Sleep Health – Moving from Qualitative to Quantitative
We believe that Sleep Health can be enhanced by adding quantitive data to current evidence-based (qualitative) data.
Enhanced Clinical Decision-Making through longitudinal data
Measurement and outcomes-based care and reimbursement
Development of Evidence-based protocols
Equitable and Patient Centered interventions
Cognitive Behavioral Therapy moving to Remote Patient Monitoring
Growing Data Sources
Sleep Studies and monitoring
Biometric devices and wearables and PDTx
EHR, Labs, Big Data Sources
Sleep Health – Data driven Tipping Point
References of Interest
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Smart Devices and Wearable Technologies to Detect and Monitor Mental Health Conditions and Stress: A Systematic Review
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Hickey, B.A.; Chalmers, T.; Newton, P.; Lin, C.-T.; Sibbritt, D.; McLachlan, C.S.; Clifton-Bligh, R.; Morley, J.; Lal, S. Smart Devices and Wearable Technologies to Detect and Monitor Mental Health Conditions and Stress: A Systematic Review. Sensors 2021, 21, 3461.
This review article also contemporaneously reviews which wearable devices have been formally validated for use in research for stress (10%), with only 5% of the wearable technologies listed in the review having been formally validated as capable of accurately detecting health parameters heart rate, heart rate variability, skin temperature, and conductance (van Kraaij et al., 2020). Algorithms developed based on these well- researched parameters have high accuracy for detecting stress more than 90% of the timein experimental conditions
Posttraumatic stress disorder increases the odds of REM sleep behavior disorder and other parasomnias in Veterans with and without comorbid traumatic brain injury
Elliot, J, Opel R. Posttraumatic stress disorder increases the odds of REM sleep behavior disorder and other parasomnias in Veterans with and without comorbid traumatic brain injury. SLEEPJ, 2020, 1–10. doi: 10.1093/sleep/zsz237
REM Sleep disorders occur in 15% of tgise with PTSD. Other parasominias approached 31% in Vets.
Nightmares and Suicide in Posttraumatic Stress Disorder: The Mediating Role of Defeat, Entrapment, and Hopelessness
Littlewood DL, Gooding PA, Panagioti M, Kyle SD. Nightmares and suicide in posttraumatic stress disorder: the mediating role of defeat, entrapment, and hopelessness. J Clin Sleep Med 2016;12(3):393–399.
Suicidal behaviors were higher in those participants who experienced nightmares (62%), in comparison to those who did not (20%). Suicide is a major public health concern accounting for approximately 800,000 deaths worldwide each year. Estimates indicate that up to 90% of individuals experience nightmares in the acute phase following trauma.
Posttraumatic Stress Disorder and Comorbidity: Recognizing the Many Faces of PTSD
Brady, K., Posttraumatic Stress Disorder and Comorbidity: Recognizing the Many Faces of PTSD. J Clin Psychiatry 1997;58[suppl 9]:12–15
80% of individuals with PTSD meet criteria for at least one other psychiatric diagnosis. and nearly 50% have three or more additional psychiatric diagnoses. PTSD is particularly likely to be comorbid with affective disorders, other anxiety disorders, somatization, substance abuse, and dissociative disorders.
First Responders, Trauma, Suicide
Center for Suicide Prevention, First Responders, trauma, and suicide.
First responders experience PTSD 2 times the rate of the average population. Up to 22% of all paramedics will develop PTSD
Posttraumatic Stress Disorder among paramedics: Exploring a new solution with occupational health nurses using the Ottawa Charter as a framework
Drewitz-Chesney, C. (2012).Posttraumatic Stress Disorder among paramedics: Exploring a new solution with occupational health nurses using the Ottawa Charter as a framework. WORKPLACE HEALTH & SAFETY, 60 (6), 257-263
An estimated 22% of all paramedics will develop PTSD
Post-Traumatic Stress Disorder in Canada
Van Amerigen, et al. (2008). Post-Traumatic Stress Disorder in Canada. CNS Neuroscience & Therapeutics, 14, 171-181.
There is a high co-occurrence of PTSD, Substance Use Disorder (SUD) and Major Depressive Disorder (MDD) among first responders which further heightens risk for suicidal behaviours
Nightmare Disorder DSM-5 307.47 (F51.5)
Nightmare Disorder DSM-5 307.47 (F51.5)
PTSD – nightmares are characteristic of PTSD, however, these unpleasant dreams usually involve the sufferer reliving trauma and will usually be accompanied by other symptoms like anxiety and difficulty sleeping
Prevalence of Post-Traumatic Stress Disorder in Emergency Physicians in the United States
DeLucia, Joseph DO, Bitter, Cindy, MD., Prevalence of Post-Traumatic Stress Disorder in Emergency Physicians in the United States. Western Journal of Emergency Medicine. Volume 20, no. 5: September 2019. DOI: 10.5811/westjem.2019.7.42671
In this study, the point prevalence of self-assessed PTSD in EPs was 15.8%. Prevalence of PTSD among resident physicians in the U.S. ranges from 5.2% in medicine and pediatrics, to 22% in surgical residents and 29% in EM residents.17-20 Intensivists, who deal with many of the same occupational stressors as EPs, have a reported PTSD prevalence of 13%.21 In one study, surgeons had a PTSD prevalence of 15% while trauma surgeons had a prevalence of 17%, not significantly different.
Study: Economic burden of PTSD 'staggering'
Veterans Affairs Research Communications. “Study: Economic burden of PTSD ‘staggering’: U.S. civilian, military populations combine for more than $230 billion in annual costs.” ScienceDaily. ScienceDaily, 25 April 2022.
The researchers estimated the cost of PTSD at $232.2 billion for 2018, the latest year for which data were available at the time of the study. The research team found that civilians accounted for 82% of the total PTSD costs, compared with 18% for the military population. That disparity is predicated on the fact that the number of civilians far exceeds that of active-duty military and veterans. the annual costs per civilian with PTSD ($18,640) were lower than that in the military population ($25,684).
Clinical Practice Guideline for the Treatment of PTSD
Guideline Development Panel for the Treatment of Posttraumatic Stress Disorder in Adults. Adopted as APA Policy February 24, 2017
The panel strongly recommends the use of the following psychotherapies/interventions (all interventions that follow listed in alphabetical order) for adult patients with PTSD: cognitive behavioral therapy (CBT), cognitive processing therapy (CPT), cognitive therapy (CT), and prolonged exposure therapy (PE). The panel suggests the use of brief eclectic psychotherapy (BEP), eye movement desensitization and reprocessing (EMDR), and narrative exposure therapy (NET). There is insufficient evidence to recommend for or against offering Seeking Safety (SS) or relaxation (RLX). For medications, the panel suggests offering the following (in alphabetical order): fluoxetine, paroxetine, sertraline, and venlafaxine. Some individuals and populations are especially at risk and co-morbidities such as substance use and abuse, depression, anxiety, dissociation and dissociative disorders, personality disorders, psychosis, cognitive impairment, violence towards self and others, increased risk of non-suicidal self-injury and of suicide, are common to the diagnosis. Psychosocial impacts can include homelessness, poverty, and incarceration.
Disturbed dreaming, posttraumatic stress disorder, and affect distress: a review and neurocognitive model
Levin R, Nielsen TA. Disturbed dreaming, posttraumatic stress disorder, and affect distress: a review and neurocognitive model. Psychol Bull 2007;133:482–528.
Estimates indicate that up to 90% of individuals experience nightmares following trauma
Management of nightmares in patients with posttraumatic stress disorder: current perspectives
El-Sohl, A., Management of nightmares in patients with posttraumatic stress disorder: current perspectives. Nature and Science of Sleep 2018:10 409–420. http://dx.doi.org/10.2147/NSS.S166089
Not surprisingly, recurrent nightmares are a central feature of posttraumatic stress disorder (PTSD) among both military combat veterans and trauma-exposed civilians.2 While the majority of individuals afflicted with PTSD experience sleep dysfunction, the prevalence of posttraumatic nightmares in patients with PTSD can be as high as 72%. *** PTSD substantially heightens the risk of suicidal behaviors,16 with one large population-based study indicating that individuals with PTSD were almost three times more likely to experience suicidal ideation than those without PTSD.1 *** Despite the interrelationships between nightmares, PTSD, and suicide, the mechanism by which nightmares confer suicidality has not been identified; however, the common denominator linking these entities together has been ascribed to the sense of entrapment, defeat, and hopelessness. *** Selecting the most appropriate treatment strategy for treating nightmares in context of PTSD should take into account the patient’s life experience. *** Recent statistics indicate that nightmares among veterans are largely underreported, as only 11% to 38% acknowledged discussing these events with their health care provider. *** Further, only one-third of adults who verbalized clinically significant nightmares believed that nightmares were a treatable condition *** There is currently no objective instrument to measure nightmare content or frequency *** These changes are associated with respiratory or leg movement events and increase in heart rate on awakening *** PSG may be warranted when obstructive sleep apnea is suspected as improvement in sleep quality and nightmares frequency has been reported after continuous positive airway pressure treatment *** The literature to date on the management of nightmares in PTSD is limited by a paucity of randomized controlled study designs and the use of different measures to assess health care outcomes *** Other studies should identify predictors of treatment efficacy and examine patient preferences in order to tailor treatment to a particular phenotype or a specific group *** Treatment of nightmares should be aligned with ongoing management of PTSD, sleep disruptions and suicide, experimentation with multifaceted behavioral and pharmaceutical therapy targeting insomnia and depression should be explored.
Disaster Technical Assistance Center Supplemental Research Bulletin First Responders: Behavioral Health Concerns, Emergency Response, and Trauma
Disaster Technical Assistance Center Supplemental Research Bulletin First Responders: Behavioral Health Concerns, Emergency Response, and Trauma. Substance Abuse and Mental Health Services Administration. May 2018
It is estimated that 30 percent of first responders develop behavioral health conditions including, but not limited to, depression and posttraumatic stress disorder (PTSD), as compared with 20 percent in the general population (Abbot et al., 2015). In a study about suicidality, firefighters were reported to have higher attempt and ideation rates than the general population (Stanley et al., 2016). In law enforcement, the estimates suggest between 125 and 300 police officers commit suicide every year (Badge of Life, 2016).
Best Practice Guide for the Treatment of Nightmare Disorder in Adults
Aurora, R., Zak, R., et al. Best Practice Guide for the Treatment of Nightmare Disorder in Adults. Journal of Clinical Sleep Medicine, Vol.6, No. 4, 2010
The Standards of Practice Committee (SPC) of the American Academy of Sleep Medicine (AASM) commissioned a task force to assess the literature on the treatment of nightmare disorder. The Board of Directors authorized the task force to draft a Best Practice Guide based on review and grading of the literature and clinical consensus.There has been a burgeoning literature about pharmacotherapy and behavioral treatment of nightmare disorder in adults, but no systematic review has been available.