B. Clinical Sleep Science and Practice I.

Insomnia

Introduction: Project Sleep was a four week online stress reduction Introduction: Complex insomnia (co-occurring chronic insom-
intervention study that aimed to decrease insomnia symptomology. nia disorder and sleep apnea) is more prevalent than previously rec-
The current follow-up study examined whether abbreviated mindful ognized, yet no RCTs have investigated different PAP modes in this
breathing (MB) or abbreviated progressive muscle relaxation (APMR) cohort. Standard CPAP often produces adverse effects (expiratory
interventions, would retain reductions in stress, cognitive arousal, and pressure intolerance; iatrogenic central apneas) in complex insomnia
insomnia symptoms. Further, the waitlist control group was randomly patients. We hypothesized ASV would alleviate side-effects and yield
assigned to an AMPR or MB group to examine if the findings from the greater improvements in insomnia severity compared to CPAP.
initial study were not replicated. Methods: A prospective, single-blind (patients), RCT studied 40
Methods: Data were collected from a sample of 111 students from a chronic insomniacs, who had never seen a sleep specialist or received
large Midwestern university. Participants who completed the pre- and a sleep apnea diagnosis; and none believed they suffered a sleep
post-intervention questionnaires. After the initial four week interven- breathing disorder or that it caused their chronic insomnia. Despite
tion, participants in the self-monitoring condition were randomized their insomnia chief complaint, all patients were diagnosed with OSA
into either a MB or APMP group and completed the four week inter- on PSG. Patients completed an intensive 15-week protocol, compris-
vention. Participants completed measures of stress, cognitive arousal, ing 5 follow-up appointments (two-week intervals) interspersed with
and insomnia symptomology. 3 in-lab retitrations (six-week intervals) to encourage regular PAP use
Results: A series of ANOVAs were conducted to examine the effective- [ASV (n=19), CPAP (n=21); ResMed AirCurveTM].
ness of the treatments from times 2 and 3. Results revealed a main effect Results: The sample suffered moderately severe insomnia (mean
for time for stress (F(1, 71)=2.12, p=.016) and a significant group X ISI=19.30) for an average of 9.81years with no baseline differences
time interaction for cognitive arousal (F(1,71) = 5.55, p = .021). Similar between groups. All patients reported failing multiple treatments for
mixed ANOVAs were conducted on self-monitoring group after com- chronic insomnia, including sleep hygiene, OTC drugs, prescription
pleting treatment. Results revealed that there was a significant effect of sedatives, psychotropic medications and psychotherapy. At final fol-
time for insomnia symptomology (F(1, 36) = 8.55, p = .004). low-up, main effect showed a significant, large decrease in ISI (mean
Conclusion: These findings suggest that in comparison to the MB change -11.43, p=.0001); group x time interaction was statistically sig-
group the AMPR group did not retain their initial “gains” from the nificant (p=.04), demonstrating ASV superiority (mean change -13.22,
treatment over the four week period. Suggesting that MB interventions g=3.82) over CPAP (mean change -9.29, g=2.07). Clinically, ASV
provide longer lasting improvements. Additionally, similar pattern of superiority manifested in 68.4% of patients no longer meeting criteria
results in the self-monitoring group after receiving the treatments were for a clinical insomnia disorder (ISI<8) compared to 23.8% of CPAP
not replicated. Implications and limitations will be discussed. users (p=.006).
Support (If Any): n/a. Conclusion: Among classic chronic insomnia disorder patients who
perceived their sleep condition as psychological and whose providers
0385 focused on conventional therapies, complex insomnia was ultimately
HEARTFULNESS MEDITATION: AN EFFECTIVE diagnosed and successfully treated with PAP therapy. Compared to
TREATMENT OPTION FOR CHRONIC INSOMNIA CPAP, ASV proved superior by nearly twice the effect size in decreas-
Yommer D1, Thimmapuram J, MD2, Tudor L3 ing insomnia severity and by three times the number of cured cases.
1
Wellspan Health, York, PA, 2Wellspan Hospital, Academic ASV provided greater comfort, adaptability, and efficacy. In sum, for
Hospitalist, PA, 3Wellspan Pulmonary and Sleep Medicine, Wellspan many patients, insomnia was caused exclusively by a patho-physiolog-
ical medical disorder. Thus, failure to utilize PSG in chronic insomnia
Pulmonary and Sleep medicine, PA
delays accurate diagnosis and precludes appropriate treatment.
Introduction: Chronic Insomnia poses a significant treatment chal- Support (If Any): ResMed.
lenge. Both pharmacological and non-pharmacological measures are
used to treat insomnia. Heartfulness Meditation, a simple heart- based
0387
meditation could be a treatment option for Insomnia. In this study, we
ASV VS CPAP RCT: CHANGES IN RACING THOUGHTS IN
intended to determine the effects of an 8-week Heartfulness Meditation
COMPLEX INSOMNIA DISORDER
program on participants being treated for chronic insomnia.
Krakow B, McIver ND, Ulibarri VA
Methods: All participants completed Insomnia Severity Index (ISI)
at the initiation of the study and received instructions in Heartfulness Sleep & Human Health Institute, Albuquerque, NM
Meditation, along with sleep hygiene, and stimulus control informa-
Introduction: Racing thoughts, described by insomniacs as the
tion. At week 8, follow-up ISI scores were obtained.
inability to “turn off the mind,” is the single most common self-re-
Results: Twenty-five participants completed 8 weeks of Heartfulness
ported etiology for chronic sleep onset or maintenance insomnia.
Meditation practice. At week 8, the average mean ISI score was 10.6
Overlapping psychological theories to explain racing thoughts
compared to 18.56 at week 1. The result was statistically significant
include worry propensity, poor coping skills, somatized tension,
with a P-value of <0.001.
stress response, inadequate emotional processing and learned
Conclusion: Our results indicate that Heartfulness Meditation may
behavior. An alternate theory—“Respiratory Threat Matrix Model
be an important option in the aggregate of treatments for chronic
of Chronic Insomnia” (RTMMCI)—described in 2007, posits rac-
insomnia.
ing thoughts as a subconscious protective mechanism to actively
Support (If Any): None.
thwart sleep and thereby limit exposure to traumatizing, sleep-dis-
ordered breathing events. As the theory implies, “it feels safer to
0386 stay awake than attempt to sleep through the threat of a collapsing
ASV VS CPAP RCT: CHANGES IN INSOMNIA SEVERITY airway.” The RTMMCI, an alleged subconscious process, there-
INDEX (ISI) fore cannot be directly tested. Nonetheless, preliminary work may
Krakow B, McIver ND, Ulibarri VA track the effects of PAP on racing thoughts in complex insomnia
Sleep & Human Health Institute, Albuquerque, NM patients.

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