SLEEPJ
May 8, 2026
Heba A Afaneh, David A Kalmbach, Philip Cheng et al.
Abstract Introduction Insomnia affects half of pregnant women and increases risk for depression. Identifying effective treatments for co-occurring insomnia and depression during pregnancy remains a critical priority. Cognitive-behavioral therapy for insomnia (CBTI) improves sleep quality but has limited impact on depression—an effect attributed to persistent cognitive arousal (worry and...
Sleep
May 1, 2026
Holland Doise, A. Gonzalez Quesada, Garrett Baber et al.
Abstract Introduction Nightmares are associated with more severe posttraumatic stress disorder (PTSD). The advent of large language models (LLM) offers unique advantages to efficiently code affective dream content over human methods, which can be resource intensive and prone to error. This study tested whether dream affect (DA), measured via self-report, human-rated narrative coding, and LLM...
SLEEPJ
May 1, 2026
Lily Jankowiak, Anthony N Reffi, Cameron McCray et al.
The Hospital Mental Health Risk Screen (HMHRS) predicts risk for negative outcomes following acute trauma, including posttraumatic stress disorder (PTSD). Insomnia and nightmares are common reactions to acute trauma and are considered modifiable risk factors for the development of PTSD. The HMHRS may be useful for detecting risk for post-trauma insomnia and nightmares, however, no studies have...
SLEEP Advances
2026
David A Kalmbach, Anthony N Reffi, Philip Cheng et al.
Insomnia is common in pregnancy and is associated with maladaptive sleep behaviors and poor emotion regulation. Cognitive-behavioral therapy for insomnia (CBTI) and Perinatal Understanding of Mindful Awareness for Sleep (PUMAS) are effective interventions for alleviating prenatal insomnia. However, clinical benefits outside the primary target of sleep remain unclear. This randomized controlled...
Journal of Clinical Sleep Medicine
September 1, 2025
Anthony N Reffi, David A Kalmbach, Philip Cheng et al.
Study objectives: Patients with acute trauma are vulnerable to suicidality following hospitalization. Research suggests nightmares and insomnia may interact to potentiate suicidality, possibly due to nightmares worsening co-occurring insomnia. Nightmares and insomnia are common stress reactions to acute trauma and might compound suicide risk within acutely traumatized patients. We tested the...
Sleep
May 1, 2025
Anthony N Reffi, Lily Jankowiak, David Moore et al.
Fear of sleep engenders arousal at bedtime that can promote nightmares. Living in disadvantaged neighborhoods with high rates of community violence may exacerbate fear of sleep and in turn increase nightmare risk. We tested fear of sleep among acute trauma patients as a prospective predictor of nightmares, and whether exposure to community violence moderated this relationship. Patients...
Sleep
May 1, 2025
Mika Hirata, Heba A Afaneh, Ishana Kapoor et al.
Perinatal women are highly vulnerable to insomnia and depression. High cognitive arousal (e.g., worry, rumination) at night is a key risk factor for developing insomnia and depression during this period. However, mindfulness skills have been proposed to reduce risk for negative health outcomes by protecting individuals against the harmful effects of cognitive arousal. This prospective study...
European Journal of Psychotraumatology
October 8, 2024
Anthony N Reffi, Philip Cheng, David A Kalmbach et al.
ABSTRACT Background: Research suggests trauma-related nightmares (TRNs) during the acute aftermath of trauma may contribute to posttraumatic stress disorder (PTSD). However, it is unknown who is most vulnerable to TRNs, which is critical to identify at-risk patients toward whom early nightmare-focused treatments can be targeted to prevent PTSD. Objective: We tested trauma type (interpersonal...
Sleep
April 1, 2024
Anthony N Reffi, David A Moore, Christopher L Drake
Anthony N Reffi, David A Moore, Christopher L Drake; Objective sleep disturbance in nightmares: Is prolonged sleep onset latency a proxy for fear-of-sleep-relat
Journal of Sleep Research
February 1, 2024
David A Kalmbach, Anthony N Reffi, Jason C Ong et al.
9 citations
Treating insomnia during pregnancy improves sleep and depressed mood. However, given well-established links between poor sleep and a broad spectrum of adverse maternal outcomes, the benefits of insomnia care may reach beyond sleep and depression. The present study evaluated the preliminary efficacy of 'Perinatal Understanding of Mindful Awareness for Sleep' (PUMAS)-a mindfulness sleep programme...
Sleep Medicine
August 1, 2023
David A Kalmbach, Philip Cheng, Anthony N Reffi et al.
15 citations
Cognitive-behavioral therapy is effective for prenatal insomnia, but unresolved cognitive arousal limits patient outcomes. Therapies aimed at reducing cognitive arousal may benefit pregnant women with insomnia. This proof-of-concept trial evaluated Perinatal Understanding of Mindful Awareness for Sleep (PUMAS, which combines mindfulness with behavioral sleep strategies) on insomnia, depression,...
Frontiers in Sleep
March 8, 2023
David A Kalmbach, P. Cheng, J. Ong et al.
Objectives Cognitive-behavioral therapy and pharmacotherapy are effective insomnia treatments, yet half of patients do not remit. Emerging evidence indicates refractory cognitive arousal is associated with poor insomnia treatment outcomes, giving rise to the concept that therapeutic approaches directly aimed at reducing cognitive arousal may benefit patients with a history of inadequate...
SLEEP Advances
2023
David A Kalmbach, Philip Cheng, Anthony N Reffi et al.
16 citations
Combining mindfulness with behavioral sleep strategies has been found to alleviate symptoms of insomnia and depression during pregnancy, but mechanisms for this treatment approach remain unclear. The present study examined nocturnal cognitive arousal and sleep effort as potential treatment mechanisms for alleviating insomnia and depression via a mindfulness sleep program for pregnant women....