Behavioral Sleep Medicine (sleep psych) ???

[The Cinnabon]

Hello SDN, the thread is exactly as it's stated. Where the hell can one learn more about Clinical Sleep psychology/ behavioral medicine and what's it actually like to be in this specialty (from my uneducated cursory view it seems to be a highly specialized health psychology specialty???). I'm a current undergrad doing unrelated research in PTSD but the effectiveness of CBT in Sleep disorders really caught my eye and it is something that looks interesting from both a clinical and research aspect, the issue is the field is small and information tends to be scarce (besides a few websites). Does anyone have any information or insights regarding Behavioral Sleep Medicine and the typical training process?

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[erg923]

Hello SDN, the thread is exactly as it's stated. Where the hell can one learn more about Clinical Sleep psychology/ behavioral medicine and what's it actually like to be in this specialty (from my uneducated cursory view it seems to be a highly specialized health psychology specialty???). I'm a current undergrad doing unrelated research in PTSD but the effectiveness of CBT in Sleep disorders really caught my eye and it is something that looks interesting from both a clinical and research aspect, the issue is the field is small and information tends to be scarce (besides a few websites). Does anyone have any information or insights regarding Behavioral Sleep Medicine and the typical training process?

This would be pretty standard, or at least readily available exposure to this in most all clinical or counseling psychology doctoral programs. Specialization would likely not be super available until post-doc

 

[thebalmofhurtminds]

Yes, as erg noted, you would likely have the opportunity for exposure in all good clinical/counseling programs and opportunity to specialize begins predominately in post-doc. There are a few specific sleep fellowships, but many folks do a health psychology postdoc where sleep is one of multiple areas of emphasis (e.g. me).

Happy to answer any questions, but while it's small, it's a growing field. It's increasingly understood (by the medical community as well as psychological) that CBT-I is the first line treatment for insomnia. Like with most things in psychology, availability of well-trained evidence-based practitioners is lacking in many areas and the primary issue. My wait list is considered short at 3 months.

 

[The Cinnabon]

Yes, as erg noted, you would likely have the opportunity for exposure in all good clinical/counseling programs and opportunity to specialize begins predominately in post-doc. There are a few specific sleep fellowships, but many folks do a health psychology postdoc where sleep is one of multiple areas of emphasis (e.g. me).

Happy to answer any questions, but while it's small, it's a growing field. It's increasingly understood (by the medical community as well as psychological) that CBT-I is the first line treatment for insomnia. Like with most things in psychology, availability of well-trained evidence-based practitioners is lacking in many areas and the primary issue. My wait list is considered short at 3 months.

Thank you both for your responses they actually cleared the air up quite a bit. Maybe one more annoying follow-up question but as someone who enjoys research and would one day like to incorporate research into their career, is it common for psychologists in your field to "combine" research interests. For example could one also do research into how other psychopathologies (such as PTSD) may affect a sleeping disorder (I assume the answer is yes but I figure why not ask)?

 

[parametric]

Behavioral Sleep Medicine for Students

Society of Behavioral Sleep Medicine

www.behavioralsleep.org

 

[DrLizG]

Hello SDN, the thread is exactly as it's stated. Where the hell can one learn more about Clinical Sleep psychology/ behavioral medicine and what's it actually like to be in this specialty (from my uneducated cursory view it seems to be a highly specialized health psychology specialty???). I'm a current undergrad doing unrelated research in PTSD but the effectiveness of CBT in Sleep disorders really caught my eye and it is something that looks interesting from both a clinical and research aspect, the issue is the field is small and information tends to be scarce (besides a few websites). Does anyone have any information or insights regarding Behavioral Sleep Medicine and the typical training process?

Hi, it me. BSM psychologist here subspecializing in sleep and PTSD, feel free to PM me. I didn't get into sleep until my internship year so you are way ahead of the game.

 

[Therapist4Chnge]

It's definitely needed....everything from educating about basic sleep hygiene through addressing PTSD w. night terrors, etc. I see a decent amount of sleep related issues post-TBI, though the largest % are typically adjustment disorder + pre-existing bad sleep hygiene following minor car accidents and/or work injuries. Short-term CBT-I is great. Referring providers love it too bc it lets them avoid/taper most use of habit forming mediocre sleep meds.

 

[PsyDr]

It's definitely needed....everything from educating about basic sleep hygiene through addressing PTSD w. night terrors, etc. I see a decent amount of sleep related issues post-TBI, though the largest % are typically adjustment disorder + pre-existing bad sleep hygiene following minor car accidents and/or work injuries. Short-term CBT-I is great. Referring providers love it too bc it lets them avoid/taper most use of habit forming mediocre sleep meds.

Sleep terrors are neither associated with PTSD nor ameliorated by sleep hygiene.

 

[Therapist4Chnge]

Prazosin, education, and treat the PTSD (Prolonged Exposure Therapy, Cognitive Processing Therapy). I wasn't implying using CBT-I for PTSD and night terrors.

 

[thebalmofhurtminds]

if you're interested in research on PTSD and sleep, that's a whole different ball game from CBT-I/insomnia, just so you know. CBT-I is not an indicated treatment for sleep problems caused by PTSD.

 

[cara susanna]

Thank you both for your responses they actually cleared the air up quite a bit. Maybe one more annoying follow-up question but as someone who enjoys research and would one day like to incorporate research into their career, is it common for psychologists in your field to "combine" research interests. For example could one also do research into how other psychopathologies (such as PTSD) may affect a sleeping disorder (I assume the answer is yes but I figure why not ask)?

Speaking as a PTSD person: yes, I know quite a few people who specialize in sleep and PTSD. For instance, there has been work looking at combining PE with CBT+I because it's likely that sleep problems will actually get in the way of trauma processing work in therapy. It's an extremely important area.

 

[cara susanna]

if you're interested in research on PTSD and sleep, that's a whole different ball game from CBT-I/insomnia, just so you know. CBT-I is not an indicated treatment for sleep problems caused by PTSD.

Actually, there is some evidence that treating PTSD alone will not necessarily help sleep (I'll try to dig up the citation) and that completing CBT-I prior to a PTSD EBP will make the latter more effective. Some VA clinics even suggest that people complete CBT-I prior to engaging in a PTSD EBP.

Edit: Some of the research is discussed here - https://www.ptsd.va.gov/publications/ctu_docs/ctu_v13n4.pdf

"PE did not improve insomnia and nightmare frequency remained clinically significant."

 

[PsyDr]

I was just trying to point out that sleep terrors are categorically different from nightmares. But I'm doing that in my characteristically aggressive way.

 

[thebalmofhurtminds]

Actually, there is some evidence that treating PTSD alone will not necessarily help sleep (I'll try to dig up the citation) and that completing CBT-I prior to a PTSD EBP will make the latter more effective. Some VA clinics even suggest that people complete CBT-I prior to engaging in a PTSD EBP.

Edit: Some of the research is discussed here - https://www.ptsd.va.gov/publications/ctu_docs/ctu_v13n4.pdf

"PE did not improve insomnia and nightmare frequency remained clinically significant."

The research I've seen suggests CBT-I after trauma-focused therapy. Which seems to match with my anecdotal clinical experiences. My patients who have significant trauma symptoms are unlikely to participate meaningfully in CBT-I. I'd be interested to see how that works in a real world setting, especially beyond the VA, where so many other factors are unfortunately at play.

The full quote: "ITT analyses showed that PE alone reduced PTSD symptoms and nightmares; however, PE did not improve insomnia and nightmare frequency remained clinically significant."

 

[thebalmofhurtminds]

Actually, there is some evidence that treating PTSD alone will not necessarily help sleep (I'll try to dig up the citation) and that completing CBT-I prior to a PTSD EBP will make the latter more effective. Some VA clinics even suggest that people complete CBT-I prior to engaging in a PTSD EBP.

Edit: Some of the research is discussed here - https://www.ptsd.va.gov/publications/ctu_docs/ctu_v13n4.pdf

"PE did not improve insomnia and nightmare frequency remained clinically significant."

I stand corrected, looks like there's emerging evidence in some small non-VA samples similar to what you mentioned (e.g. Cognitive Behavioral Therapy for Insomnia in Posttraumatic Stress Disorder: A Randomized Controlled Trial), although there is some indication of regression to the mean here and can't find much research since. I'm so curious about what that would look like in clinical practice where there is a dearth of CBT-I providers already, let alone trying to combine the treatments or try CBT-I first.

 

[cara susanna]

I stand corrected, looks like there's emerging evidence in some small non-VA samples similar to what you mentioned (e.g. Cognitive Behavioral Therapy for Insomnia in Posttraumatic Stress Disorder: A Randomized Controlled Trial), although there is some indication of regression to the mean here and can't find much research since. I'm so curious about what that would look like in clinical practice where there is a dearth of CBT-I providers already, let alone trying to combine the treatments or try CBT-I first.

Yes, basically there's a concern that poor sleep impedes ability for trauma processing. Hence why you'd do CBT-I first.

 

[thebalmofhurtminds]

Yes, basically there's a concern that poor sleep impedes ability for trauma processing. Hence why you'd do CBT-I first.

Has there been any development in that area specifically? Beyond evidence that sleep is important in memory and emotional processing generally, I haven't seen specific studies showing that as a mechanism of impediment for trauma-focused therapy. For example, a plethora of studies have shown significant decrease of sleep symptoms with CPT and PE: Change in Sleep Symptoms across Cognitive Processing Therapy and Prolonged Exposure: A Longitudinal Perspective

"Taken together, the role of sleep disturbance in response to PTSD treatment may not be as directly linked with respect to poor sleep interfering with emotional processing (Walker, 2010) or generalization of extinction learning (Pace-Schott et al., 2009) required for symptom reduction in these treatments. In this light, full remission of sleep disturbance was not necessary to achieve a clinically significant treatment response for PTSD, or to maintain these gains years after treatment completion. Poor sleep hygiene may become an independent problem that must be treated separately."

 

[deuce22]

This is an area of active study (how best to sequence sleep-focused vs trauma-focused interventions in PTSD) and I don't think we have all the answers yet. This article provides a nice summary of current understanding here: Sleep in PTSD: treatment approaches and outcomes .

Here's an excerpt:

"Given that sleep complaints often persist following a course of PTSD-focused interventions and that successful nightmare and insomnia treatments may improve daytime PTSD symptoms, it also is important to understand the potential benefit of sequential or integrated sleep-targeted and PTSD-targeted interventions. A trial examining the efficacy of IRT before CBT for PTSD compared to CBT alone found no superiority of the sequential treatment protocol on PTSD symptoms [27]. However, the group that received supplemental IRT showed greater improvements in sleep symptoms, including nightmare frequency, nightmare-associated distress, and sleep quality. Colvonen et al. [28 ] recently reported on a small pilot study examining the outcomes from an integrated protocol of CBT-I and prolonged exposure (PE), an evidence-based treatment for PTSD, in a sample of Veterans diagnosed with insomnia and PTSD. Following treatment there were clinically significant improvements in PTSD and insomnia severity, with increases in quality of life ratings. The authors posited that providing CBT-I before the start of PE may allow opportunity for sleep consolidation and potentially increase PE’s efficacy. Further investigations are required to determine whether such integrated protocols outperform PTSD-treatment alone, and to determine the optimal timing of when sleep-focused treatment should be introduced during PTSD treatment"

 

[cara susanna]

This is an area of active study (how best to sequence sleep-focused vs trauma-focused interventions in PTSD) and I don't think we have all the answers yet. This article provides a nice summary of current understanding here: Sleep in PTSD: treatment approaches and outcomes .

Here's an excerpt:

"Given that sleep complaints often persist following a course of PTSD-focused interventions and that successful nightmare and insomnia treatments may improve daytime PTSD symptoms, it also is important to understand the potential benefit of sequential or integrated sleep-targeted and PTSD-targeted interventions. A trial examining the efficacy of IRT before CBT for PTSD compared to CBT alone found no superiority of the sequential treatment protocol on PTSD symptoms [27]. However, the group that received supplemental IRT showed greater improvements in sleep symptoms, including nightmare frequency, nightmare-associated distress, and sleep quality. Colvonen et al. [28 ] recently reported on a small pilot study examining the outcomes from an integrated protocol of CBT-I and prolonged exposure (PE), an evidence-based treatment for PTSD, in a sample of Veterans diagnosed with insomnia and PTSD. Following treatment there were clinically significant improvements in PTSD and insomnia severity, with increases in quality of life ratings. The authors posited that providing CBT-I before the start of PE may allow opportunity for sleep consolidation and potentially increase PE’s efficacy. Further investigations are required to determine whether such integrated protocols outperform PTSD-treatment alone, and to determine the optimal timing of when sleep-focused treatment should be introduced during PTSD treatment"

Yes, thank you. I actually attended a seminar by Colvonen on sleep and PTSD and that really changed my thoughts about how to treat it.

 

[Therapist4Chnge]

I was just trying to point out that sleep terrors are categorically different from nightmares. But I'm doing that in my characteristically aggressive way.

I took no offense. I know how you roll.

 

[PsychPhDMama]

When you do your clinical training, primary care might be worth considering since people often first go to their PCP with sleep issues. I’m in a counseling psych PhD program and just finished my advanced practicum in primary care. About 20% of my caseload involved insomnia. COVID escalated the rates. Also, at least in my program, we didn’t receive academic training r/t insomnia. I didn’t read the thread so sorry if I’m repeating anything. CBT-I is pretty straightforward. I found it helped new and/or mild cases, but more complex folks need more complex care.

 

[pediatric_psydoc]

I work in pediatric primary care and see sleep issues in probably 40% of the kids. Behavioral insomnia, insomnia s/t ADHD and/or ASD, and insomnia s/t anxiety or depression are most common. Sometimes I see CPAP non-adherence.

 

[psychnomster]

I think there are a couple of things you want to figure out
1) do you want to do both research and clinical work? do you want to go into academia or do clinical work primarily?
2) do you want to work from a psychology perspective or a medical perspective?

A couple of different routes to finding out more details:
1) check programs/schools across the nation to see if they have labs that specialize in sleep research e.g., Stanford has a lab that does research on sleep
2) check to see which VAs/medical centers do research on sleep (e.g., VA.gov | Veterans Affairs)

I would recommend looking up journal articles related to sleep (e.g., on google scholar) and checking who the authors are and what facility/school they are affiliated with. You can use this bottoms-up approach to find the relevant people doing the type of research that you are interested in. I would challenge the notion that this field is "small." For example, I think esp. among the Veteran's community, sleep and PTSD is a huge issue and one that is actively being researched in VAs across the nation.

To get you started, there's the Journal of Clinical Sleep Medicine: Journal of Clinical Sleep Medicine
Peruse the American Academy of Sleep Medicine: American Academy of Sleep Medicine (AASM) | Sleep | Medical Society
The VA does a lot of research with sleep and PTSD specifically: VA.gov | Veterans Affairs
Here's a VA newsletter where there's a bunch of different VA researchers and their published findings: https://www.ptsd.va.gov/publications/rq_docs/V27N4.pdf

Contact students and professors involved in these labs/studies for informational interviews and go from there.