Adam D. Bramoweth

Patterns and consequences of inadequate sleep in college students: substance use and motor vehicle accidents

We examined college sleep patterns and consequences using a cross-sectional design. We found that students get insufficient sleep and frequently use medication and alcohol as sleep aids, use stimulants as alertness aids, and fall asleep at the wheel, or have motor vehicle accidents due to sleepiness. Future studies should focus on effective interventions for sleep in college students.

Epidemiology of insomnia in college students: relationship with mental health, quality of life, and substance use difficulties.

The purpose of this study was to evaluate the prevalence and correlates of insomnia using rigorous diagnostic criteria and a comprehensive assessment battery. In a large sample (N=1,074) of college students (mean age 20.39years), participants were asked to complete a week-long sleep diary and comprehensive questionnaire packet assessing recommended daytime functioning domains (i.e., fatigue, quality of life, depression, anxiety, stress, academic performance, substance use) during the academic year. A significant portion of this sample of college students met proposed DSM-5 criteria for chronic insomnia (9.5%). The chronic insomnia group reported significantly worse sleep, fatigue, depression, anxiety, stress, and quality of life, and greater hypnotic and stimulant use for sleep problems. There were no differences between groups on excessive daytime sleepiness, academic performance, or substance use. This was a rigorous and comprehensive assessment of the prevalence and psychosocial correlates of insomnia. Insomnia is a significant problem in college students and should be regularly assessed. More research is also needed to guide treatment in this population.

Circadian Phase Preference in College Students: Relationships With Psychological Functioning and Academics

The current study offers a comprehensive assessment of psychosocial functioning and academic performance in relation to circadian phase preference in a US sample of undergraduate college students (N = 838), aged 17–26 (M = 19.78, SD = 1.89). Women had greater morning preference than men, and seniors had greater morning preference than freshmen. Circadian phase preference, fatigue, perceived stress, depression, anxiety, and substance use were assessed cross-sectionally and grade point average (GPA) was assessed prospectively. Evening phase preference was related to higher levels of fatigue, alcohol and caffeine use, and worse academic performance than morning or intermediate phase preferences. (Author correspondence: djtaylor@unt.edu)

Deployment-Related Insomnia in Military Personnel and Veterans

Insomnia is a prevalent disorder that greatly impacts military personnel, especially those deployed in support of combat efforts. Deployment-related stressors like combat exposure, mild traumatic brain injury (mTBI) irregular sleep-wake schedules, and adjustment to the return home all contribute to insomnia. However, insomnia can also exacerbate the deployment experience and is a risk factor for traumatic stress reactions such as PTSD, depression, and suicide. Military personnel with mTBI are significantly impacted by insomnia; the majority experience sleep disruption and this can impede recovery and rehabilitation. As more service members return home from deployment, treatment is vital to reduce the impact of insomnia. Preliminary outcome data, showing positive results for reduction of sleep disruption, has been found with treatments such as combined cognitive behavioral treatment of insomnia (CBTI) and imagery rehearsal therapy (IRT), preference-based interventions, as well as efforts to broadly disseminate CBTI. The recent literature on the impact and treatment of deployment-related insomnia is reviewed.

Insomnia and mental health in college students.

Insomnia is strongly associated with certain mental health problems in the general population. However, there is little research examining this relation in young adults—an age group where many mental health problems first present. This study examined relations between insomnia and mental health symptoms in a college population (N = 373; 60.9% women; mean age of 21 years). Insomnia was assessed via self-report and sleep diaries, and mental health was assessed via the Symptom Check List–90. Analyses revealed insomnia was prevalent (9.4%), and these young adults had significantly more mental health problems than those without insomnia, although some significant results were lost after controlling for comorbid health problems.

The Role of Sleep in Predicting College Academic Performance: Is it a Unique Predictor?

Few studies have looked at the predictability of academic performance (i.e., cumulative grade point average [GPA]) using sleep when common nonsleep predictors of academic performance are included. This project studied psychological, demographic, educational, and sleep risk factors of decreased academic performance in college undergraduates. Participants (N = 867) completed a questionnaire packet and sleep diary. It was hypothesized that low total sleep time (TST), increased sleep onset latency, later bedtimes, later wake times, and TST inconsistency would predict decreased academic performance. The most significant predictors of academic performance were high school GPA, standardized test scores (i.e., SAT/ACT), TST, time awake before arising (TWAK), TST inconsistency, and the quadratic terms of perceived stress (PSS) and TST.

Cognitive-behavioral therapy of insomnia: A clinical case series study of patients with co-morbid disorders and using hypnotic medications

Cognitive-behavioral therapy for insomnia (CBTi) has demonstrated considerable efficacy within randomized clinical trials and case-series designs. This case-series study in a community sleep medicine clinic assessed the effectiveness of an eight-session CBTi protocol chronic insomnia patients who were allowed to continue their use of hypnotics (intent-to-treat n = 48), administered by a clinical psychology doctoral student receiving training and supervision in CBTi by a behavioral sleep medicine certified clinician. Outcome measures included daily sleep diaries, self-report measures on insomnia severity, dysfunctional beliefs and attitudes about sleep, daytime sleepiness, as well as medication usage. Patients showed significant improvements in sleep onset latency, wake time after sleep onset, sleep efficiency, insomnia severity, and dysfunctional sleep beliefs from pre- to post-treatment. No changes were seen in daytime sleepiness - patients were not excessively sleepy either before or after treatment. Use of sleep medication declined significantly from 87.5% pre-treatment to 54% post-treatment, despite no active efforts to encourage patients to withdraw. Results demonstrate that a CBTi conducted in a community sleep medicine clinic with patients not required to discontinue sleep-related medications can have similar effects as therapy delivered among those not on medication.

Chronic Insomnia and Healthcare Utilization in Young Adults

Chronic insomnia is prevalent, contributes a significant economic burden, and people with insomnia have increased health care utilization (HCU). The purpose of this study was to investigate the relationship between chronic insomnia and HCU in a population with fewer medical/mental health problems, using current operational definitions of chronic insomnia and multiple measures of HCU. Participants with chronic insomnia had greater HCU than normal sleepers. Participants with chronic insomnia plus a comorbid condition had greater HCU than normal sleepers with a medical/mental health problem and participants with only chronic insomnia. The relationship between chronic insomnia and HCU was moderated by comorbid medical/mental health problems. Early identification and intervention of chronic insomnia may help reduce HCU and costs associated with chronic insomnia.

Implementation of Sleep and Circadian Science: Recommendations from the Sleep Research Society and National Institutes of Health Workshop.

Sairam Parthasarathy, MD1; Mary A. Carskadon, PhD2,3; Girardin Jean-Louis, PhD4; Judith Owens, MD, MPH5; Adam Bramoweth, PhD6; Daniel Combs, MD1; Lauren Hale, PhD7; Elizabeth Harrison, PhD8; Chantelle N. Hart, PhD9; Brant P. Hasler, PhD10; Sarah M. Honaker, PhD, CBSM11; Elisabeth Hertenstein, PhD12; Samuel Kuna, MD13; Clete Kushida, MD, PhD14; Jessica C. Levenson, PhD10; Caitlin Murray, MA15; Allan I. Pack, MD, PhD13; Vivek Pillai, PhD16; Kristi Pruiksma, PhD17; Azizi Seixas, PhD4; Patrick Strollo, MD18; Saurabh S. Thosar, PhD19; Natasha Williams, MD4; Daniel Buysse, MD6

Psychometric Evaluation of the PSQI in U.S. College Students.

STUDY OBJECTIVES Examine the psychometric properties of the PSQI in two U.S. college samples. METHODS Study I assessed convergent and divergent validity in 866 undergraduates who completed a sleep diary, PSQI, and other sleep and psychosocial measures. Study II assessed PSQI insomnia diagnostic accuracy in a separate sample of 147 healthy undergraduates with and without insomnia. RESULTS The PSQI global score had only moderate convergent validity with sleep diary sleep efficiency (prospective global measure of sleep continuity; r = 0.53), the Insomnia Severity Index (r = 0.63), and fatigue (r = 0.44). The PSQI global score demonstrated good divergent validity with measures of excessive daytime sleepiness (r = 0.18), circadian preference (r = -0.08), alcohol (r = 0.08) and marijuana (r = 0.05) abuse scales, and poor divergent validity with depression (r = 0.48), anxiety (r = 0.40), and perceived stress (r = 0.33). Examination of other analogous PSQI and sleep diary components showed low to moderate convergent validity: sleep latency (r = 0.70), wake after sleep onset (r = 0.37), sleep duration (r = 0.51), and sleep efficiency (r = -0.32). Diagnostic accuracy of the PSQI to detect insomnia was very high (area under the curve = 0.999). Sensitivity and specificity were maximized at a cutoff of 6. CONCLUSIONS The PSQI demonstrated moderate convergent validity compared to measures of insomnia and fatigue and good divergent validity with measures of daytime sleepiness, circadian phase preference, and alcohol and marijuana use. The PSQI demonstrated considerable overlap with depression, anxiety, and perceived stress. Therefore, caution should be used with interpretation.