SLEEP: A Core Component of Mental

Readiness

Anne Germain, Ph.D.

Associate Professor of Psychiatry & Psychology University of Pittsburgh School of Medicine

Military Sleep Tactics and Resilience Research Teamgermax@upmc.edu

24 June 2014

Anne Germain, Ph.D. 24 June, 2014

MILITARY SLEEP TACTICS AND RESILIENCE RESEARCH TEAM: Robin Richardson, Ryan Stocker, Oommen Mammen, Rachel Good, Tyler Conrad, Becky McNamee, John Skicki, Noelle Rode, Hassen Khan

WPIC/UPMC RESOURCES: NCTRC, WPIC Pharmacy, UPMC Central Lab, UPMC MR Center. UPMC PET Center

FUNDING AGENCIES: Department of Defense; National Institutes of Health

Anne Germain, Ph.D. 24 June, 2014

“In peace and war,

the lack of sleep works like termites

in a house:

Below the surface, gnawing quietly

and unseen

to produce gradual weakening,

which can lead to sudden and

unexpected collapse.”

Maj. Gen. Aubrey “Red” Newman, Follow Me , 1981

Anne Germain, Ph.D. 24 June, 2014

Building Mental Readiness through Sleep

CHALLENGES

• The good ones

• The not so good ones

• The bad ones

RESOURCES

• Training /expertise

• Equipment

• Reliable Team

• External Support

PROBLEMS when:

• Unavoidable insult

• Overuse/abuse

• Poor maintenance

• Wrong team

• Cut from support

Anne Germain, Ph.D. 24 June, 2014

Sleep: a fundamental brain function

Anne Germain, Ph.D. 24 June, 2014

Sleep Across the Deployment Cycle

Adapted from Seelig, et al., 2010

Anne Germain, Ph.D. 24 June, 2014

Non-Deployed Service Members Sleep LESS than Civilians

Anne Germain, Ph.D. 24 June, 2014

TBI PTSD

Anne Germain, Ph.D. 24 June, 2014

Stress

Pre-existing Sleep Disturbances

Poor Outcomes

SLEEP : Core Component of Brain Health

Sleep Consolidation Mental Readiness

•PTSD •Anxiety disorders•Depression/Suicidality•Addictive disorders•Chronic mTBI

Sleep Disturbances

Anne Germain, Ph.D. 24 June, 2014

Sleep disturbances are VISIBLE Operational Stress Injuries

OEF/OIF with PTSD > OEF/OIF without PTSDNREM (deep) Sleep> Wakefulness

Anne Germain, Ph.D. 24 June, 2014

OEF/OIF with PTSD > OEF/OIF without PTSDREM (dream) SLEEP

Germain et al., 2011

Threat detection

Vigilance

Goal-oriented

behaviors

Germain et al., J Psychosom Res, 2012

Sleep: A modifiable risk factor & treatable OSI

Diary Nightmare Frequency d= 0.9 Insomnia Severity Index d= 2.14

PTSD Checklist d= .85

Anne Germain, Ph.D. 24 June, 2014

Sleep: A modifiable risk factor & treatable OSI

• To distill principles of sleep regulation into 4 sleep-promoting behaviors,

1.Get up at the same time every day

2.Don’t nap3.Don’t go to bed unless sleepy4.Don’t stay in bed unless asleep

• Develop an intervention package, based on empirical findings and specifically aimed at enhancing resilience through sleep and fatigue management in deployed military personnel.

Brief behavioral treatment of insomnia (BBTI-MV; 2 sessions/4

weeks)Warfighter Sleep Kit

Anne Germain, Ph.D. 24 June, 2014

Clinicians

Patient

Self-managementDiary and tracking

BBTI

IRT

Monitoring

Reinforcing

Case-by-case modifications

Thought control

Reminders

Reminders

Courtesy of Dr. Bambang Parmanto, University of Pittsburgh

Mindfulness

User app Clinician Portal

Anne Germain, Ph.D. 24 June, 2014

Anne Germain, Ph.D. 24 June, 2014

Army Medicine, 2013

TEAM-TBI(PI: Okonkwo, University of Pittsburgh)

Anne Germain, Ph.D. 24 June, 2014

SoftwareDigital Sleep Diary

IREST mHealth ToolsPhysical

Fit BitSleep MaskEar plugs

Softw

are

Breathe 2 R

elax

Mindfulness Techniques

Physical

Fit Bit

Vestibular Exercise Videos

OCULAR MOTOR

AN

XIE

TY/M

OO

DV

ES

TIBU

LAR

SLEEP

CO

GN

ITIV

E

MIG

RA

INE

S/

CE

RV

ICA

L

?

Ocular motor Exercise Videos

Good Days Ahead

Stick N Find

GE

NE

RA

LiP

ad M

ini

IMAGING

SoftwareHDFT Report App

TEAM TBI Trajectory Map

Summary

1. Sleep is a core component of mental readiness.

2. Sleep disturbances compromise mental readiness.

3. Sleep disturbances are a modifiable risk factor.

• Evidence -based behavioral or pharmacological strategies.

4. Interventions focused on promoting sleep health can enhance brain health and resilience, and accelerate recovery from operational stress injuries.

• Need to package intervention tools into military-relevant tools.

Germain, Ph.D. 24 June, 2014