MEET A SBSM FOUNDER - RYAN WETZLER, PSYD, C.BSM, APBB

As one the founding board members and a past president of the Society of Behavioral Sleep Medicine, I was asked to introduce myself and share some thoughts on the field. My work in behavioral sleep medicine began in 2002, when I was a 4th year health psychology graduate student at Spalding University. I had accepted an invitation to develop an insomnia treatment program for a local sleep disorders center. I had no idea what I was getting myself into.

In 2002 there was little guidance on how to set up such a program. We also did not have nearly the degree of scientific support that we have today. I recall meeting with one of the sleep physicians to discuss project and being handed a copy of the book “No More Sleepless Nights” by Peter Hauri and Shirley Linde. Apparently, the insomnia program involved handing a patient this book. The insomnia program definitely needed some work.

I continued to dabble in the sleep field through a behavioral sleep minor rotation that was developed during my internship with the VA Medical Center in Danville, Illinois from 2003-2004. I really enjoyed the sleep work and wanted to try and make a career out of it. In 2004, I was hired to develop a behavioral sleep program within an independent sleep disorders center in Louisville, Kentucky. Around this time, the American Academy of Sleep Medicine began offering a Behavioral Sleep Medicine Course. There was also an idea floating around that the AASM might begin to require sleep centers to have a behavioral sleep specialist in order to qualify for sleep center accreditation. In 2005, the NIH identified behavioral intervention strategies as a first-line treatment for insomnia. This was a very exciting time! It seemed like every year I was meeting new clinicians who were hired to develop behavioral sleep programs within sleep disorders centers. These behavioral sleep programs were being developed in a variety of healthcare systems and independent sleep practices. Each year we would meet up at APSS to share ideas, discuss challenges, and create solutions. The move toward integration of psychology and medicine was flourishing within the sleep field!

Over the years, the field of behavioral sleep medicine encountered challenges. The AASM ultimately retracted from requiring behavioral sleep specialists for sleep center accreditation. Sleep study reimbursement declined and many sleep centers closed. When sleep became an official medical sub-specialty, sleep psychologists and other PhDs lost the ability to interpret sleep studies. Adding insult to injury, some began advocating for the utilization of non-mental health trained providers to offer psychological services. The integration of psychology and medicine had hit a speed bump and the proliferation of behavioral sleep programs appeared to slow. It was time to form a new society to advocate for the behavioral sleep specialist and to move forward efforts to integrate physical and mental healthcare. The Society of Behavioral Sleep Medicine has not only survived, it has flourished. Although the decision to separate from the American Academy of Sleep Medicine was difficult, it sure seems as though it was the right thing to do. We now have an independent voice for behavioral sleep specialists and there are no constraints on what this group of devoted professionals can accomplish. When I was asked to write this article, I revisited my letter of intent to run for President.

I believe the goals are still relevant today:

• The Society of Behavioral Sleep Medicine is now established, yet needs to be maintained
• Although the research base for behavioral sleep has made tremendous strides forward, practitioners of this science remain few. Securing a clinical base is a critical next step. • Each new provider will have challenges to overcome and would benefit from having a guide. The Society of Behavioral Sleep Medicine can serve as this guide.
• The Society should take a more proactive role with insurance carriers through development of collaborative relationships and serving as a resource for optimal management of sleep disorders. During my earlier years in the sleep field I had the privilege of meeting a number of incredible clinicians. These practitioners were successful in moving behavioral sleep from the bench to the bedside. They all have successful practices, many of which have expanded to include multiple providers.

These unsung heroes of the behavioral sleep field are those who I call whenever I encounter a clinical or practice-related challenge. They include:

• Anne Bartolucci, PhD, CBSM—Owner, Atlanta Insomnia and Behavioral Health Services
• Michael Scherer, PhD, CBSM—Director, Behavioral Sleep Medicine, The Center for Sleep Medicine
• Michael Schmitz, PsyD, CBSM—Director, Behavioral Sleep Medicine Services at Fairview Health Services
• Robert Glidewell, PsyD, CBSM—Founder and Clinical Director, The Insomnia Clinic
• Jonathon Cole, PhD, ABPP—Owner, Bluegrass Health Psychology, Inc.
• Emerson Wickwire, PhD, CBSM, ABPP—Director, Insomnia Program at University of Maryland School of Medicine.
• Michelle Drerup, PsyD, CBSM—Director of Behavioral Sleep Medicine at the Cleveland Clinic
• Kelly Byars, PsyD, CBSM, ABPP—Professor of clinical pediatrics for Behavioral Medicine and Clinical Pediatrics at Cincinnati Children's Hospital Medical Center

In recent years, behavioral sleep has gotten a lot of great press. CBT-I is now recognized as a first line treatment for chronic insomnia by the American College of Physicians. There is renewed interest in behavioral sleep medicine and there are many new graduates interested in starting a behavioral sleep practice. The aforementioned list of providers have all succeeded in doing just that. If you are interested in starting a practice, I would encourage you to reach out to those on this list or to the SBSM leadership. With the sage guidance of the SBSM leadership, board, and committees the society appears poised for progress. There is new energy and the time is right for another push towards integration. Looking forward to seeing everybody at the SBSM Educational meeting and Bootzin Awards and Recognition Meeting on June 2nd!

Meet an SBSM Founder - Michael Smith, PhD

Dear SBSM Members,

As one of the founding past presidents, I was asked to share my memory of the early years of the Society.  I hope this does not mean I am perceived as either rapidly dementing or about to die. 

It will be a decade ago this June 2018 at the Baltimore APSS (SLEEP) meeting, over beer and muscles at “Berthas” that a small group of us decided to launch the Society of Behavioral Sleep Medicine. It grew out of a passion to take destiny by the reigns. The field was discovering great things; our interventions were standing up to double-blinded placebo controlled designs, head-to-head challenges, meta-analyses, outcomes were lasting for two years, as long as we could measure them; but people had no access. Much of the medical profession, even within sleep and I was sorry later find out Psychology equated BSM with sleep hygiene education. It was and sometimes still is a frustrating state of affairs.

We needed an organized voice to advocate for our discipline. We needed legitimacy to realize our full impact on health.  Were we a growing interdisciplinary field with unique skills sets, burgeoning subspecialties within our field, and our own scientific methods? or were we the “insomnia section” of the American Academy of Sleep Medicine. As Sleep Medicine was working to formally recognize itself as medical subspecialty, we seemed to be losing, not gaining ground.

So…. we planned a consensus conference for the field with financial backing from Johns Hopkins Department of Psychiatry and in many ways blind faith that we would not lose money (and we did not, I am happy to say!)  After much debate, we left the conference with enough support, though it was tenuous, at times, to forge ahead. We further solidified support by surveying the field. We negotiated with the American Academy, made our case and ultimately with perseverance, the American Academy of Sleep Medicine agreed. They helped us write our bylaws, became our management company and we were off.  Dr. Michael Perlis was our first president. We formed our Board with many senior leaders stepping up, including Drs. : Kenny Lichstein, Daniel Buysse, Michael Vitiello, Judy Owens.

Running the Society in the early days was hard on us all. With little money, we were always under threat, we worked hard to put things in place: a website; holding our first meeting in Boston; and a subsequent meeting in Baltimore.  Through Kenny Lichstein’s Leadership, we negotiated with Taylor Francis Publishing and adopted the Journal of Behavioral Sleep Medicine as our Society’s Journal. 

We grappled with how best to develop a board exam. Should there be one exam for all practitioners? Should we have multiple exams based on each discipline’s clinical profession? Should there be different levels of certification based on degrees?  The majority, but certainly not all of the membership were psychologists.  The American Psychological Association (APA) offered structural pathways to clearly define the psychology subset of the BSM field. The closely aligned, but separate American Board of Professional Psychology (ABPP) had a process for board certification that might help define and preserve a role for doctoral level clinical psychologists to practice Sleep Psychology.  So with major tension between embracing our diversity of professions and seeking to first define a legitimate pathway for the majority of members, we pursued developing Sleep Psychology as a formally recognized “specialty” of psychology.  This was a required step to approach the ABPP to create a new Board of Sleep Psycholology that would permit us to develop an ABPP exam for psychologists.  These decisions were difficult to make. The idea, whether it will prove true or not, was that with changes in the health care system under “Obamacare,” there was ample precedent that certifications and the reimbursements tied to them were being defined by licenses and degrees, not broad interdisciplinary certification organizations.  The vision was, that for the Society to be vibrant and strong it needed to be interdisciplinary, but certification procedures would need to be developed within each profession. Psychology, because of its critical mass, would go first. Further down this road, other professions that comprise the field, such as nursing and social work, etc. with the Society’s support, would create certifications processes based on the scopes of practices within each clinical license.

We spent many months toiling on the application to recognize Sleep Psychology as a professional specialty. This required us to define all of the proficiencies, skill sets, training standards, etc. needed to practice sleep psychology. To be a specialty and not a proficiency, the field needed to be both broad, but also with enough true depth and scientific foundation that it would meet criteria.  We had to demonstrate that we in fact were a legitimate specialty that cut across more the one disorder, that we had a critical mass of providers and training programs across the country. We had to demonstrate that we did not overlap with other specialties within psychology that could call us a subspecialty. It was quite rigorous and simply put, we met those criteria.  The APA’s commission for the Recognition of Specialties and Proficiencies in Professional Psychology granted specialty recognition for Sleep Psychology in 2013 under Dr. Christina McCrae’s stewardship. We are up for renewal in 2020. As part of this process, we realized that we needed to continue to develop, maintain and expand BSM core competency areas for our field to thrive. This was the impetus behind our decision to create and publish the SBSM Guide to Actigraphy Monitoring, which we published as a special edition of Behavioral Sleep Medicine. I became the Society’s first delegate, so to speak, joining the Board of the Council of Specialties in Professional Psychology.  With these accomplishments under our belt, we applied to develop a board exam in Sleep Psychology.

Much to our surprise, ABPP rejected our application, encouraging us instead to apply as a subspecialty within one of the already established boards. Things were quite political and complicated, but it is fair to say ABPP was expressly seeking to expand and promote a newly developed subspecialty program.  The argument was in fact that sleep medicine itself is subspecialty in medicine and so Sleep Psychology should be too. Needless to say, many of us were disappointed, especially since we appeared to meet all of the criteria and had already achieved independent recognition as a Specialty from APA. We appealed to no avail.  ABPP reiterated the subspecialty pathway, but this itself was vaguely defined and would require members to first become certified in one of the existing ABPP specialties, such as Health Psychology, Clinical Psychology, Cognitive and Behavioral, etc.  We would have to petition these Boards and work with them to develop a subspecialty exam. It was going to be even more costly to become board certified in Sleep Psychology. We were getting a big dose of psychology politics.  I think at this point many of us began to feel that we needed to get back to grass roots BSM. We ultimately decided it did not make sense for us to pursue a subspecialty ABPP exam. 

My hope is that this will become an important inflection point in our continued professional development.  I think it can be a point where we buck the trend and lead the way toward developing a truly interdisciplinary field where we work out some of the professional trade issues over time, but ultimately come to embrace our larger BSM field as our most important identity.

Within this context, we broke away from the Academy of Sleep Medicine. We needed to be more free to pursue our self-interests. It has been quite a journey in 10 years and looking back, a lot was accomplished. It is time for another run. With the American College of Physician’s recommending CBT-I as the first line treatment for Insomnia disorder, we are well positioned to aggressively pursue growth on our field.  We have a strong foundation. We need to focus on expanding our membership base; dramatically. We need to increase our public profile in the media and we need develop a serious philanthropy campaign. We need to forge strong working relationships with primary care and family medicine organizations.  They want to work with us now more than ever.  We need to translate our new science into practice faster.  I think this is where we can really shine. We are a nimble enough community that we need to make sure we a learning new treatments as they come out.

For those of us developing new BSM approaches, we need to ensure that we are training our field to implement them. I look forward seeing what we can all accomplish in the next 10 years.

Sincerely, 
Michael T. Smith

MEET AN SBSM FOUNDER - CHRISTINA MCCRAE, PhD, CBSM

As one of the organizing and founding members of the Society of Behavioral Sleep Medicine and the second President (2011-2012), I have been so excited to see the SBSM continue to grow and develop over the past seven years.  I have been particularly excited to watch as new members join the society, get involved, and change it for the better. I love seeing all the new member benefits and have enjoyed attending the SBSM receptions at SLEEP.

My winding pathway to behavioral sleep medicine

My own pathway to behavioral sleep medicine and eventual involvement in the launching of the SBSM has been anything but direct. I have been involved in research since 1984, but my early focus was aging.  My undergraduate (Penn State; Robert Stern, PhD), master’s (Washington University in St. Louis; Martha Storandt, PhD), and doctoral (Washington University in St. Louis; Richard Abrams, PhD) research focused on aging-related topics. It was not until late in graduate school that I became interested in sleep. Initially, my interest was clinical, and I completed a year long practicum as a behavioral sleep therapist for the Sleep Disorders Center at Barnes Jewish Hospital in St. Louis (supervisors Amy Bertelson, PhD; Stephen Duntley, MD). My internship year was spent at the Audie L. Murphy VA in San Antonio where I (again) focused primarily on aging, but also completed a rotation in sleep (supervisor Paul Igmundson, PhD). 

It was not until my postdoctoral fellowship with Kenny Lichstein, PhD at the University of Memphis that I became involved in sleep research for the first time. As a post-doc, I served as the project coordinator for Kenny’s randomized controlled trial on the impact of the combination of CBT-I and tapered withdrawal on sleep and sleep medication use in hypnotic dependent older adults. That was also my first experience with clinical trial research as my previous experiences had been largely experimental in nature. My dissertation was a series of four related experiments that each required about a week to run participants. Needless to say, I experienced some research ‘culture shock’ while on post-doc as I learned about the amount of effort and time required to run a clinical trial. Despite that, I was hooked and have been involved in conducting behavioral clinical sleep trials (primarily CBT-I or some variation thereof) ever since. I have also branched out from my initial aging only focus and now conduct research and clinical work with children and adults of all ages. 

My goal in providing this overview of my background is to demonstrate that your path to behavioral sleep medicine does not need to be a straight one. What matters is that you eventually find your way here like I did!  

My research program on comorbid insomnia

The common thread in my current research program is comorbid insomnia and my desire to learn more about potentially shared mechanisms underlying the high rates of comorbidity between insomnia and many other chronic conditions across the lifespan. Better understand of those mechanisms will inform better management and treatment of not only insomnia, but also (ideally) the comorbid condition.

My specific areas of research interest are:

• Mechanisms underlying normal and pathological sleep
• Linkages between sleep and cognition
• Daily (or nightly!) variability in sleep and sleep-related behaviors
• Efficacy and effectiveness of cognitive behavioral interventions to treat comorbid insomnia in autism, cancer, cardiac disease, chronic pain, and obesity. 

Reasons for starting the SBSM

Timing, timing, timing. I recognize that my response here is oversimplified, because a variety of factors contributed to the timing being right for the establishment of a behavioral sleep medicine focused society. The groundwork laid by many individuals in our field in terms of clinical service, research, and professional service, including (but not limited to) the establishment of committees and interest groups in broader focused professional societies, Behavioral Sleep Medicine (the journal), certification in behavioral sleep medicine, and accreditation of behavioral sleep medicine training programs. In 2007 when myself and fellow originators started meeting and discussing the potential for SBSM, the behavioral sleep medicine field had grown sufficiently and established key components of the infrastructure (see groundwork above) needed to support the development of a sustainable, dedicated membership organization. The needs of our growing field had outgrown what we were able to get through interest groups and committees that were part of larger, more broadly focused membership organizations. We both wanted and (importantly) were ready to take control of our own destiny! 

It took a village

While I appreciate being acknowledged for the contributions that I and my fellow originators made (and continue to make) to the SBSM, I also want to thank everyone who has made contributions.  There are too many to name individuals by name.  However, I think it is important to note that the SBSM was made possible and importantly, continues to be made possible by the contributions of its many amazing members. It literally ‘took a village’ to launch the SBSM, and village input is needed to keep it going! I encourage all members to get involved in whatever capacity you are able (sustaining your membership, joining a committee, attending the reception, etc.).

My involvement in the launching of the SBSM alongside my fellow co-originator organizers (Kenny Lichstein, PhD; Michael Perlis, PhD; Michael Smith, PhD, Daniel Taylor, PhD) was definitely one of the highlights of my career so far!  It was definitely a labor of love (as well as some blood, sweat, and tears along the way!)…but so, so worth it.

My perspective of the SBSM since 2010

MEET AN SBSM FOUNDERS - MICHAEL PERLIS, PhD

Dr Perlis was one of the five organizing and founding members of the Society of Behavioral Sleep Medicine and served as the SBSM’s first president (2010-2011). He has been in sleep research and sleep medicine since 1984 and his academic parentage includes: Wallace Mendelson MD (Post Bac); Richard Bootzin PhD (Graduate School); Mary Carskadon PhD & Donn Posner PhD (Internship); Daniel Buysse MD, Michael Thase MD, and Donna Giles PhD (Post-Doctoral Fellowship); and Donna Giles (Jr. Faculty Years).  

Dr Perlis' research interests include seven topic areas:

1. behavior, cognitive, and physiologic factors in acute and chronic insomnia;
2. the relative efficacy of behavioral and pharmacologic treatments for insomnia;
3. the potential of behavioral pharmacotherapeutics;
4. insomnia as risk factor for new onset and recurrent depression and the anti-depressant effects of CBT-I;
5. cortical arousal and conditioned CNS activation as a primary perpetuator of chronic insomnia;
6. sensory and information processing and long term memory formation as key features of Insomnia Disorder and insomnia as a hybrid state between wake and sleep; and
7. sleep homeostasis effects on the frequency and severity of insomnia (and the patterning of insomnia over time). 

He has contributed to the editorial boards of Sleep, the Journal of Sleep Research, the journal of Sleep Medicine Research, the journal of Behavioral Sleep Medicine, and the journal of Health Psychology, has served as a member, or chair, of several committees and task forces of the Sleep Research Society and the American Academy of Sleep Medicine and assistant chair for the training program of the SRS for five years.

Where would you like to see the field in 10 years?

Things I would like see completed: 

• Create one or more board/certification exams for which PhDs, MDs, NPs, PAs, MSWs, OTs, and other MLPs are eligible
• Establish SBSM sponsored courses that span the breadth of Behavioral Sleep Medicine (esp. for BSM TXs for OSA, CRDs, and Ped Sleep DXs)
• Establish a CE credentialing body to support (vet and accredit) non-SBSM courses and workshops
• Establish masters level (designated expert status) membership for qualifying clinicians, educators, and scientists
• Enhance the SBSM’s relationship with ABCT, SBM, AASM, and the SRS
• Reach out and develop relationships with the national societies that represent NPs, PAs, MSWs, OTs, and other MLPs
• Reinstitute an annual SBSM meeting
• Create an archive (real and virtual) for materials of relevance to the history, politics, science, and practice of BSM
• Consider a revision (or re-write) of the society’s by-laws to be more commensurate with the needs of a young society

Who goes on your BSM Mount Rushmore?

I can’t imagine that my candidates are much different from those that most people would suggest. The founding fathers for both insomnia research and CBT-I are clearly Richard Bootzin and Art Spielman. The most seminal thinker and doer since has been Charles Morin. Other critical “players” include: Peter Hauri, Jack Edinger, Kenny Lichstein, Colin Espie, and Wally Mendelson. All but one of these people are clearly on the “Who’s Who” list.  Dr. Mendelson is one of the only insomnia researchers whose career spanned from bench to bedside. More, his ideas about the “cognitive” aspect of insomnia presaged (and predated) all those that now view chronic insomnia as a behaviorally induced neurobiological disorder (i.e., as an altered or hybrid state). His work in this area are “must reads” for all of us.

What is your advice to early career individuals, or those re-specializing into behavioral sleep medicine?

Seek out supervision early on and work as collaboratively as possible for the whole of your careers.  What is the next step that you plan on taking either in your research program or clinical practice?Evaluate how behavioral principles (conditioning and reinforcement) can be used to modify how medical maintenance therapy is conducted (behavioral pharmacotherapeutics).  What is your favorite sleep resource that you would like others to be made aware of?Two words: Donn Posner. All kidding aside, Dr. Posner is our single best resource for clinical mentorship and vision for what the next generation of training and therapy may look like.

Is there anything else you would like to let members know about you?

Not so much about me but about society membership. While any professional society should offer its membership much (credentialing, courses, recognition of individual achievement, etc.), it is equally important that members serve the society. I would strongly recommend that our members dedicate some of their time and mind to the furtherance of our field by volunteering to work for the SBSM (sit on or chair committees, design courses, provide lectures, etc.).