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SLEEP: A Core Component of Mental Readiness

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 Team germax@upmc.edu 24 June 2014. Acknowledgments.

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SLEEP: A Core Component of Mental Readiness

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  1. Anne Germain, Ph.D. 24 June, 2014 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 Team germax@upmc.edu 24 June 2014

  2. Anne Germain, Ph.D. 24 June, 2014 Acknowledgments Military Sleep Tactics and Resilience Research Team:Robin Richardson, Ryan Stocker, OommenMammen, Rachel Good, Tyler Conrad, Becky McNamee, John Skicki, Noelle Rode, HassenKhan WPIC/UPMC Resources:NCTRC, WPIC Pharmacy, UPMC Central Lab, UPMC MR Center. UPMC PET Center Funding agencies: Department of Defense; National Institutes of Health

  3. 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

  4. Anne Germain, Ph.D. 24 June, 2014 Building Mental Readiness through Sleep 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

  5. Anne Germain, Ph.D. 24 June, 2014 Sleep: a fundamental brain function • Serves a basic biological needs • Essential for survival and sustaining homeostasis • Alertness and vigilance • Emotion regulation and executive functions • Learning and memory • Cardiovascular & immune functions • Can (temporarily) adapt to demands and conditions: • Like (mal)nutrition, chronic sleep deficiency and fatigue will compromise health, fitness, readiness, and performance, and lead to organ (brain) failure.

  6. Anne Germain, Ph.D. 24 June, 2014 Sleep Across the Deployment Cycle Adapted from Seelig, et al., 2010

  7. Anne Germain, Ph.D. 24 June, 2014 Non-Deployed Service Members Sleep LESS than Civilians

  8. Anne Germain, Ph.D. 24 June, 2014 Operational Injuries Compromise Sleep & Brain Health TBI PTSD

  9. Anne Germain, Ph.D. 24 June, 2014 SLEEP : Core Component of Brain Health Poor Outcomes Sleep Disturbances • PTSD • Anxiety disorders • Depression/Suicidality • Addictive disorders • Chronic mTBI Stress Sleep Consolidation Mental Readiness Pre-existing Sleep Disturbances

  10. Anne Germain, Ph.D. 24 June, 2014 Sleep disturbances are VISIBLE Operational Stress Injuries Germain et al., 2011 OEF/OIF with PTSD > OEF/OIF without PTSD NREM (deep) Sleep> Wakefulness • Threat detection • Vigilance • Goal-oriented behaviors OEF/OIF with PTSD > OEF/OIF without PTSD REM (dream) SLEEP

  11. Anne Germain, Ph.D. 24 June, 2014 Sleep: A modifiable risk factor & treatable OSI Diary Nightmare Frequency d= 0.9 Insomnia Severity Index d= 2.14 Germain et al., J Psychosom Res, 2012 PTSD Checklist d= .85

  12. Anne Germain, Ph.D. 24 June, 2014 Sleep: A modifiable risk factor & treatable OSI Brief behavioral treatment of insomnia (BBTI-MV; 2 sessions/4 weeks) Warfighter Sleep Kit • To distill principles of sleep regulation into 4 sleep-promoting behaviors, • Get up at the same time every day • Don’t nap • Don’t go to bed unless sleepy • 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.

  13. Anne Germain, Ph.D. 24 June, 2014 iREST(Interactive Resilience Enhancing Sleep Tactics) Self-management Monitoring Reinforcing Diary and tracking BBTI IRT Case-by-case modifications Thought control Reminders Mindfulness User app Clinician Portal Reminders Courtesy of Dr. Bambang Parmanto, University of Pittsburgh

  14. Anne Germain, Ph.D. 24 June, 2014 Army Medicine, 2013

  15. Anne Germain, Ph.D. 24 June, 2014 TEAM-TBI (PI: Okonkwo, University of Pittsburgh)

  16. SLEEP Software Digital Sleep Diary IREST mHealth Tools Physical Fit Bit Sleep Mask Ear plugs TEAM TBI Trajectory Map GENERAL iPad Mini Software Breathe 2 Relax Mindfulness Techniques Physical Fit Bit ANXIETY/MOOD MIGRAINES/ CERVICAL ? IMAGING Software HDFT Report App Vestibular Exercise Videos Good Days Ahead Stick N Find COGNITIVE VESTIBULAR Ocular motor Exercise Videos OCULAR MOTOR

  17. Germain, Ph.D. 24 June, 2014 Summary • Sleep is a core component of mental readiness. • Sleep disturbances compromise mental readiness. • Sleep disturbances are a modifiable risk factor. • Evidence -based behavioral or pharmacological strategies. • 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.

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