Timothy A Roehrs

• PhD
• Senior Researcher at Henry Ford Health System

After describing my serendipitous discovery of sleep research as a potential career, I note how my openness and inquisitiveness led to a broad contribution to sleep science. After a PhD in biological psychology, I completed a postdoctoral fellowship in alcoholism and drug abuse. This led to my first studies on rebound insomnia. I then describe earl...

Introduction Clinicians prescribing hypnotics remain concerned regarding the inability to discontinue hypnotics after chronic use. In a controlled prospective study using self-administration choice procedures we tested whether BZRA hypnotic receptor specificity is predictive of discontinuation difficulty in a clinical trial in which insomnia subjec...

The aim of this ongoing research is to compare WP300 sleep staging to the gold standard NPSG in OUD patients and assess for any differences in measurement between the two.

Introduction Inability to discontinue chronic hypnotic use by people with insomnia remains a clinical problem. Sleep was recorded by actigraphy during a two-week discontinuation in an on-going “blinded” clinical trial in which people with insomnia were instructed to discontinue their study medication after 6 months of nightly use. Methods DSM-V di...

Introduction Clinicians prescribing hypnotics remain concerned regarding the inability to discontinue hypnotics after chronic use, which has never been directly tested in a controlled prospective study using self-administration choice methodology. This study reports on difficulty discontinuing medication as a function of basal sleep disturbance in...

The objective of this editorial is to summarize the findings published in the special issue on “Sleep and Drug Abuse”. The manuscripts in this issue include review articles as well as original investigations, and cover topics ranging from pre-clinical investigation to epidemiological-based clinical studies. Together, these papers provide evidence t...

Introduction Sleep disturbances are commonly reported by chronic marijuana (MJ) users and often identified as reasons for MJ relapse and/or other drug use. In the current study we compared the sleep architecture of 12 heavy MJ users to 11 normal controls. Methods Participants in the marijuana group met DSM-V criteria for cannabis use disorder but...

The majority of the literature describing the relation of sleep/alertness disturbance and substance use disorders (SUD) has focused on the disruptive effects of substances with abuse liability on sleep and alertness. Rarely have studies or literature reviews assessed or discussed how sleep/alertness disturbance affects substance use. This paper foc...

The overall concept and aim of this chapter is to provide a basic sleep medicine “crash course” with a specific goal of describing a practical approach to treating the patient population afflicted with substance dependence and concomitant sleep complaints.

Objectives: The chronic pain disorder, fibromyalgia, is associated with sleep disturbance, typically sleep maintenance. No studies have evaluated the effect of sleep medication on pain sensitivity in this population. Suvorexant, an orexin antagonist, approved for treatment of insomnia was evaluated for effects on both the sleep and pain of fibromy...

None: The prevalence of shift work in the United States is nearly 20%, but recognition of shift work disorder (SWD) among shift workers is still a challenge. The health care sector is no exception. While a substantial portion of shift workers are physicians and nurses, expertise in identifying SWD is lacking. Shift work adjustment occurs spontaneo...

None: The prevalence of shift work in the United States is nearly 20%, but recognition of shift work disorder (SWD) among shift workers is still a challenge. The health care sector is no exception. While a substantial portion of shift workers are physicians and nurses, expertise in identifying SWD is lacking. Shift work adjustment occurs spontaneo...

Introduction: Depression increases during menopause, and subclinical depressive symptoms increase risk for major depression. Insomnia is common among postmenopausal women and increases depression-risk in this already-vulnerable population. Recent evidence supports the efficacy of cognitive-behavioral therapy for insomnia (CBTI) to treat menopausal...

Introduction The chronic widespread pain disorder, fibromyalgia, is known for its nociceptive hypersensitization and disturbed sleep. The relation of sleep and pain is bidirectional and data suggest that improving sleep in chronic pain disorders would attenuate daytime pain sensitivity. Here we report on suvorexant’s next-day pain effects following...

Introduction The chronic pain disorder, fibromyalgia, is associated with sleep disturbance, typically sleep maintenance. Pharmacological treatment studies have either focused on the pain or the sleep disturbance with equivocal results in that few studies have improved both sleep and pain. No studies have evaluated the effect of sleep medication on...

Introduction A concern among physicians prescribing hypnotics is the inability to discontinue hypnotics after chronic use. This concern has never been directly tested in a controlled prospective study. This is a report of results from an on-going “blinded” trial in which insomnia subjects are instructed to stop taking study medication after 6 month...

Introduction A recent meta-analysis compared polysomnograms (PSGs) of people with insomnia to healthy controls; results showed short sleep time and reduced slow-wave and REM sleep in insomnia. Among people with insomnia, studies have shown morbidity associated with insomnia is found primarily in people with PSG short sleep. Here we characterize the...

Actigraphy is increasingly used in practice and research studies because of its relative low cost and decreased subject burden. How multiple nights of at‐home actigraphy compare to one independent night of in‐laboratory polysomnography (PSG) has not been examined in people with insomnia. Using event markers (MARK) to set time in bed (TIB) compared...

We report a case series of four patients where tachypnea was observed during positive airway titration studies, double the baseline breathing rate (tachypnea range 46-68 breaths/min). It happened mainly during non-rapid eye movement to rapid eye movement sleep transitions without significant changes in oxygen saturation or signs of autonomic hypera...

Randomized controlled trials (RCTs) have eligibility criteria for the inclusion of participants. Ideally, the RCT sample would be representative for the patient population that will use the drug under investigation. However, external validity may be at stake when applying too many or too restrictive eligibility criteria. The current two-part study...

Background Insomnia and depression are highly comorbid and mutually exacerbate clinical trajectories and outcomes. Cognitive behavioral therapy for insomnia (CBT-I) effectively reduces both insomnia and depression severity, and can be delivered digitally. This could substantially increase the accessibility to CBT-I, which could reduce the health di...

Purpose Heavy drinking has been shown to disrupt sleep, increase sleepiness the next day, and produce symptoms collectively referred to as “hangover”. A survey was conducted to determine the impact of heavy alcohol consumption on sleep, daytime sleepiness, and hangover severity. Methods N = 335 adults, experienced with alcohol hangover, completed...

Study objectives: To examine the real-world effectiveness of benzodiazepine receptor agonists (BzRAs) by quantifying response and remission rates in a clinical sample receiving chronic BzRA treatment for insomnia. Methods: Participants were outpatients (N = 193; 72% female; 55.2 ± 11.1 yo) who had an insomnia diagnosis per medical records, and w...

Background: Given concerns about the abuse liability of hypnotics, this study assessed hyperarousal in people with insomnia and its relation to hypnotic self-administration over 12 months of nightly hypnotic use. Methods: Ninety-five subjects with insomnia (age 32-64 years) underwent screening nocturnal polysomnogram (NPSG) and Multiple Sleep La...

This chapter reviews the research supporting the bidirectional relationship between pain and sleep. Research has established that sleep is disturbed in both acute and chronic pain conditions, and studies are now showing that reduced sleep time, sleep disrupted by frequent brief arousals, and possibly specific sleep-stage deprivation enhance the exp...

Study Objectives: Despite mounting evidence for the overuse of prescription sleep aids (PSA), reliable data on PSA use among insomniacs are unavailable. Current studies focus on trends in PSA use at the general population level, and thus do not distinguish between transient sleep disturbance and insomnia disorder. Therefore, we prospectively examin...

Objective: Studies have shown pharmacokinetic differences for hypnotics in women compared to men, but few studies have assessed either short- or long-term differences in efficacy and safety. Methods: To evaluate gender differences in the efficacy and safety of chronic nightly zolpidem (10 mg), we did a post hoc assessment of a large clinical tri...

This article discusses the role sleep and alertness disturbance plays in the initiation, maintenance and relapse of substance use disorders.

To investigate the differential nature of disturbed sleep in subjects with fibromyalgia (FM) reporting sleep difficulties versus subjects with primary insomnia (PI) and subjects who do not complain of disturbed sleep ("normals"). Subjects (FM: n=132; PI: n=109; normals: n=52) were recruited for different studies. FM and PI subjects were pre-selecte...

To identify the amount of sleep disruption that occurs in the postoperative inpatient hospital setting, determine the relationship between sleep disruption and the quantity of narcotics taken for postoperative pain, and determine if hospital length of stay is related to sleep disruption. Prospective cohort study. Single tertiary care academic insti...

Objectives (1) Identify the amount of sleep disruption that occurs in the postoperative inpatient hospital setting. (2) Determine the relationship between sleep disruption and the use of postoperative narcotic for pain. (3) Determine if the postoperative hospital course is impacted by sleep disruption. Sleep disturbance is a common complaint among...

Insomnia is a prevalent sleep disorder that is typically comorbid with medical, psychiatric, and other sleep disorders. Yet, it is a disorder with its own course and morbidity that can persist if untreated. This chapter describes the physiological correlates of insomnia expressed during sleep and during the daytime. Together, the data from nighttim...

Psychiatry lags other fields in development of diagnostic tests. A literature review and meta-analysis was conducted to ascertain if polysomnographic abnormalities (REM density, REM latency, sleep efficiency, slow wave sleep, stage 1 and stage 2 sleep) warrant additional effort to develop them into a clinical diagnostic test for major depressive di...

Sleep hygiene recommendations are widely disseminated despite the fact that few systematic studies have investigated the empirical bases of sleep hygiene in the home environment. For example, studies have yet to investigate the relative effects of a given dose of caffeine administered at different times of day on subsequent sleep. This study compar...

Readaptation to the sleep laboratory was assessed in 10 volunteers complaining of insomnia with polysomnographic evidence of disturbed sleep. After an initial 3-night adaptation to the laboratory, subjects slept in the laboratory on 2 consecutive nights per week for 10 weeks and were administered medication according to the following protocol: plac...

To determine whether an extended bedtime in sleepy and otherwise healthy volunteers would increase alertness and thereby also reduce pain sensitivity. Outpatient with sleep laboratory assessments. Healthy volunteers (n = 18), defined as having an average daily sleep latency on the Multiple Sleep Latency Test (MSLT) < 8 min, were randomized to 4 nig...

Objective: Fibromyalgia (FM) and rheumatoid arthritis (RA) are pain disorders, both of which are associated with complaints of sleep disturbance, non-refreshing sleep, and daytime sleepiness and fatigue. Given the putative differential central versus peripheral nervous system involvement in these disorders, subjective and objective measures of noc...

To evaluate the long-term (8 months) efficacy of zolpidem in adults with chronic primary insomnia using polysomnography. Randomized, double-blind, placebo-controlled clinical trial. Sleep disorders and research center. Healthy participants (n = 91), ages 23-70, meeting DSM-IV-TR criteria for primary insomnia. Nightly zolpidem, 10 mg (5 mg for patie...

The benzodiazepine receptor agonists (BzRAs) a melatonin receptor agonist and a histamine antagonist have all been approved as hypnotics. Beyond their differing mechanisms of action, they have differences in pharmacokinetics, and among the BzRAs differences in receptor subtype affinity and formulations, which provides the physician with broad optio...

To compare 24-hour postsurgical patient-controlled analgesia (PCA) in smokers and nonsmokers. Patients completed a presurgical questionnaire inquiring about sleep, nicotine and other substance use, and comorbid disorders. Nicotine use was discontinued on hospital admission on the day of surgery. After morning surgery and (spinal) anesthesia recover...

Nearly all drugs of abuse and alcohol have considerable effects on sleep efficiency, sleep continuity, sleep stages, and consequent next-day alertness. It has been hypothesized that such drug effects on sleep and wake function may act as contributing factors in maintaining compulsive and excessive drug use, as well as factors that increase the risk...

To assess the stability of the multiple sleep latency test (MSLT) in primary insomnia and its relation to total sleep time. Randomized, double-blind, placebo controlled, clinical trial. Outpatient with sleep laboratory assessments in months 1 and 8 of treatment. Ninety-five primary insomniacs, 32-64 years old and 55 age- and sex-matched general pop...

To evaluate effects of CPAP on pain sensitivity in severe OSA patients. Within-subject treatment study. Hospital-based sleep disorders center. Twelve severe OSA patients (7 men, 5 women), 50.2 ± 12.5 years, with no pain. The morning after a diagnostic nocturnal polysomnogram (NPSG), patients underwent a training session of finger withdrawal latency...

Rebound insomnia, worsened sleep when discontinuing use of a hypnotic, is reported in some short-term studies. No study has prospectively assessed, using patient reports or nocturnal polysomnography (NPSG), the likelihood of rebound insomnia with chronic hypnotic use. The objectives of this study was to assess in primary insomniacs the likelihood o...

To assess hypnotic self-administration and likelihood of dose escalation over 12 months of nightly use of zolpidem versus placebo in primary insomniacs. Randomized, double-blind, placebo-controlled, clinical trial. Outpatient with tri-monthly one-week, sleep laboratory assessments. Thirty-three primary insomniacs, without psychiatric disorders or d...

Insomnia is a disorder characterized by chronic difficulty with sleep and associated impairments in daytime function. This article discusses diagnostic criteria as therapeutic targets for insomnia, self-medication, over-the-counter and prescription medications, and new therapeutic targets and approaches.

Slow wave sleep changes as a function of age and more rapidly in men than women, and stage 1 sleep increases slightly with age in men. Apart from the presence of primary sleep disorders, no other functional or clinical significance is found with these changes. Selective slow wave sleep deprivation does not produce specific impairment and insomniacs...

Sleep restriction and sleep disorders are common causes of excessive daytime sleepiness (EDS). Medical disorders (MD) can also cause EDS, but previous studies have used non-standardized measures, selected samples, or have examined EDS in singular disorders. This study describes the relative degree of EDS associated with medical disorders to provide...

Basal sleepiness-alertness modulates drug effects. Sleepiness produced by sleep restriction leads to increased nociceptive sensitivity, suggesting opioid analgesia may also be modulated by sleepiness-alertness. This study compared thermal nociceptive sensitivity in sleepy versus nonsleepy participants after codeine or placebo. Twelve healthy normal...

The purpose of this study was to determine the risk of DMV documented crashes as a function of physiological sleepiness in a population-based sample. 24-hour laboratory assessment (nocturnal polysomnogram and daytime MSLT) and 10-year crash rate based on DMV obtained accident records. 618 individuals (mean age = 41.6 +/- 12.8; 48.5% male) were recr...

Nocturnal awakenings are one of the most prevalent sleep disturbances in the general population. Little is known, however, about the frequency of these episodes and how difficulty resuming sleep once awakened affects subjective sleep quality and quantity. This is a cross-sectional telephone study with a representative sample consisting of 8937 non-...

Co-morbid insomnia is a much more frequent problem than primary insomnia. In co-morbid insomnia, management of the underlying disease can improve sleep difficulty. Conversely, treating the sleep disorder may also improve the co-morbid condition. For example, patients with painful chronic illnesses are more likely to experience sleep disturbance tha...

3,4-Methylenedioxymethamphetamine (MDMA) affects monoamine neurotransmitters that play a critical role in sleep and daytime alertness. However, the acute effects of MDMA on sleep and daytime sleepiness have not been studied under placebo-controlled conditions. This study was designed to establish the effects of acute MDMA or placebo administration...

Past studies have shown that acute experimental reduction of time in bed in otherwise healthy, non-sleepy people leads to hyperalgesia. We hypothesized that otherwise healthy, sleepy people may also exhibit hyperalgesia relative to their non-sleepy counterparts. Between-groups sleep laboratory study. Hospital-based sleep disorders center. Twenty-se...

We report a case of severe restless legs syndrome (RLS) that occurred as a side effect of olanzapine therapy. It was refractory to treatment with 2 mg of clonazepam and 3 mg ropinirole. There was partial relief with propoxyphene, however, it was stopped because of side effects. The symptoms disappeared once olanzapine was switched to another antips...

This chapter provides an overview of the multiple sleep latency test (MSLT) for the measurement of sleepiness/alertness. Normal and pathologic variations in daytime sleepiness and alertness—used as antonyms—can be directly assessed and quantified by the MSLT. It is a test of the rapidity with which a subject falls asleep in a standardized, sleep-co...

As described in this article, the management of insomnia has been affected dramatically by advances in the understanding of the pathophysiology and morbidity of insomnia, by new applications for behavioral treatments of insomnia, and by the development of new therapeutic targets for the pharmacologic management of insomnia.

Insomnia is defined as difficulty initiating or maintaining sleep and/or nonrestorative sleep which impairs daytime function. Self treatment with over-the-counter (OTC) sleep aids, herbal and dietary supplements, and/or alcohol is common. Problems associated with insomnia self treatment are ineffectiveness, tolerance, dependency, and potentially ha...

Caffeine is one of the most widely consumed psychoactive substances and it has profound effects on sleep and wake function. Laboratory studies have documented its sleep-disruptive effects. It clearly enhances alertness and performance in studies with explicit sleep deprivation, restriction, or circadian sleep schedule reversals. But, under conditio...

Alcohol disrupts sleep even in healthy individuals, and when consumed in excessive amounts for long periods, the sleep disturbance remains even after prolonged abstinence. Disturbed sleep is an important factor contributing to poor quality of life (QoL) in clinical samples of alcohol-dependent subjects as well as in population-based samples. Relaps...

To determine the sources of sleep complaints in peri- and postmenopausal women reporting disturbed sleep. A total of 102 women, ages 44 to 56 years, who reported disturbed sleep were recruited through newspaper advertisements. They were assessed with the Pittsburgh Sleep Quality Index and the Hamilton Anxiety and Depression Rating Scales. Complete...

No psychometrically established measure of acute hangover symptoms is published and available to use in experimental investigations. The present investigation combined data across three studies of residual alcohol effects to establish the properties of a new Acute Hangover Scale (AHS) based on symptoms supported in previous lab studies. Professiona...

The reliability and validity of EEG arousals and other types of arousal are reviewed. Brief arousals during sleep had been observed for many years, but the evolution of sleep medicine in the 1980s directed new attention to these events. Early studies at that time in animals and humans linked brief EEG arousals and associated fragmentation of sleep...

Interest in developing a greater understanding of the pathophysiogical mechanisms underlying primary insomnia has increased. Recent evidence indicates that there may be some neuroendocrine and clinical similarities between primary insomnia and major depressive disorder, that abnormal corticotropin releasing factor (CRF) activity occurs in major dep...

To determine the sleep response to caffeine in individuals vulnerable to stress-related sleep disturbance as measured by polysomnography. Eleven healthy individuals without insomnia scoring low (4 women, mean age=32.64+/-15.46 years) and 10 healthy individuals also without insomnia scoring high (6 women, mean age=34.20+/-13.73 years) on a measure o...

The presence and severity of the chronic pain syndrome fibromyalgia (FM) is associated with unresolved stress and emotional regulation difficulties. Written emotional disclosure is intended to reduce stress and may improve health of people with FM. This study tests the effects of at-home, written emotional disclosure about stressful experiences on...

Most of the information regarding the safety of insomnia pharmacotherapy has been obtained through short-term laboratory-based studies of FDA-approved hypnotics. In the few older population-based, retrospective studies that have reported increased falls in elderly persons and an increased mortality associated with drugs to promote sleep, the increa...

In replyIn our article entitled “Sleep in Lifetime Posttraumatic Stress Disorder: A Community-Based Polysomnographic Study,”1 we report polysomnographic findings from a large study nested in a well-described, longitudinal epidemiologic sample. The PTSD subset comprises lifetime cases, both current and past, combined based on the absence of any evid...

To determine whether hot flashes produce sleep disturbance in postmenopausal women. This study was performed in a university medical center laboratory with 18 postmenopausal women with hot flashes, six with no hot flashes, and 12 cycling women, all healthy and medication free. Polysomnography, skin and rectal temperatures, and skin conductance to d...

To evaluate the impact of enhanced slow-wave sleep (SWS) on behavioral, psychological, and physiologic changes resulting from sleep restriction A double-blind, parallel-group, placebo-controlled design was used to compare tiagabine, 8 mg, (a SWS-enhancing drug) to placebo during 4 nights of sleep restriction (time in bed = 5 hours per night). Behav...

Twelve healthy young men were assessed in each of four experimental conditions presented in a Latin Square design: 8-hr time in bed (TIB) and placebo, 4-hr TIB and placebo, 8-hr TIB and ethanol, and 4-hr TIB and ethanol. After consuming ethanol (0.6 g/kg) or placebo (0900–0930 hr) with 20% supplements at 1030 and 1100 hr, subjects were tested for s...

Disturbed sleep is observed in association with acute and chronic pain, and some data suggest that disturbed and shortened sleep enhances pain. We report the first data showing, in healthy, pain-free, individuals, that modest reductions of sleep time and specific loss of rapid eye movement (REM) sleep produces hyperalgesia the following morning. Tw...

In small, clinical samples, men have reduced slow wave sleep compared to women. Given the higher prevalence of sleep-related breathing disturbance in men, this study assessed sex differences in sleep in a large, non-clinical sample of adults and controlled for primary sleep disorders. Men and women, 31-40 years old, drawn from a longitudinal sample...