Kenneth L. Lichstein's research while affiliated with University of Alabama and other places

Publications (188)

Article
Background Insomnia identity, the conviction that one has insomnia, occurs independently of sleep quality or quantity, and is associated with numerous negative health outcomes. Little is known about factors influencing insomnia identity. This study planned to evaluate insomnia identity, perceived sleep experience, and sleep parameters. Method Indi...
Article
Given that sleep-related impairment during the waking period is proposed to play an important role in maintaining insomnia, more research is needed on factors that relate specifically to the daytime symptoms of sleep problems. This study investigated whether trait mindfulness predicts daytime impairment attributed to poor sleep after accounting for...
Article
Full-text available
Introduction: This guideline establishes clinical practice recommendations for the use of behavioral and psychological treatments for chronic insomnia disorder in adults. Methods: The American Academy of Sleep Medicine (AASM) commissioned a task force of experts in sleep medicine to develop recommendations and assign strengths based on a systema...
Article
Full-text available
Introduction: The purpose of this systematic review is to provide supporting evidence for a clinical practice guideline on the use of behavioral and psychological treatments for chronic insomnia disorder in adult populations. Methods: The American Academy of Sleep Medicine commissioned a task force of nine experts in sleep medicine. A systematic...
Article
Objective: To assess whether worry and rumination differ in predicting nighttime sleep disturbance versus daytime sleep-related impairment, as assessed using short forms from the Patient Reported Outcomes Measurement Information System (PROMIS). Participants: Adults recruited from the United States population (N = 459) via an online crowdsourcing s...
Chapter
Older adults experience many physical and health-related changes, including normative changes in sleep patterns characterized by greater fragility of sleep and a tendency toward “lightening” of sleep. This altered sleep patterning combined with an accumulation of other age-related changes (such as illness, polypharmacy, institutionalization, and so...
Article
Regression mixture models are one increasingly utilized approach for developing theories about and exploring the heterogeneity of effects. In this study we aimed to extend the current use of regression mixtures to a repeated regression mixture method when repeated measures, such as diary-type and experience-sampling method, data are available. We h...
Poster
Introduction The current study piloted the Sleep Experiences and Assessment Application (SEAA), a smartphone application developed for cost-effective, naturalistic, event-level assessment of pre-sleep experiences. The SEAA delivers audible prompts immediately before sleep and throughout the sleep period, which users respond to by verbally recording...
Article
Objectives: To identify factors that most saliently characterize the profile of individuals who complain of chronic insomnia, with or without quantitative sleep impairment. Design: Community-dwelling adults reported on their demographics and functioning via questionnaires and completed 2 weeks of sleep diaries. Setting: Shelby County in the Me...
Article
Full-text available
Study Objectives: Intraindividual variability (IIV) in sleep may be a risk factor for disease above the influence of mean sleep. Associations between IIV in sleep and risk for a comprehensive set of common medical and mental health conditions have not been assessed in a representative sample. Methods: The current study examined mean and IIV in tot...
Article
Possessing an evening circadian preference is associated with greater subjective sleep disturbance. The present study sought to determine whether day-to-day restoration from sleep upon waking mediates the relation between eveningness and general insomnia symptomology, as well as whether this association occurs independently of quantitative sleep im...
Article
Objective: Insomnia identity refers to the conviction that one has insomnia, which can occur independently of poor sleep. Night-to-night variability in sleep (termed intraindividual variability [IIV]) may contribute to insomnia identity yet remain undetected via conventional mean analyses. This study compared sleep IIV across four subgroups: nonco...
Article
Background: We examined the effects of integrated cognitive-behavioral therapy for depression and insomnia (CBT-D + CBT-I) delivered via videoconferening in rural, middle aged and older adults with depressive and insomnia symptoms. Method: Forty patients with depressive and insomnia symptoms were randomized to receive either 10 sessions of CBT-D...
Article
Objective: To compare therapeutic response to behavioral therapy for insomnia (BT-I) among hypnotic-dependent insomnia (HDI) patients with and without Cluster C personality disorders. Participants: Twenty-three adults with HDI (17 females), aged between 33 and 68 (M = 53; SD = 9.9) were included in the study. Methods: Participants completed a perso...
Article
Introduction Individuals who report having insomnia may or may not display quantitative sleep impairment. Furthermore, possessing an insomnia identity is associated with a range of health difficulties, regardless of actual sleep pattern. The present study examined which facets of health and functioning are most relevant in differentiating individua...
Article
Introduction Insomnia identity refers to the conviction that one has insomnia, which can occur despite the presence of quantitatively-defined good sleep. Night-to-night variability in sleep may contribute to insomnia identity yet remain undetected via conventional analyses of mean sleep parameters. This study aimed to compare combined mean differen...
Article
Full-text available
The present investigation sought to extend extant research on subjective sleep complaints by examining their relation to perceived sleep norms. Results from two studies showed that individuals' distress and illness behavior in response to symptoms of fatigue and non-restorative sleep was influenced by their perceptions of peer norms for those sympt...
Article
Nonrestorative sleep, a form of subjective sleep disturbance that has been largely neglected in the literature, is newly accessible to researchers via the validated restorative sleep questionnaire (RSQ). The daily version of the RSQ allows for analysis of within-subjects variation in restorative sleep across repeated samplings, and such day-to-day...
Article
Insomnia identity refers to the conviction that one has insomnia, and this sleep complaint can be measured independently of sleep. Conventional wisdom predicts that sleep complaints are synchronous with poor sleep, but crossing the presence or absence of poor sleep with the presence or absence of insomnia identity reveals incongruity with expected...
Article
Full-text available
Objectives: A validated survey instrument to assess general sleep health would be a useful research tool, particularly when objective measures of sleep are not feasible. Thus, the National Sleep Foundation spearheaded the development of the Sleep Health Index (SHI). Design: The development of the SHI began with a task force of experts who identi...
Article
Introduction Individuals may endorse an “Insomnia Identity”, described as believing that one has insomnia, which can be measured independently of other sleep parameters or a diagnosis of insomnia disorder. Pathologizing sleep concerns, as may be done with endorsement of insomnia identity even in the presence of a normal sleep pattern, may be linked...
Article
Introduction Nonrestorative sleep, characterized by lack of refreshment from the previous sleep bout, is an understudied sleep complaint that has recently become more accessible via the newly validated restorative sleep questionnaire (daily version; RSQ). Within-subjects variation in self-reported restorative sleep across multiple daily samplings m...
Article
Insomnia, difficulty falling asleep, staying asleep, or waking earlier than desired, is often associated with complaints of nonrestorative sleep, but these complaints can occur independently. Fragmented sleep and nonrestorative sleep relate to one's mood, ability to process their own or others' emotions, and can lead to changes in cognitions and be...
Article
Objectives: To provide evidence-based recommendations and guidance to the public regarding indicators of good sleep quality across the life-span. Methods: The National Sleep Foundation assembled a panel of experts from the sleep community and representatives appointed by stakeholder organizations (Sleep Quality Consensus Panel). A systematic litera...
Article
Presents an obituary for William R. Shadish who passed away on March 27, 2016, after a long, arduous battle with prostate cancer. Shadish was a distinguished professor for the University of California, Merced. He was elected president of three organizations: American Evaluation Association (1996), Society for Research Synthesis Methodology (2013),...
Chapter
The etiology and course of sleep complaints and disorders in older adults is often complicated, which is partially attributable to changes in social rhythms (e.g., retirement) and other age-related factors (e.g., increases in medical, physical, cognitive, and psychological complaints and conditions). Geropsychologists should be aware of the nuances...
Article
Nonrestorative sleep (NRS), characterized by a lack of refreshment upon awakening, has received little attention in the sleep literature even though it can occur and cause impairment apart from other sleep difficulties associated with insomnia. The Restorative Sleep Questionnaire (RSQ) is one of the first validated self-report instruments for inves...
Article
Full-text available
We examined the unique and shared contributions of pain catastrophizing, cognitive pre-sleep arousal, and somatic pre-sleep arousal, to the prediction of insomnia severity in chronic pain. Forty-eight adults with chronic pain completed self-report measures of these study variables, health, and mood. Hierarchical regression showed that pain catastro...
Article
To illuminate the course of insomnia in the presence of an acute comorbidity, we examined the association between insomnia severity and breast cancer symptom severity over time and determined if this association varies with insomnia history and presleep arousal. Twenty-nine newly diagnosed breast cancer patients, who also exhibited insomnia, comple...
Article
This study explored the association of engagement in pleasant events and global sleep quality, as well as examined the intermediary roles of positive affect and depressive symptoms in this association. Data were derived from the Midlife in the United States-II study. The sample consisted of 1054 community-dwelling adults. Participants completed the...
Article
The purpose of this study was to determine which aspects of insomnia best predict suicidal ideation (SI). Participants were grouped according to whether they complained of insomnia and whether their sleep would be characterized as poor or good by applying quantitative criteria for insomnia to their sleep diary data. Analyses revealed that insomnia...
Chapter
This chapter summarizes previous reviews and merges them with up-to-date evidence describing the prevalence and clinical presentation of insomnia symptoms and chronic insomnia among older adults.
Article
Full-text available
Introduction: A growing body of literature indicates that insomnia is related to suicidality. However, the mechanism through which insomnia correlates with suicide risk is unclear. The goal of the present research was to determine whether hopelessness, a robust predictor of suicidality, mediates the relation between insomnia and suicidal ideation...
Article
The study determined the prevalence of sleep disorders by ethnicity and sex, and related daytime functioning, working memory, and mental health among older adolescent to emerging adult college students. Participants were U.S.A. undergraduates (N = 1684), aged 17-25, recruited from 2010 to 2011. Participants completed online questionnaires for all v...
Chapter
In this chapter, we will discuss some of the more common factors associated with the development and maintenance of insomnia such as age, physiology, circadian rhythms, and environment.
Article
Illustrate the importance of examining within- and between-person differences in sleep across the adult age span. Two weeks of sleep diary data were analyzed for 592 normal sleepers ranging in age from 20 to 96 years. Variability in total sleep time (TST), number of nighttime awakenings (NWAK), sleep-onset latency (SOL), and wake-time after sleep o...
Article
Behavioral interventions for insomnia are effective in improving sleep, yet adherence is variable, and predictors of adherence have not been consistently replicated. The relationships between daily variations in state factors at the initiation of treatment and adherence have not been investigated. Using two-week, self-report online logs, this study...
Article
Background: Suicidal ideation (SI), a significant predictor of suicide, is associated with sleep disturbance, which is seldom assessed using stringent diagnostic criteria and validated sleep instruments in community samples. Methods: Cross-sectional data,including sleep diaries and validated instruments, from 767 community adults were used to ident...
Article
This study examined the relationship between dysmenorrhea and insomnia, as well as variability in sleep across the menstrual cycle. Participants were 89 women, ages 18 to 24 (M = 18.63, SD = 0.93), who completed daily surveys for five weeks. On the second day of menses, they completed a questionnaire regarding dysmenorrhea. Participants having inso...
Book
Insomnia is the difficulty initiating or maintaining sleep, including poor quality or quantity of sleep, often leading to impaired functioning and development of chronic sleep disturbances. Insomnia affects up to 50% of the general population globally, of which approximately 10% suffer from chronic insomnia. However, according to the National Sleep...
Article
Telehealth has proven effective with a wide range of disorders, but there is a paucity of data on the use of telehealth using cognitive-behavior therapy (CBT) with late-life insomnia and depression. This pilot study was designed to examine the feasibility and effectiveness of using telehealth to treat older adults with comorbid insomnia and depress...
Article
This study tested cognitive behavior therapy (CBT) in hypnotic-dependent, late middle-age and older adults with insomnia. Seventy volunteers age 50 and older were randomized to CBT plus drug withdrawal, placebo biofeedback (PL) plus drug withdrawal, or drug withdrawal (MED) only. The CBT and PL groups received eight, 45 min weekly treatment session...
Article
Study objectives: Prior research investigating co-occurring insomnia/obstructive sleep apnea (CIO) has mainly focused on comparing comorbid patients, obstructive sleep apnea (OSA), and insomnia (INS) to those with OSA alone. This approach is informative but omits the potentially interesting comparison of comorbid patients to those with INS alone....
Article
Full-text available
This study investigated the epidemiology of bedtime (BT), arising time (AT), and time in bed (TIB) as a function of age, gender, and ethnicity. Sleep diary data were analyzed for 746 randomly selected community participants. This sample was comprised of 364 men (48.8%) and 382 women (51.2%), 532 Caucasians (71.3%) and 214 African Americans (28.7%),...
Article
This article describes qualitative research conducted with patients with clinical diagnoses of insomnia and focuses on the development of a conceptual framework and endpoint model that identifies a hierarchy and interrelationships of potential outcomes in insomnia research. Focus groups were convened to discuss how patients experience insomnia and...
Article
Full-text available
The present study determined which self-reported sleep variables and daytime impairment measures are most closely associated with sleep quality ratings (SQR) in men and women with insomnia. The participants were 137 people with insomnia, 56 men and 81 women. Multiple regression found that for men, sleep efficiency best predicted SQR, explaining 26....
Article
Introduction: Actigraphy has gained popularity as an objective method for measuring sleep in a home setting. We evaluated whether missing data affects the utility of actigraphy for the measurement of sleep parameters in normal sleepers. Methods: We evaluated actigraphy data from 60 normal sleepers who participated in a study of the effects of ch...
Article
Full-text available
To present an expert consensus, standardized, patient-informed sleep diary. Sleep diaries from the original expert panel of 25 attendees of the Pittsburgh Assessment Conference(1) were collected and reviewed. A smaller subset of experts formed a committee and reviewed the compiled diaries. Items deemed essential were included in a Core sleep diary,...
Article
Cognitive behavioral therapy (CBT) for insomnia comprises a collection of relatively brief, empirically validated treatments for this common disorder. The main CBT treatments described in this chapter are relaxation approaches (a collection of methods designed to induce physiological and experiential calm by quiescent self-inquiry), stimulus contro...
Chapter
Relaxation methods are used when heightened somatic and/or cognitive arousal interferes with sleep. As most people with insomnia experience some form of arousal, relaxation techniques are appropriate for most people with insomnia. There are no serious contraindications for relaxation therapy. Patients who do not have time to practice will not profi...
Article
Sleep compression is ideal for those who exhibit sleep continuity disturbance but not substantial daytime deficits. Poor sleep accompanied by little daytime impairment suggests that enough sleep has been obtained to satisfy biologic need. Decreasing wake time in bed not increasing sleep becomes the primary therapeutic goal. There are no serious con...
Article
This case study series investigated a new treatment for paradoxical insomnia patients as there is no standard treatment for this patient group at this time. Four paradoxical insomnia patients had a polysomnography (PSG) sleep study, an unsuccessful brief course of behavioral treatment for insomnia, and then a novel sleep education treatment compris...
Article
Sleep duration among breast cancer survivors correlates with fatigue, depression, and health-related quality of life (HRQOL); however, this has not been studied longitudinally. This study investigated patterns of sleep duration change across the early breast cancer survivorship period, their demographic and clinical predictors, and their relationsh...
Article
This study explored cognitive pre-sleep arousal in chronic pain patients with varying degrees of insomnia symptoms. Forty-eight adult outpatients with chronic pain completed the Pre-Sleep Arousal Scale (PSAS) and self-report questionnaires on sleep, pain, and other health and mood issues. Participants were divided into two subgroups based on scores...
Article
Previous research suggests that ethnic groups differ in the prevalence and severity of disordered sleep symptoms. This study used meta-analysis to determine the magnitude of ethnic differences between African Americans (AAs) and Caucasian Americans (CAs) in insomnia symptoms and sleep-disordered breathing (SDB). It also used moderator analyses to e...
Article
To produce a valid insomnia treatment satisfaction questionnaire (ITSAT-Q) to assess treatment satisfaction with pharmacotherapy for use in patients with insomnia. Items developed for a self-administered questionnaire were analyzed using exploratory factor analysis (EFA), which produced 5 dimensions. Confirmatory factor analysis was used to verify...
Chapter
Sleep and aging There are many health-related changes that occur in older adulthood that are associated with reduced quality of life. Among the most prominent are changes in sleep patterns. These changes are accompanied by a greater likelihood of poor sleep and they become more significant with age. Furthermore, advancing age is also associated wit...
Article
The relationship between reports of insomnia and daytime functioning was investigated using hierarchical regression. The presence or absence of a report of insomnia was the predictor of primary interest. A number of covariates were included in the model: demographic variables, health variables, and quantitative sleep parameters. Data were collected...
Article
This Internet-based investigation assessed the frequency of multiple sleep hygiene practices in 128 good sleepers and 92 poor sleepers (mean age = 41.6, SD = 12.8, 61.8% women). The Pittsburgh Sleep Quality Index was used to measure sleep quality (< 5 = good sleep, > 7 = poor sleep). Although sleep hygiene practices were generally good, poor sleepe...
Article
Following a discussion of the impact of sleep disorders, the clinical management of chronic obstructive pulmonary disorder is discussed, as are asthma and obstructive sleep apnea. Restrictive lung diseases are outlined. The behaviorial management of insomnia appears to improve sleep and the implications are detailed. Finally, the pharmacologic trea...
Article
Following a discussion of the impact of sleep disorders, the clinical management of chronic obstructive pulmonary disorder is discussed, as are asthma and obstructive sleep apnea. Restrictive lung diseases are outlined. The behaviorial management of insomnia appears to improve sleep and the implications are detailed. Finally, the pharmacologic trea...
Article
The current review presents the empirical findings on varying definitions of nonrestorative sleep (NRS). Despite lacking a standard, operational definition, NRS is investigated in research studies and included in diagnostic manuals. However, because of the absence of standardization, the conclusions that can be drawn about NRS based on the current...
Article
Full-text available
This study aimed to document the psychometric properties of the Beck Anxiety Inventory (BAI) within a population with sleep-disordered breathing (SDB), given concerns about overlapping symptomatology between anxiety and sleep apnea. Results supported good internal consistency and convergent and discriminant validity for the BAI and a single-factor...
Chapter
Everyone has suffered through a night of bad sleep. Whether it is lying in bed worrying about a big presentation the next day, coping with the reality of a life-changing diagnosis, or wondering how long it will take you to adjust to that 8-hour time change so that you can enjoy your vacation, we can all recall a less than pleasant memory about a sl...
Article
Sleep, demographics, health, and daytime functioning were examined in young old (60-74 years; n = 175) and old old (75-98 years; n = 147) community-dwelling seniors. Sleep diaries (2 weeks), 6 daytime functioning measures, and a demographics-health questionnaire were collected. The old old reported worse sleep than the young old. Women reported wor...
Article
The existing literature does not address the question of whether cognitive-behavioral therapy would have an impact on insomnia in older adults who are chronic users of sleep medication and have current insomnia, but are also stable in their quantity of medication usage during treatment. The present report seeks to answer this question. Hypnotic-dep...
Article
We analyzed archival data from an epidemiology study to test the association between vitamin use and sleep. Random digit dialing was used to recruit 772 people ranging in age from 20 to 98 for a study of people's sleep experience. These individuals completed a set of questionnaires about their sleep, health, and daytime functioning. Five hundred an...
Chapter
Practitioners knowledgeable in psychologically treating late-life insomnia improve the overall care of patients by (1) using insomnia complaints and symptoms to screen for medical, mental, and organic sleep disorders and (2) treating the insomnia instead of referring the patient to a sleep specialist, thereby ensuring efficient and effective indivi...