Current Research

Hypnotics and Sleep Apnea


We are completing a series of chart reviews on our insomnia disorders patients with a special emphasis on those who use a prescription medication to help them sleep.  In our first paper, currently in submission, we are looking at the differences in sleep between insomnia patients with and without psychiatric comorbidities.  And, we are comparing both their subjective and objective sleep data, that is the self-reported information they provide on questionnaires and the physiological data from overnight sleep studies.

In a second chart review, we are looking at a similar type of patient to learn how they interacted with the prescribing physician who placed them on the sleep medication. We want to learn about the initial instructions and education they received from the prescribing physician, and we want to clarify the self-reported efficacy of the medication on their insomnia problem. Last, we will be reviewing their responses to questions about their motivation to sleep without drugs.  In this study, we will also look at both self-report and objective data.


Nocturia and Sleep Apnea

We are looking at a large sample of patients who presented to our sleep centers with complaints of snoring and with nocturia (using the bathroom at some point during the normal sleep period).  Because nocturia has such a strong pathophysiological link to sleep apnea, we are researching whether this symptom is as common as snoring in patients with breathing disorders.

The research will attempt to clarify whether snoring and nocturia are equivalent predictors of a sleep breathing disorder or whether one of these symptoms has advantages over the other when a clinical evaluation can only rely on self-report.  Such information helps us know who needs a sleep study and who does not.

Suicide and Fatigue

In prior studies we've participated in, we found that sleep disorders such as insomnia or nightmares may create some risk for suicidal ideation or behavior (suicidality).  Other researchers have found similar findings.  To our knowledge, though, there has been limited investigation of the influence of fatigue or sleepiness on sucidality, that is, from a sleep medicine perspective.

At our sleep medical facilitites, we see thousands of patients who complain of daytime fatigue and sleepiness.  Some of these patients also suffer from suicidal ideation or behaviors, and we are interested in learning whether or not fatigue and sleepiness might be associated with their mental health to the point of influencing these suicidal thoughts or actions.

Insomnia Awakenings

A most remarkable aspect of insomnia is that the individual rarely can sort out the cause of their middle of the night awakenings.  Indeed, the most common response to the question, "why did you wake up?" is usually answered with, "I don't know."

It seems some insomniacs have a propensity though to "backtrack" in their mind as if to see, "what do I imagine woke me up."  A lot of these individuals state that stress, worries, or other thoughts must have provoked the awakening.  However, upon further discussion, these insomnia patients usually realize that they are simply reporting what they may notice in their minds soon after an awakening, which of course may or may be the cause of the awakening.

In this project, we will be interviewing insomniacs prior to a sleep test to determine their perceptions about the causes of the awakenings.  We use an extensive semi-qualitative interview technique to insure we gain the most possible data from the patients.  Then, we will complete overnight sleep studies on these patients, and examine any factors that might be related to their awakenings.

Sleep Apnea and Insomnia

We have a long-standing interest in the interactions between insomnia and sleep-disordered breathing (SDB).  When first conducting imagery rehearsal treatment on chronic nightmare sufferers in 1993, we began noticing that a large number of these nightmare patients reported insomnia as well as sleep breathing symptoms.  When their nightmare improved after IRT, their reports of poor sleep quality persisted, leading us to speculate that many of them suffered from obstructive sleep apnea (OSA) or upper airway resistance syndrome (UARS).

In 1998, we published our first data on this topic as an abstract and presented the work at the Associated Professional Sleep Societies annual meeting. Since then have published more than 20 peer-reviewed articles, 20 peer-reviewed abstracts, and 2 trade books that delve at various levels into the relatonships between insomina and SDB.

Grant Awarded

Monday, 09 February 2009 00:00

Respironics Funds Controversial Study to Test Link Between Insomnia and Sleep Apnea

The Sleep and Human Health Institute (SHHI) was awarded a grant to study one of the most controversial aspects of Chronic Insomnia. Conventional wisdom connects insomnia to psychological factors – stress, racing thoughts, and worries – and is usually treated with sleeping pills or talk therapy.  Pitted against the CW is the provocative theory that a large percentage of Chronic Insomniacs suffer from Obstructive Sleep Apnea (OSA), a physical breathing problem that might cause unwanted or unexpected sleeplessness.