therapy (CBT) + usual care or to usual care only in an effectiveness pilot study. The treatment will combine/integrate compact CBT for insomnia (including relaxation, sleep restriction, and stimulus control) and for depression (including cognitive therapy and behavioral activation). The experimental intervention comprises delivering CBT services by videoconferencing to patients in primary care settings who live in rural areas. Treatment will be evaluated by pre, post, and follow-up self report instruments on insomnia, depression, and quality of life. In addition, the stage 1 pilot will use investigator designed quantitative and qualitative measures to evaluate critical process variables including patient acceptability of the video format, patient acceptability of the treatments, and obstacles to adherence. Depending on stage 1 data, these measures may be incorporated into stage 2 as well. Several innovative features of this exploratory project include: intervening with CBT on both disorders hoping to gain a synergy by their combined presentation;use of telehealth to deliver treatment to distant locations;translation of efficacy findings to an effectiveness trial;treatment will be delivered in the primary care setting, the preferred locale of rural, older adults;the study will extend knowledge of the range of CBT applications by enrolling under-represented groups with respect to ethnicity, literacy, and financial resources. The primary aims of this project are (1) to determine the feasibility and maximal therapy characteristics of integrated CBT for co-occurring insomnia/depression in both the case study series (stage 1) and the experimental investigation (stage 2), (2) collect pilot data on whether participants receiving integrated CBT + usual care show comparable or greater reductions in insomnia symptoms compared to participants receiving usual care at posttreatment and follow-up, and (3) collect pilot data on whether participants receiving integrated CBT + usual care show comparable or greater reductions in depression symptoms compared to participants receiving usual care at posttreatment and follow-up. PUBLIC HEALTH RELEVANCE: Co-occurring insomnia and depression is a highly prevalent mental health disorder. This combination is well represented in groups characterized by health disparities: rural, African-Americans. We propose an R34 exploratory project to test the feasibility of delivering high-fidelity insomnia and depression psychological services to these underserved populations.
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0.987 |