Anne Germain

• Ph.D.
• University of Pittsburgh

Introduction Insomnia is the most prevalent sleep disorder among active duty service members (ADSMs) and compromises readiness. Cognitive-behavioral therapy for insomnia (CBTI) is the DoD/VA recommended treatment, but access and delivery of CBTI is impeded by gaps between high patient demand for care and clinical capabilities. We evaluated the effe...

Introduction Insomnia affects approximately 40% of active duty service members and adversely affects health, readiness, and safety. The VA/DoD Clinical Practice Guideline for the management of insomnia recommends cognitive-behavioral treatment of insomnia (CBTI) or its abbreviated version (brief behavioral treatment of insomnia [BBTI]) as the first...

Background Chronic insomnia is the most prevalent sleep disorder among military service members, and it compromises readiness, performance, and physical and mental health. Cognitive behavioral treatment for insomnia (CBTI) is the standard of care for the treatment of insomnia recommended by the VA/DoD Clinical Practice Guideline, the American Acade...

• Background Chronic insomnia is the most prevalent sleep disorder among military service members, and it compromises readiness, performance, and physical and mental health. Cognitive Behavioral Treatment for Insomnia (CBTI) is the standard of care for the treatment of insomnia recommended by the VA/DoD Clinical Practice Guideline, the American Aca...

Optimal sleep health is a critical component to high-level performance. In populations such as the military, public service (eg, firefighters), and health care, achieving optimal sleep health is difficult and subsequently deficiencies in sleep health may lead to performance decrements. However, advances in sleep monitoring technologies and mitigati...

Introduction: Multi-domain operational combat environments will likely restrict key components of current behavioral health (BH) service delivery models. Combat teams in far-forward outposts or extended missions may need to rely on their own internal assets to manage combat and operational stress reactions for extended periods of time. As such, co...

Laboratory-based studies designed to mimic combat or military field training have consistently demonstrated deleterious effects on warfighter’s physical, cognitive, and emotional performance during simulated military operational stress (SMOS). Purpose The present investigation sought to determine the impact of a 48-h simulated military operational...

Background: Military personnel must maintain physical performance despite exposure to operational stressors such as sleep loss, caloric restriction and high cognitive load. Habitual sleep and specific sleep features are positively associated with fitness and may contribute to physical performance in operational settings. Further, by affecting musc...

Perception-action coupling, the ability to ‘read and react’ to the environment, is essential for military personnel to operate within complex and unpredictable environments. Exposure to military operational stressors (e.g., caloric restriction, sleep loss, physical exertion), including around-the-clock operations, may compromise perception-action c...

Objectives: To examine whether gender moderates the effects of childhood trauma on subjective and objective sleep measures. Design: Secondary data analysis, exploratory SETTINGS: Sleep research lab PARTICIPANTS: A total of 213 men and 278 women aged 18-30 completed subjective measures. A subsample of 172 participants without any psychiatric, med...

Background Military service inherently includes frequent periods of high-stress training, operational tempo, and sustained deployments to austere far-forward environments. These occupational requirements can contribute to acute and chronic sleep disruption, fatigue, and behavioral health challenges related to acute and chronic stress and disruption...

Introduction Despite exposure to operational stressors (e.g., sleep loss, caloric restriction), military personnel must maintain different aspects of neurobehavioral function (i.e., subjective alertness, behavioral alertness, perception-action coupling) to operate safely within military environments. It is unclear whether perception-action coupling...

Introduction Sleep and fatigue management strategies can substantially impact the Armed Forces’ readiness and fitness. These strategies can be implemented with behavioral health personnel and Wi-Fi connectivity to support real-time assessment, monitoring, and intervention. However, these resources are not readily available in multi-domain operation...

Childhood adversity is associated with altered or dysregulated stress reactivity; these altered patterns of physiological functioning persist into adulthood. Evidence from both preclinical animal models and human neuroimaging studies indicates that early life experience differentially influences stressor-evoked activity within central visceral neur...

Study Objectives Within-subject stability of certain sleep features across multiple nights is thought to reflect the trait-like behavior of sleep. However, to be considered a trait, a parameter must be both stable and robust. Here, we examined the stability (i.e., across the same sleep opportunity periods) and robustness (i.e., across sleep opportu...

Objective: Sleep changes over the human lifespan, and it does so across multiple dimensions. We used individual-level cross-sectional data to characterize age trends and sex differences in actigraphy and self-report sleep dimensions across the healthy human lifespan. Methods: The Pittsburgh Lifespan Sleep Databank (PLSD) consists of harmonized p...

Co-author Review: All authors have seen and approved the final version of the manuscript. Previous Presentations: None. Lt Col Matthew S. Brock, LTC Jennifer L. Creamer, Emmanuel P. Espejo, Rachel R. Markwald, CAPT Gregory N. Matwiyoff, John T. Peachey, Brian M. O’Reilly, Nita L. Shattuck are military service member or employee of the U.S. Governme...

Simulated military operational stress (SMOS) provides a useful model to better understand resilience in humans as the stress associated with caloric restriction, sleep deficits, and fatiguing exertion degrades physical and cognitive performance. Habitual physical activity may confer resilience against these stressors by promoting favorable use-depe...

To understand how a population natively conceptualizes insomnia along with related mental health and related disabilities, understanding how an insomnia severity spectrum operates in any given population will be a goal for sleep epidemiology. To facilitate this international goal, the comparatively theory-tolerant 65-item Pittsburgh Insomnia Rating...

Posttraumatic stress disorder-related sleep disturbances may increase daytime sleepiness and compromise performance in individuals with posttraumatic stress disorder. We investigated nighttime sleep predictors of sleepiness in Veterans with and without posttraumatic stress disorder. Thirty-seven post-9/11 Veterans with posttraumatic stress disorder...

Introduction Sleep continuously changes over the human lifespan and it does so across multiple dimensions, including duration, timing, efficiency, and variability. Although studies focused on specific developmental periods have shown age-related changes in sleep, methodological differences make it difficult to synthesize information across studies...

Introduction Alertness, essential for optimal performance, may be modulated by acute stressors including: sleep loss, caloric restriction, cognitive load, and physical exertion. Prior sleep may attenuate sleep loss-related alertness decrements, thereby influencing performance and safety. We examined the effects of prior sleep and changes in alertne...

Conkright, WR, Beckner, ME, Sinnott, AM, Eagle, SR, Martin, BJ, Lagoy, AD, Proessl, F, Lovalekar, M, Doyle, TLA, Agostinelli, P, Sekel, NM, Flanagan, SD, Germain, A, Connaboy, C, and Nindl, BC. Neuromuscular performance and hormonal responses to military operational stress in men and women. J Strength Cond Res XX(X): 000-000, 2021-Women have recent...

While stress may be a potential mechanism by which childhood threat and deprivation influence mental health, few studies have considered specific stress‐related white matter pathways, such as the stria terminalis (ST) and medial forebrain bundle (MFB). Our goal was to examine the relationships between childhood adversity and ST and MFB structural i...

Transcranial magnetic stimulation (TMS) is increasingly used to examine lower extremity corticospinal excitability (CSE) in clinical and sports research. Because CSE is task-specific, there is growing emphasis on the use of ecological tasks. Nevertheless, the comparative test-retest reliability of CSE measurements during established (e.g. knee exte...

PURPOSE To study the impact of 48 h of simulated military operational stress (SMOS) on executive function, in addition to the role of trait resilience (RES) and aerobic fitness (FIT) on executive function performance. Associations between executive function and neuropeptide-Y (NPY), brain-derived neurotropic factor (BDNF), insulin-like growth facto...

Background Preliminary evidence indicates that non-rapid eye movement (NREM) sleep is implicated in enhancing working memory (WM) performance across days in healthy individuals. While REM sleep has been implicated in other forms of memory, its role in WM remains unclear. Further, the relationship between sleep changes and WM improvement is largely...

Background Insomnia affects almost one in four military service members and veterans. The first-line recommended treatment for insomnia is cognitive-behavioral therapy for insomnia (CBTI). CBTI is typically delivered in-person or online over one-to-four sessions (brief versions) or five-to-eight sessions (standard versions) by a licensed doctoral o...

Background: Previously, we identified sleep-electroencephalography (EEG) spectral power and synchrony features that differed significantly at a population-average level between subjects with and without posttraumatic stress disorder (PTSD). Here, we aimed to examine the extent to which a combination of such features could objectively identify indiv...

Background: /Aims: Sleep disturbances and fatigue are common symptoms amongst patients with Crohn's disease (CD). The aim of this study was to test the feasibility and effects of a pragmatic, stepped-care intervention for the treatment of poor sleep quality and fatigue in adolescents and young adults with CD. Methods: This study is a two-phase o...

Background We assessed the impact of total and partial sleep loss on neural correlates of fear conditioning, extinction learning, and extinction recall in healthy young adults. Methods Participants (56.3% female, age 24.8 ± 3.4 years) were randomized to a night of normal sleep (NS) (n = 48), sleep restriction (SR) (n = 53), or sleep deprivation (S...

Sleep disturbances are common complaints in patients with post-traumatic stress disorder (PTSD). To date, however, objective markers of PTSD during sleep remain elusive. Sleep spindles are distinctive bursts of brain oscillatory activity during non-rapid eye movement (NREM) sleep and have been implicated in sleep protection and sleep-dependent memo...

Study objectives: High frequency electroencephalographic (EEG) activity (>16 Hz activity) is often elevated during non-rapid eye movement (NREM) sleep among individuals with insomnia, in line with the hyperarousal theory of insomnia. Evidence regarding sleep depth marked by slow-wave activity (<4 Hz) is more mixed. Distinguishing subcomponents of...

Study Objectives Sleep disturbances are core symptoms of post-traumatic stress disorder (PTSD), but reliable sleep markers of PTSD have yet to be identified. Sleep spindles are important brain waves associated with sleep protection and sleep-dependent memory consolidation. The present study tested whether sleep spindles are altered in individuals w...

The goal of this study was to compare a brief behavioral treatment for insomnia (BBTI), which has fewer sessions (4), shorter duration (< 30–45 minutes), and delivers treatment in-person plus phone calls to cognitive behavioral therapy for insomnia (CBTI), which has 5 in-person sessions. The hypothesis was BBTI would be non-inferior to CBTI. The Re...

Childhood trauma may sensitize the brain, increasing vulnerability to maladaptive stress responses following adulthood trauma exposure. Previous work has identified the cingulum as a white matter pathway that may be sensitized to adulthood trauma by childhood maltreatment. In this pilot study of young adult male military veterans (N = 28), we exami...

Study Objectives We assessed whether the synchrony between brain regions, analyzed using electroencephalography (EEG) signals recorded during sleep, is altered in subjects with post-traumatic stress disorder (PTSD) and whether the results are reproducible across consecutive nights and subpopulations of the study. Methods Seventy-eight combat-expos...

Objective: To synthesize the current evidence on sleep disturbances in military service members (SMs) and veterans with traumatic brain injury (TBI). Methods: An electronic literature search first identified abstracts published from 2008-2018 inclusively referencing sleep, TBI, and military personnel from Operation Enduring Freedom, Operation Ir...

PURPOSE: Physical exertion, cognitive overload, sleep deprivation and caloric restriction are factors of operational stress in the military. This study aimed to investigate how Simulated Military Operational Stress (SMOS) effects performance on Tactical Mobility Test (TMT) both in men and women. METHODS: As part of an ongoing study; Forty male sold...

Sleep deprivation is a prevalent operational stressor that may degrade neurophysiological performance in military personnel. Transcranial magnetic stimulation (TMS) is an established non-invasive brain stimulation technique capable of assessing corticospinal excitability that is not extensively investigated in military populations. PURPOSE: To exam...

Introduction Sleep deprivation improves mood in depressed individuals. We recently showed that partial or total sleep deprivation altered regional and global cerebral glucose metabolism during NREM sleep and reduced depressed mood in a sample including individuals with primary insomnia (PI; n=17) and good sleeper controls (GS; n=19). This follow-up...

Introduction Insomnia is a prevalent and impactful disorder among Veterans. An evidence-based behavioral intervention, cognitive behavioral therapy for insomnia (CBTI), has strong evidence but its use in the VA is still limited by numerous barriers. An alternative behavioral treatment with comparable evidence and that addresses barriers of CBTI del...

Background: Restricting time in bed improves insomnia symptoms, but the neural mechanisms for this effect are unknown. Total and partial acute sleep restriction may be useful paradigms for elucidating these effects. We examined the impact of acute sleep restriction on cerebral glucose metabolism during non-rapid eye movement (NREM) sleep in indivi...

This consensus paper provides an overview of the state of the art in research on the aetiology and treatment of nightmare disorder and outlines further perspectives on these issues. It presents a definition of nightmares and nightmare disorder followed by epidemiological findings, and then explains existing models of nightmare aetiology in traumati...

Objective: Brief Behavioral Treatment for Insomnia (BBTI) is an efficacious treatment of insomnia in older adults. Behavioral treatments for insomnia can also improve depression. However, it is unknown if BBTI is feasible or has an effect in patients with insomnia and late-life treatment resistant depression (LLTRD). The aims of this study were tw...

Study Objectives: To determine whether high frequency heart rate variability (HF-HRV) during sleep differs between those with and without PTSD diagnosis as a function of sleep type (NREM versus REM), and to explore this relationship across successive sleep cycles. We hypothesized that study participants with PTSD would have lower HF-HRV across both...

Comparing the neural outcomes of two randomized experimental groups is a primary aim of many functional neuroimaging studies. However, between-group effects can be obscured by heterogeneity in neural responses. Optimal Combined Moderator (OCM) approaches have previously been used to clarify heterogeneity in clinical outcomes following treatment ran...

A rapidly expanding scientific literature supports the frequent co-occurrence of sleep and circadian disturbances following mild traumatic brain injury (mTBI). Although many questions remain unanswered, the preponderance of evidence suggests that sleep and circadian disorders can result from mTBI. Among those with mTBI, sleep disturbances and clini...

Introduction Insomnia is pervasive among Veterans, but Veteran access to the standard of care (CBTI) is limited. Self-management CBTI requires fewer provider resources and Veterans prefer provider support with self-management. Prior self-management CBTI findings may not generalize to Veterans since individuals with mental health disorders, which ar...

Combat and operational stress control (COSC) surveys guide allocation of high-demand, low-quantity mental health assets to support combat-deployed U.S. forces. The current article describes an innovative application of machine learning, decision tree analysis, to predict unit-level risk for combat mental health outcomes like posttraumatic stress di...

Background: Chronic insomnia is among the most reported complaints of Veterans and military personnel referred for mental health services. It is highly comorbid with medical and psychiatric disorders, and is associated with significantly increased healthcare utilization and costs. Evidence-based psychotherapy, namely Cognitive Behavioral Therapy f...

Sleep is a universal, biologically driven, and multifaceted state of behavioral quiescence that supports mental and physiological health and well-being. Different observable dimensions of sleep, however, are direct expressions of the complex, recurrent, and reversible neurobiological processes that support the experience of sleep. Dimensions such a...

Limbic white matter pathways link emotion, cognition, and behavior and are potentially malleable to the influences of traumatic events throughout development. However, the impact of interactions between childhood and later life trauma on limbic white matter pathways has yet to be examined. Here, we examined whether childhood maltreatment moderated...

Objectives: Sleep discrepancies are common in primary insomnia (PI), and include reports of longer sleep onset latency (SOL) than measured by polysomnography (PSG), or "negative SOL discrepancy." We hypothesized that negative SOL discrepancy in PI would be associated with higher relative glucose metabolism during non-rapid eye movement (NREM) slee...

Study objectives: Insomnia is a widespread issue among United States adults and rates of insomnia among veterans are even higher than the general population. Prior research examining primary care provider (PCP) perspectives on insomnia treatment found that: sleep hygiene and pharmacotherapy are the primary treatments offered; PCPs tend to focus on...

Insomnia is prevalent among Veterans with post-traumatic stress disorder (PTSD), it exacerbates PTSD symptoms, and it contributes to impaired functioning and quality of life. To improve treatment outcomes, it is important to identify risk factors for insomnia and sedative-hypnotic use. Classification and regression trees and logistic regression mod...

Introduction: Changes in the frequency, duration, and nature of military deployments over the past 14 years have spurred efforts to understand the effects of deployment on the health of military service members and their spouses. However, few studies have examined the impact of deployments on health outcomes in both veterans and their partners. Th...

In sleep research, applying finite mixture models to sleep characteristics captured through multiple data types, including self-reported sleep diary, a wrist monitor capturing movement (actigraphy), and brain waves (polysomnography), may suggest new phenotypes that reflect underlying disease mechanisms. However, a direct mixture model application i...

Background Emerging research has begun to examine associations between relationship functioning and sleep. However, these studies have largely relied on self-reported evaluations of relationships and/or of sleep, which may be vulnerable to bias. PurposeThe purpose of the study was to examine associations between relationship functioning and sleep i...

Introduction The insomnia-short sleep (ISS) phenotype has previously been characterized based upon one night of laboratory-based polysomnography (PSG). It is unknown if these individuals would be similarly classified based upon habitual sleep duration, as measured by sleep diaries or wrist actigraphy. Moreover, the stability of the ISS classificati...

Objective: This study examined the effects of total and partial sleep deprivation on subjective symptoms and objective neurocognitive performance, as measured by the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) in a sample of healthy adults. Method: One-hundred and two, right-handed, healthy participants (between ages 18 a...

Objective: Our goal was to examine the association between marital conflict and nocturnal blood pressure dipping (NBP) in Iraq/Afghanistan healthy veterans and their partners and to determine whether sleep disturbances mediate such associations. Method: The sample consisted of 25 heterosexual couples comprised of male veterans and their female c...

Background: Task-switching deficits are common in older adults and in those with insomnia. Such deficits may be driven by difficulties with sleep continuity and dampened homeostatic sleep drive. Objective: To identify the aspects of task switching affected by insomnia and its treatment, and to determine whether such effects are associated with s...

Study objective: The neurobiological mechanisms of insomnia may involve altered patterns of activation across sleep-wake states in brain regions associated with cognition, self-referential processes, affect, and sleep-wake promotion. The objective of this study was to compare relative regional cerebral metabolic rate for glucose (rCMRglc) in these...

Nightmares are a unique feature of posttraumatic stress disorder (PTSD). Although nightmares are a symptom of PTSD, they have been shown to independently contribute to psychiatric distress and poor outcomes, including heightened suicidality and suicide. Nightmares are often resistant to recommended pharmacological or psychological PTSD treatments....

Objective. To present the seventh in a series of articles designed to deconstruct chronic low back pain (CLBP) in older adults. This article focuses on insomnia and presents a treatment algorithm for managing insomnia in older adults, along with a representative clinical case. Methods. A modified Delphi process was used to develop the algorithm and...

Disturbed sleep is one of the most common complaints following traumatic brain injury (TBI) and worsens morbidity and long-term sequelae. Further, sleep and TBI share neurophysiologic underpinnings with direct relevance to recovery from TBI. As such, disturbed sleep and clinical sleep disorders represent modifiable treatment targets to improve outc...

Background: Sleep disturbance and fatigue are common in patients with IBD. Sleep disturbance has recently been linked to inflammation and may be a risk factor for Crohn's disease (CD) relapse. Sleep is particularly critical during early adulthood; little is known about sleep disturbance in young IBD cohorts. This study evaluated sleep disturbance i...

Background: Sleep disturbance is common in patients with Crohn's disease (CD) and has been associated with fatigue and increased disease activity. Behavioral interventions for insomnia have improved sleep and associated fatigue in other populations but have not been tested in young adults with IBD. This study presents results of an open trial over...

Sleep disturbances are common in adults with posttraumatic stress disorder (PTSD) and range from insomnia and nightmares to periodic leg movements and disruptive nocturnal behaviors. Together, these findings suggest profound disturbances in rapid eye movement (REM) and non-REM sleep, although there is a lack of consensus regarding a distinct profil...

Electroencephalographic slow-wave activity (0.5–4 Hz) during non-rapid eye movement (NREM) sleep is a marker for cortical reorganization, particularly within the prefrontal cortex. Greater slow wave activity during sleep may promote greater waking prefrontal metabolic rate and, in turn, executive function. However, this process may be affected by a...

Study objective: To investigate the influence of sleep disordered breathing (SDB) on weight loss in overweight/obese veterans enrolled in MOVE!, a nationally implemented behavioral weight management program delivered by the National Veterans Health Administration health system. Methods: This observational study evaluated weight loss by SDB statu...

The impact of trauma exposure on sleep may depend on the interaction between biological vulnerability of the individual and environmental factors. We recently established a mouse model of posttraumatic stress disorder (PTSD) utilizing a novel conditioning stimulus (CS) with which to re-expose mice during sleep. The current study assessed the effect...

Morningness-eveningness (M-E) is typically considered to be a trait-like construct. However, M-E could plausibly shift in concert with changes in circadian or homeostatic processes. We examined M-E changes across three studies employing behavioral or pharmacological sleep treatments. Baseline and posttreatment M-E scores were strongly correlated ac...

Daytime and nighttime symptoms of posttraumatic stress disorder (PTSD) are common among combat veterans and military service members. However, there is a great deal of heterogeneity in how symptoms are expressed. Clarifying the heterogeneity of daytime and nighttime PTSD symptoms through exploratory clustering may generate hypotheses regarding ways...

Study objectives: This study examined the extent to which self-reported exposure to blast during deployment to Iraq and Afghanistan affects subjective and objective sleep measures in service members and veterans with and without posttraumatic stress disorder (PTSD). Methods: Seventy-one medication-free service members and veterans (Mean age = 29...

Childhood maltreatment can disturb brain development and subsequently lead to adverse socioemotional and mental health problems across the life span. The long-term association between childhood maltreatment and resting–wake brain activity during adulthood is unknown and was examined in the current study. Forty-one medically stable and medication-fr...

Poor quality of sleep predicted readmissions to partial psychiatry hospitalization program

Sleep disturbance is among the most common complaints of veterans and military personnel who deployed to the conflicts in Iraq and Afghanistan. A growing body of research has examined cross-sectional and longitudinal relationships between sleep disturbance and mental health symptoms and specific diagnoses in this population. However, prior research...

Post-traumatic stress disorder (PTSD) is accompanied by disturbed sleep and an impaired ability to learn and remember extinction of conditioned fear. Following a traumatic event, the full spectrum of PTSD symptoms typically requires several months to develop. During this time, sleep disturbances such as insomnia, nightmares, and fragmented rapid ey...

Learning and memory for extinction of conditioned fear is a basic mammalian mechanism for regulating negative emotion. Sleep promotes both the consolidation of memory and the regulation of emotion. Sleep can influence consolidation and modification of memories associated with both fear and its extinction. After brief overviews of the behavior and n...