SLEEP 2011 Abstract Supplement

B. Clinical Sleep Science III. Sleep Disorders – Insomnia
0525
A PILOT PROGRAM TO EXAMINE ALTERNATIVE
APPROACHES TO CBT-I
Cuellar NG 1 , Bundrum J 2 , Champion K 2 , McCleod B 1 , Chandra D 2 ,
Krishnamurthy N 2
1
Capstone College of Nursing, University of Alabama, Tuscaloosa, AL,
USA, 2 Tuscaloosa Lung & Sleep Consultants, , Tuscaloosa, AL, USA
Introduction: There is overwhelming evidence of the benefits of cognitive
behavior therapy for insomnia (CBT-I); however, there continues
to be only a scarcity of providers of CBT-I. We developed a CBT-I program
to be delivered in a group session by trained physicians and nurses
in sleep and CBT. The purpose of this pilot program was to determine
feasibility of a group approach, outcomes of CBT-I using physicians and
nurses as providers, and payment mechanisms of CBT-I through insurance.
Methods: Patients were screened at the Tuscaloosa Lung & Sleep Clinic
using inclusion/exclusion criteria. The program consisted of 4 sessions
beginning with basic information related to sleep, then introducing basic
concepts and components of CBT-I. Subjective data was collected at
each session (4 times) using the Epworth Sleepiness Scale, Generalized
Anxiety Disorder (GAD)-7, Quick Depression Assessment Score, Insomnia
Severity Index, Fatigue Inventory, and Sleep Quality Inventory.
If needed, participants were referred to a mental health care provider
(social workers, psychiatric nurse practitioners, psychologists or psychiatrists).
Participants completed sleep diaries between sessions.
Results: There were 6 participants (one male) in the study with 3 Caucasians
and 3 Blacks (mean age = 55.5 years). Simple t-test compared
total mean scores of each of the variables at each of the 4 times. Significant
differences were reported in insomnia severity (p=0.04), sleep quality
(p=0.03), time in bed (p=0.01), and average number of awakenings
(p=0.01). One participant asked to see a mental health care provider.
Conclusion: Board-certified sleep physicians, nurses trained in CBT
and nurse practitioners can effectively provide CBT-I. Limitations include
a small, purposive sample and no objective measures of sleep
(actigraphy). The group therapy approach was effective in improving insomnia.
Participants’ evaluations were positive and identified the group
format as very helpful. No reimbursement for the program was received
through any of the insurance providers.
Support (If Any): Tuscaloosa Lung & Sleep Consultants, PC Resperonics
0526
INFLUENCE OF SLOW OSCILLATING TRANSCRANIAL
DIRECT CURRENT STIMULATION (SO-TDCS) ON
ELECTROENCEPHALOGRAMM AND SLEEP PARAMETERS
von Mengden I, Garcia C, Glos M, Schoebel C, Fietze I, Penzel T
Sleep Medicine Center Depart. of Cardiology, Charité University
Hospital, Berlin, Germany
Introduction: Transcranial stimulation has an impact on EEG oscillations
characteristics (e. g. power), memory performance as well as on
sleep architecture. It was shown that so- tDCS increased slow oscillation
(0.4-1.2Hz) power as well as theta (4-8Hz) and beta (15-25Hz) power.
Enhancing the excitability of the prefrontal cortex (PFC), by means of
anodal tDCS, is proposed to result in improved working memory function.
Primary endpoint is an increase in slow oscillation power, at F7,
F8 and Fz, as well as on theta and beta power across electrode sites.
Secondary it is hypothesized that stimulation enhances cortical excitability
in PFC, resulting in increased cognitive performance (indicated
in improved Digit Span, DSST and PVT test results).
Methods: In a randomized, sham-controlled, double-blind cross-overtrial
30 healthy individuals are stimulated during daytime with anodal
so- tDCS of 0.75Hz and 250µA at EEG position F3/ F4. Subjects are
divided into 3 groups and receive different numbers of stimulation sessions
per day from one up to five sessions according to their group. One
stimulating session includes 30min of stimulation, EEG recording during
rest (eyes closed vs. eyes open) as well as several cognitive tests
(PVT, Digit Span, DSST) and a subjective sleepiness questionnaire
(KSS). Subjects assigned to group 3 will additionally receive polysomnography
the night before and after daytime stimulation.
Results: Data analysis suggests that so- tDCS increases slow oscillation
power at central sites (Cz) but not at frontal EEG position (F7). Moreover
EEG theta power increased by means of stimulation on Cz and
F7. Concerning cognitive performance tests visual short term memory
and reaction time was enhanced, indicated by improved results in DSST
and PVT tests. Furthermore subjective sleepiness decreased, assessed
by means of KSS.
Conclusion: These results indicate that it is possible to awaken subjects
through anodal so- tDCS. For definite conclusions final data collection
and analysis needs to be completed. It is conceivable that short term
memory improvement is mediated through theta oscillations power increase.
Support (If Any): European HIVE project: FP7 - FET OPEN - 222079
0527
HELPFUL COMPONENTS OF GROUP COGNITIVE
BEHAVIORAL THERAPY FOR INSOMNIA (CBTI) FOR
PATIENTS WHO PERCEIVED PAIN TO INTERFERE WITH
SLEEP
Suh S 1 , Dowdle CL 2 , Willett ES 2 , Nowakowski S 1 , Siebern AT 1 , Ong J 3 ,
Bernert RA 1 , Manber R 1
1
Department of Psychiatry, School of Medicine, Stanford University,
Redwood City, CA, USA, 2 Stanford Psy.D. Consortium, Pacific
Graduate School of Psychology, Palo Alto, CA, USA, 3 Department of
Behavioral Sciences, Rush University Medical Center, Chicago, IL,
USA
Introduction: Past literature has indicated that CBTI is effective for patients
with chronic pain, improving insomnia and reducing pain levels.
This study aimed to identify the components of CBTI that patients with
chronic pain found to be particularly helpful.
Methods: Participants were 183 patients (55% male, mean age 43.4)
who completed group CBTI. Participants rated their perception of pain
interfering with sleep on a 6-point scale from “I don’t have pain” to “all
of the time” at baseline. Groups were dichotomized with 73 participants
classified as pain interfering with sleep (Pain group) and 110 without
pain interfering with sleep (NonPain group). All patients rated 24 therapeutic
elements on how helpful each was (using a scale of 0 - 3). The
patients also completed a questionnaire asking about how difficult it was
to follow treatment components.
Results: The therapeutic elements were organized by four conceptual
categories: behavioral (eg, anchoring wake-up time), cognitive components
(eg, changing the way I think about not sleeping), sleep hygiene
(eg, reducing caffeine) and non-specific therapeutic elements (eg,
trusting treatment provider). Category scores were the average of its
individual items. The patients in the Pain group identified the behavioral
components as the most helpful (X=2.62), followed by cognitive
components (X=2.18), non-specific therapeutic elements (X=2.17), and
sleep hygiene (X=1.67). Compared to the NonPain group, patients in the
Pain group had significantly more difficulty decreasing time in bed [F(1,
80)=9.599, p=0.003] and changing thoughts about not sleeping [F(1,
73)=5.22, p=0.03].
Conclusion: These results suggest that patients who perceive pain to
interfere with their sleep found behavioral components most helpful
but also had the most difficulty restricting time in bed, a key behavioral
component. They also found it more difficult to change their beliefs
about sleep. Future studies should focus on identifying specific cognitions
that hinder adherence with time in bed restriction.
SLEEP, Volume 34, Abstract Supplement, 2011
A180