At UVA School of Medicine, endowed professorships are reserved for the most distinguished of our faculty. Please join us in congratulating the below faculty for their election in 2017 to an endowed chair!

Stewart F. Babbott, MD, Ward K. Ensminger Professor of Medicine, Geriatric Medicine, and Palliative Care, Department of Medicine

Karen K. Ballen, MD, Cancer Center Distinguished Professor, Department of Medicine

Ananda Basu, MD, Harrison Distinguished Teaching Professor of Medicine, Department of Medicine

Amy H. Bouton, PhD, Harrison Distinguished Teaching Professor of Microbiology, Immunology, and Cancer Biology,

Department of Microbiology, Immunology, and Cancer Biology

Raymond A. Costabile, MD, Hovey S. Dabney Eminent Scholar Professor of Urology (former occupant of the Jay Y. Gilllenwater Professorship in Urology), Department of Urology

Camilo E. Fadul, MD, Jean and Ronald Butcher, MD, Eminent Scholar Professor of Neurology, Department of Neurology

John D. Ferguson, MD, Julian Ruffin Beckwith Professor of Medicine, Department of Medicine

Tracey L. Krupski, MD, Jay Y. Gillenwater Associate Professor of Urology, Department of Urology

Coleen A. McNamara, MD, Frances Myers Ball Professor of Medicine (former occupant of the Edward W. and Betty Knight Scripps Professorship in Medicine), Department of Medicine

Susan M. Pollart, MD, Walter M. Seward Professor of Family Medicine (former occupant of the Ruth E. Murdaugh Professorship in Family Practice),
Department of Family Medicine

Lee M. Ritterband, PhD, Jean and Ronald Butcher, MD, Eminent Scholar Professor of Psychiatry and Neurobehavioral Sciences,
Department of Psychiatry and Neurobehavioral Sciences

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(Boston) — Black women are among those most likely to have insomnia, according to Lynn Rosenberg, ScD, associate director of Boston University’s Slone Epidemiology Center and a principal investigator of the Black Women’s Health Study (BWHS). Rosenberg has been awarded a three year $2,225,495 grant from the Patient-Centered Outcomes Research Institute (PCORI) to study this. The study will be using a self-administered internet program called SHUTi (Sleep Healthy Using the Internet), a web-tool based on cognitive behavioral therapy (CBT).

CBT is the most effective treatment for insomnia because it treats the underlying causes of the disorder, unlike medications that only treat the symptoms. Unfortunately, there are few healthcare providers in the United States that are trained to provide CBT. There also are other barriers for black women, such as not having adequate access to health care.

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In the frenzied, never-ending search for more sleep, you can’t say people aren’t getting creative. There are beanie-like sleep caps that claim to bring down brain activity, magnetized pillows to align the biological clock, and body creams that “rub out” insomnia, such as the pale purple Sleepy Lotion by Lush, which boasts a cult-like following among the restless. Even podcasts like Sleep With Me or Sleep Whispers have been specially designed to bore, and in turn, help clock in more nighttime hours. And let’s not forget about creative pill cocktail-ing: “It’s not uncommon for people to tell me they’re taking an Ambien, two Tylenol PM, and a glass of wine and still only get 3 and a half hours of sleep at night,” says Michael Breus, Ph.D., a fellow of the American Academy of Sleep Medicine. Desperate? That might be an understatement. But there’s exciting news for the bleary-eyed: A non-addictive, healthy bedtime fix already exists. And it’s really effective.

The official title—Cognitive Behavioral Therapy for Insomnia (CBT-I)—carries the appeal of raw broccoli to an 8-year-old stuck at dinner, but it’s been shown to help 70 to 80 percent of people with the disorder, which is diagnosed after enduring broken, irregular, or inadequate sleeping habits at least three times a week. (After three months, it’s labeled chronic insomnia—a struggle for a staggering 10 percent of the population.) And for those with milder or new sleep problems who can’t seem to benefit from white noise, a chilled room, or fewer later-in-the-day caffeine fixes, CBT-I works beautifully, says Michael Grandner, Ph.D., director of the Sleep and Health Research Program at the University of Arizona.

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How you’d sleep last night? There’s a hefty chance it was not so good. According to the Centers for Disease Control and Prevention, one-third of the American public is suffering from insomnia. Whether this number sounds like a lot or a total understatement probably depends on whether you’re the one tossing and turning at night. Insomnia can make everyday life hard—that is, difficult to function during the day at work and scary to get behind the wheel of a car. In addition to fatigue, too little sleep impacts mental and physical health in a variety of less immediate ways, making us more likely to be depressed, sick and overweight.

For years, doctors have been telling sleep-deprived patients to practice to good sleep hygiene, for example, cutting back on coffee, nicotine, alcohol, naps and bouts of vigorous exercise right before bedtime; and creating a cool, quiet, dark and comfortable sleep environment in the bedroom. If those commonsense recommendations don’t do the trick, there are high-tech tools that offer some relief—for a price.

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Web-based therapy for insomnia is an effective option that could reach “previously unimaginable numbers of people,” researchers suggest.

Although cognitive behavior therapy for insomnia (CBT-I) is the first-line treatment for adults with chronic insomnia, there aren’t enough trained clinicians to deliver the treatment, according to Dr. Lee Ritterband of the University of Virginia School of Medicine in Charlottesville and colleagues.

To investigate whether web-based CBT-I is effective over the long term and might enable more people to benefit, the team randomly assigned 303 adults with chronic insomnia to a six-week automated, interactive and tailored web-based program (Sleep Healthy Using the Internet, or SHUTi, at www.myshuti.com) or an online, nontailored patient education program about insomnia.

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Those with sleeping troubles can now turn to their screens for effective treatment, that is as long as they don’t do the turning in the middle of the night when the should be sleeping. The treatment is an Internet-based cognitive-behavioral therapy know as SHUTi (for “Sleep Healthy Using the Internet”) and new research documents the effectiveness of this automated approach. That’s right, automated. Therapy without a therapist has come of age, at least for insomnia.

As anyone who has struggled with sleepless nights knows, and 50% of adults do at some point, insomnia is a big problem. For 2 out of 10 adults sleeplessness is severe enough to meet criteria for an insomnia disorder. Sleeplessness has been shown to crash one’s mood, slow thinking, impair judgement, increase workplace accidents and absences while decreasing performance, and just generally ruin one’s day.

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ADHD – or attention deficit hyperactivity disorder – tends to be characterised by difficulties in concentrating, impulsivity, and hyperactivity. Claudia Hammond talks to Philip Asherson, Professor of Clinical and Molecular Psychiatry at Kings College London and a consultant at the Maudsley Hospital in London, who has recently published research that shows that excessive mind-wandering might be at its core. She also hears from two teenage girls with ADHD about their experience of mindwandering during school lessons.

it’s not at all unusual for people with depression to have difficulty sleeping. Now a trial has focussed on treating the insomnia in the hope that it improves the depression, rather than vice versa. Professor of Mental Health, Helen Christensen, and Dr Aliza Werner-Saidler, a Research Fellow and Clinical Psychologist at the Black Dog Institute at the University of New South Wales in Australia, showed Claudia Hammond how an online programme called SHUTi – developed by the University of Virginia and commercially available – helped people with insomnia and depression.

Two years ago on All in the Mind we debated the merits of a new scheme to get more high-flying graduates into the mental health field. Called Think Ahead it follows in the footsteps of similar schemes like Teach First. This time top graduates train, mostly on the job, to become mental health social workers. Claudia finds out how two of the first graduates are getting on in the their first placements.

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Can’t get to sleep? Try online therapy. While a glowing screen is a counter-intuitive cure for insomnia, there is evidence that online cognitive behavourial therapy (CBT) can restore normal sleep patterns. In a study published in this month’s Jama Psychiatry, an online CBT programme cured 57% of those who used it, compared with 27% who had standard education about insomnia.

Insomnia affects up to half of all people – with up to 20% having a serious problem with getting off to sleep (or falling asleep again if they wake up). Chronic insomnia can last for years – making people feel sleepy during the day and anxious at night. Standard advice includes promoting “sleep hygiene”: a cool, dark bedroom; going to bed and getting up at the same time every day; and not napping. After that, it’s face-to-face cognitive behavioural therapy – but there aren’t enough therapists to go round. This may be why people are still prescribed sleeping tablets that make them feel pleasantly dissociated and are very addictive.

In an editorial accompanying this latest research, Andrew D Krystal from the department of psychiatry at the University of California says it is inevitable that internet CBT will become the first line of treatment for insomnia.

So should you be asking for it already?

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Lee M. Ritterband, Ph.D.
Professor, Department of Psychiatry and Neurobehavioral Sciences
Director, Center for Behavioral Health and Technology
University of Virginia School of Medicine
Ivy Foundational Translational Research Building
Charlottesville, VA 22903

MedicalResearch.com: What is the background for this study?

Response: Cognitive behavioral therapy for insomnia, a non-pharmacological intervention, is the first line recommendation for adults with chronic insomnia (see recommendations made earlier this year from the American College of Physicians). Access to CBT-I, however, is limited by numerous barriers, including a limited supply of behavioral medicine providers. One way to help improve access to this effective treatment is to develop and evaluate additional delivery methods of CBT-I, including Internet-delivered CBT-I.

This study was designed to evaluate the efficacy of an Internet-delivered CBT-I program (SHUTi: Sleep Healthy Using The Internet) over the short-term (9-weeks) and long-term (1-year).

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