Sleep health in special populations

PROJECT SUMMARY The goal of this renewal application is to provide support for mentoring of trainees and junior investigators in the areas of sleep disorders and sleep health among patient populations who are “at risk.” The applicant’s current research program focuses on treatment of sleep disorders in populations who have not been studied or who have achieved less benefit from current evidence-based interventions. This program provides rich opportunities for mentees to experience direct engagement in patient-oriented sleep research. Currently funded work focuses on veterans with comorbid insomnia disorder and post-traumatic stress disorder (PTSD) for whom standard cognitive-behavioral therapy for insomnia (CBT-I) is less acceptable and less efficacious than among individuals without PTSD. Based on emerging evidence that the theoretical underpinning and specific exercises of Acceptance and Commitment Therapy (ACT) present a viable approach to improving sleep when combined with evidence-based behavioral strategies, a novel ACT-based insomnia treatment, called "Acceptance and the Behavioral Changes to Treat Insomnia (ABC-I) is being tested in a clinical trial. ABC-I combines core behavioral components (sleep restriction, stimulus control, sleep hygiene, relaxation) with ACT-based techniques will be evaluated in a randomized trial. Using a comparative effectiveness design (n=200 randomized to ABC-I or cognitive-behavioral therapy for insomnia (CBT-I)), the primary aims of the study are to evaluate the benefits of ABC-I in reducing insomnia severity (non-inferiority) and PTSD symptoms (superiority) as compared to CBT-I. Additional aims address potential mechanisms of change from before to after treatment and explore potential ancillary benefits in terms of reducing other symptoms. The proposed analytic plan will simultaneously address superiority of ABC-I over CBT-I for improving PTSD symptoms and non-inferiority of ABC-I compared to CBT-I for improving insomnia symptoms. In addition to other ongoing and recently-completed projects, the study provides rich opportunities for trainees to engage in all aspects of patient-oriented research on sleep disorders, including direct interaction with research participants and engagement with data analysis and dissemination of findings. The research environment at UCLA and VAGLAHS is rich with opportunities for learning and for collaborative mentoring in areas of sleep health and sleep disorders. Building upon activities during the prior K- 24 award, the applicant will engage in formal leadership training and engage the support of a Leadership Development Council.