Board of Behavioral Sleep Medicine Update - July 2019

On behalf of the BBSM, I invite you to join your CBSM holder colleagues and take advantage of this dedicated pathway to becoming a Diplomate in Behavioral Sleep Medicine. With this application, CBSM holders will be exempted from taking the current BSM examination provided they otherwise meet DBSM eligibility criteria.

For more information visit the Board of Behavioral Sleep Medicine.

As you know, after the CBSM was discontinued by the American Board of Sleep Medicine the BBSM was formed as an independent credentialing board dedicated to BSM credentialing The BBSM is currently in the process of pursuing accreditation of its certification program to enhance recognition of the DBSM by health care organizations.

Different from your CBSM, the DBSM has been developed according to current regulatory standards for accreditation of credentialing programs by the National Commission for Credentialing Agencies. This requires verified continuing education to attain and maintain credentials. The BBSM believes this level of credential standard is essential in that it is increasingly expected by health care organizations and insurers.

If you have not completed enough CE hours over the past five year to apply now, you have time. The Society of Behavioral Sleep Medicine (SBSM) hosts a number of online, webinar and in-person training opportunities throughout the year. This includes the SBSM Scientific Conference to be held September 12-15, 2019 in Birmingham, AL. For more information about the conference view the schedule at https://behavioralsleep.org

CBSM holder application and information can be found at www.bsmcredential.org. Please feel free to reach out to Kathryn Hansen, our BBSM executive director at info@bsmcredential.org if you would like further assistance or to answer any additional questions you may have.

With warm regards,

Michael Schmitz, PsyD, DBSM
President, Board of Behavioral Sleep Medicine

2019 Award Winners

2019 PETER HAURI CAREER DISTINGUISHED ACHIEVEMENT AWARD           

The Peter Hauri Career Distinguished Achievement Award is awarded to a member of SBSM who has made significant, sustained scientific contributions to behavioral sleep medicine or who has made significant, sustained clinical contributions to behavioral sleep medicine as exemplified by innovations in service delivery, dissemination, and public policy. This year Dr Daniel Buysse was honored as the recipient of the 2019 Peter Hauri Career Distinguished Achievement Award.

Daniel Buysse, MD is Professor of Psychiatry in the Department of Psychiatry at Western Psychiatric Institute and Clinic and Co-director of the UPMC Sleep Medicine Center.

In 2000, he served as AASM President, and during his tenure, he was responsible for establishing Behavioral Sleep Medicine, and integral in developing a BSM certification exam.  He identified the standards for accreditation of BSM training programs, and worked to create the Behavioral Sleep Medicine journal.

Dr Buysse has published extensive scholarly contributions:  books, chapters, articles, and in 2014 he was awarded the UPMC Endowed chair in Sleep Medicine.  He is first author of the publication defining the Pittsburgh Sleep Quality Index.  He has been a leader in developing diagnostic criteria for insomnia, novel treatment approaches (BBTI), sleep and depression, sleep and aging.

Dr Buysse promoted sleep health as a distinct discipline.

Congratulations to Dr Daniel Buysse for the award and for his contributions to the Society of Behavioral Sleep Medicine and the Behavioral Sleep Medicine as a discipline.

 

2019 ARTHUR J. SPIELMAN EARLY CAREER DISTINGUISHED ACHIEVEMENT AWARD      

The Arthur J. Spielman Early Career Distinguished Achievement Award is awarded to a member who has made significant scientific or clinical contributions to behavioral sleep medicine as exemplified by innovations in service delivery, dissemination, and public policy.

This year Dr Sara Nowakowski was honored as the recipient of the 2019 Arthur J. Spielman Early Career Distinghished Achievement Award.

Dr Nowakowski is a Research Health Scientist with the Center for Innovation in Quality, Effectiveness, and Safety at the Michael E. DeBakey VA Medical Center in Houston, Texas.  She has been licensed in BSM since 2015 and received her Diplomate in Behavioral Sleep Medicine in 2019.

She has served for three years with the SBSM Board of Directors as a Director at Large and Chair and Board Liaison to the Membership Committee.

Dr Nowakowski serves on the SRS Scientific Review and Pipeline Development Committee, the Editorial Boards with the Journal of Behavioral Sleep Medicine and Sleep Health.  She has published 26 peer-reviewed articles, 9 book chapters, 50+ abstracts. And for her work with the editorial boards, in 2018 she received the Editor’s Choice in SLEEP award. 

Her grant awards include:  K23 Career Development Award; Examine feasibility of CBTi for insomnia and hotflashs in midlife women.

She serves as a mentor to:  3 undergraduate, 2 master’s, 5 doctoral, and 3 medical students

In 2017 she directed her passion through advocating for the Houston Area Chapter for Start School Later times.

Congratulations to Dr Nowakowski for the award and her contributions to Behavioral Sleep Medicine and support of the Society of Behavioral Sleep Medicine.

Sleep 2019 Course Review - Leisha Cuddihy, PHD, DBSM

One of our primary objectives in a behavioral sleep medicine practice is to accurately diagnose a patient so that we can provide the most appropriate treatment. Often times, diagnosis is more complicated than our manuals would lead us to believe. One distinction that can be particularly cumbersome is the differentiation between insomnia disorder and delayed sleep phase disorder. Many times patients present with very similar symptoms, and clinics do not often have the resources to obtain biological measures of circadian rhythms (e.g., dim light melatonin onset) to aid in diagnosis.

This issue was the topic of a workshop at this year’s sleep conference entitled “Is it Insomnia or Delayed Circadian Rhythm or Both? How to Diagnose and Treat.”  Drs. Shea Golding and Hovig Artinian reviewed in detail the challenges of this differential diagnosis in both children and adults, and discussed implications for treatment. There is significant overlap between these two syndromes and this can make accurate diagnosis challenging. There are established treatments for both disorders, but less evidence for how and when to treat circadian rhythm disorders. CBT-I and chronotherapy were reviewed, in addition to the use of bright light and melatonin in treating delayed sleep phase. Often these approaches are combined to craft a treatment that is going to be both effective and acceptable to the patient. Chronotherapy is challenging and requires strict adherence from patients, but can be highly effective if used correctly. CBT-I can be used in combination with shifting a patient’s schedule to avoid the development of conditioned arousal in bed. Morning bright light and evening melatonin can also facilitate a shift in schedule, but there is not much evidence regarding dose and timing of these strategies. To summarize, it can be challenging sometimes to differentiate between a delayed circadian rhythm and insomnia disorder; however, effective treatments can be provided even if the diagnosis is not completely clear.

Drs. Golding and Artinian highlighted some of the main differences to look for when differentiating between insomnia disorder and delayed circadian rhythm, including (but not limited to) duration and quality of sleep at a later schedule, weekday vs. weekend (or school break) discrepancies, quality of time awake (frustrated and trying to sleep, or awake and bored). They also highlighted several treatment options including CBT-I, chronotherapy, bright light, and melatonin. This workshop was a great reminder that not all cases are clear-cut, but that doesn’t necessarily mean that treatment will not be effective. We have a plethora of treatment options to choose from, and they can be used in combination to produce the best outcomes for our patients.

Leisha Cuddihy, PHD, DBSM

Journal Article Review - Michael Nadorff, PHD

Journal Article Review - Michael Nadorff, PHD

Identifying the Demographic and Mental Health Factors That Influence Insomnia Treatment Recommendations Within a Veteran Population

Adam D. Bramoweth ORCID Icon, Jenna G. Renqvist, Barbara H. Hanusa, Jon D. Walker, Anne Germain & Charles W. Atwood Jr.

Pages 181-190 | Published online: 02 May 2017

Those of you who frequently read The Sleep Talker likely already know I am a huge fan of implementation science.  One can have the best treatment in the world,but if you cannot implement it in the real world, or it is not used, it is not worth much.  Sadly, our interventions commonly have this issue: they are very good,as many of us have shown time and time in our research, but they are not commonly utilized .  We have gotten the recognition the treatments deserve in the AASM treatment guidelines, but those recommendations are often not followed.

So what gives?  Why is it that despite the strength of evidence for CBT-I, and the recommendations supporting its use, I still see so many clients prescribed trazodone for sleep?  Perhaps the first step is looking at prescriptions/referrals to see when hypnotics are being prescribed vs. CBT-I referrals are being made.

Bramoweth and colleagues (2019) examined this question in more than 5,000 Veterans who were referred for either CBT-I or a hypnotic medication.  The authors found that, unsurprisingly and dishearteningly, that hypnotic prescriptions far outnumbered CBT-I referrals.   Factors that increased CBT-I referrals were military service-related disability, insomnia diagnosis, and having one or more psychiatric diagnoses.  On the other side, having a diagnosis of PTSD decreased the likelihood of a CBT-I referral.   

These findings are very interesting, as it is not that prescribers are not making referrals, but they appear to be to vary referrals based upon other factors. 

Why is it that prescribers are less likely to send patients with PTSD our way?  Certainly there is research that demonstrates CBT-I is still effective with PTSD (e.g. Taylor & Pruiksma, 2014).  Perhaps we need to reach out to our prescriber colleagues and make sure they are aware of this research, or ask them what barriers exist for CBT-I referrals? 

Regardless, Bramoweth and colleagues (2019) show that there is a great need for implementation work in behavioral sleep medicine, and they lay important groundwork for this research.  If you are interested in this topic as well, there is a career to be had in improving the utilization of behavioral sleep medicine interventions.  It is very valuable work!

American College of Physicians (ACP) recommends cognitive-behavioral therapy for insomnia (CBT-I)

American College of Physicians (ACP) recommends cognitive-behavioral therapy for insomnia (CBT-I)

The American College of Physicians (ACP) recommends cognitive-behavioral therapy for insomnia (CBT-I) as first-line therapy for chronic insomnia. Click below to view the recent article from Psychiatric News.

Treat Chronic Insomnia With CBT-I, Says American College of Physicians
Psychiatric News, July 1, 2016, Vol. 51, No. 13
Author: Lynne Lamberg

http://psychnews.psychiatryonline.org/doi/full/10.1176/appi.pn.2016.6b19

New issue of Behavioral Sleep Medicine Journal Available (Vol. 13, Issue 6)

New issue of Behavioral Sleep Medicine Journal Available

The new issue of Behavioral Sleep Medicine (Vol. 13, Issue 6) is now available on the website of publisher Taylor & Francis. The issue includes an SBSM announcement.

Topics of original articles in this issue include Sleep as a Support for Social Competence, Peer Relations, and Cognitive Functioning in Preschool Children; Sleep Outcomes in Youth With Chronic Pain Participating in a Randomized Controlled Trial of Online Cognitive-Behavioral Therapy for Pain Management; Dissemination of an Internet-Based Treatment for Chronic insomnia into primary care; Psychiatric Comorbidity and Aspects of Cognitive Coping Negatively Predict Outcome in Cognitive Behavioral Treatment of Psychophysiological Insomnia; Validation of an Automated Wireless System for Sleep Monitoring During Daytime Naps; and The Course and Character of Sleepwalking in Adulthood: A Clinical and Polysomnographic Study.

SBSM regular and associate members receive a complimentary subscription to the journal as a benefit of membership, and student members can purchase a subscription for an additional fee. If you have lost your password to access the journal on the Web, send an email to support@tandfonline.com.