Bio

Clinical Focus


  • Sleep Medicine
  • CPAP Adherence
  • Circadian Rhythm Disorders
  • Psychology
  • Non-pharmacological Treatment of Insomnia

Academic Appointments


Administrative Appointments


  • Co-Director of Behavioral Sleep Medicine Fellowship Training, Department of Psychiatry & Behavioral Sciences (2012 - Present)
  • Associate Director, Insomnia & Behavioral Sleep Medicine Program, Stanford Sleep Medicine Center (2010 - Present)

Professional Education


  • Fellowship:Stanford Hospital and Clinics (04/18/2010) CA
  • Medical Education:Nova Southeastern University (08/2008) FL
  • Board Certificate, American Board of Sleep Medicine, Behavioral Sleep Medicine (2010)
  • Internship:Miami Children's Hospital (08/2008) FL

Research & Scholarship

Current Research and Scholarly Interests


Research interests are focused on the study of cognitive behavioral therapy for insomnia (CBTi) treatment outcome, modification of CBTi and use in special populations, treatment development, and evaluation of clinical factors in early remission and relapse prevention. Additional area of research interest includes development of an integrated model of care for improved CPAP adherence outcomes.

Teaching

Postdoctoral Advisees


Publications

Journal Articles


  • Lessons Learned from the National Dissemination of Cognitive Behavioral Therapy for Insomnia in the Veterans Health Administration: Impact of Training on Therapists' Self-Efficacy and Attitudes Sleep Medicine Clinics Manber, R., Trockel, M., Batdorf, W., Siebern, A. T., Taylor, C. B., Karlin, B. E. 2013; 8 (3): 399-405
  • Non-Pharmacological Treatment of Insomnia NEUROTHERAPEUTICS Siebern, A. T., Suh, S., Nowakowski, S. 2012; 9 (4): 717-727

    Abstract

    Insomnia is one of the most common sleep disorders, which is characterized by nocturnal symptoms of difficulties initiating and/or maintaining sleep, and by daytime symptoms that impair occupational, social, or other areas of functioning. Insomnia disorder can exist alone or in conjunction with comorbid medical and/or psychiatric conditions. The incidence of insomnia is higher in women and can increase during certain junctures of a woman's life (e.g., pregnancy, postpartum, and menopause). This article will focus on an overview of cognitive behavioral therapy for insomnia, evidence of effectiveness for this treatment when insomnia disorder is experienced alone or in parallel with a comorbidity, and a review with promising data on the use of cognitive behavioral therapy for insomnia when present during postpartum and menopause.

    View details for DOI 10.1007/s13311-012-0142-9

    View details for Web of Science ID 000310325000005

    View details for PubMedID 22935989

  • Sleepiness and fatigue following traumatic brain injury: a clear relationship? SLEEP MEDICINE Siebern, A. T., Guilleminault, C. 2012; 13 (6): 559-560

    View details for DOI 10.1016/j.sleep.2012.03.003

    View details for Web of Science ID 000306304700002

    View details for PubMedID 22608678

  • Clinical significance of night-to-night sleep variability in insomnia SLEEP MEDICINE Suh, S., Nowakowski, S., Bernert, R. A., Ong, J. C., Siebern, A. T., Dowdle, C. L., Manber, R. 2012; 13 (5): 469-475

    Abstract

    To evaluate the clinical relevance of night-to-night variability of sleep schedules and insomnia symptoms.The sample consisted of 455 patients (193 men, mean age=48) seeking treatment for insomnia in a sleep medicine clinic. All participants received group cognitive behavioral therapy for insomnia (CBTI). Variability in sleep parameters was assessed using sleep diary data. Two composite scores were computed, a behavioral schedule composite score (BCS) and insomnia symptom composite score (ICS). The Insomnia Severity Index, the Beck Depression Inventory, and the Morningness-Eveningness Composite Scale were administered at baseline and post-treatment.Results revealed that greater BCS scores were significantly associated with younger age, eveningness chronotype, and greater depression severity (p<0.001). Both depression severity and eveningness chronotype independently predicted variability in sleep schedules (p<0.001). Finally, CBTI resulted in reduced sleep variability for all sleep diary variables except bedtime. Post-treatment symptom reductions in depression severity were greater among those with high versus low baseline BCS scores (p<0.001).Results suggest that variability in sleep schedules predict reduction in insomnia and depressive severity following group CBTI. Schedule variability may be particularly important to assess and address among patients with high depression symptoms and those with the evening chronotype.

    View details for DOI 10.1016/j.sleep.2011.10.034

    View details for Web of Science ID 000303346800004

    View details for PubMedID 22357064

  • Cognitions and Insomnia Subgroups. Cognitive therapy and research Suh, S., Ong, J. C., Steidtmann, D., Nowakowski, S., Dowdle, C., Willett, E., Siebern, A., Manber, R. 2012; 36 (2): 120-128

    Abstract

    This study explored cognitive predictors of multiple symptoms of insomnia (difficulty with sleep initiation, maintenance, and early morning awakenings) among a sample of individuals seeking cognitive-behavior therapy for insomnia.Participants consisted of 146 clinical patients with insomnia of which 67 (45.89%) were classified as Single Symptoms subgroup and 79 (54.11%) as Combined subgroup. A receiver operating curve (ROC) analysis was conducted to identify predictors of Combined versus Single Symptom subgroups. The set of predictor variables included demographics, sleep-related cognitions, circadian preferences, depression symptoms, and self-report sleep parameters with insomnia subgroups (Combined versus Single Symptom only) as the dependent variable.The ROC analysis identified two significant predictors: Self Efficacy Scale (SES) < 23 and a 3-item subscale of the Glasgow Content of Thoughts Inventory (GCTI) assessing "thoughts about the environment" with scores ? 5. Post-hoc comparisons revealed that individuals with combined symptoms who had SES score < 23 had significantly longer sleep onset latency (SOL) and more number of nights with SOL>30 minutes, poorer sleep quality, higher insomnia severity, less morningness tendency, higher depression symptom severity, and more anxiety about anxiety and about sleep compared to individuals with SES score ? 23.These findings indicate that low self-efficacy and increased thoughts about the environment are associated with having multiple symptoms of insomnia. Further research should examine the specific role of self-efficacy and thought content in the etiology of individuals who suffer from multiple symptoms of insomnia.

    View details for PubMedID 23794767

  • Dissemination of CBTI to the Non-Sleep Specialist: Protocol Development and Training Issues JOURNAL OF CLINICAL SLEEP MEDICINE Manber, R., Carney, C., Edinger, J., Epstein, D., Friedman, L., Haynes, P. L., Karlin, B. E., Pigeon, W., Siebern, A. T., Trockel, M. 2012; 8 (2): 209-218

    Abstract

    Strong evidence supports the efficacy of cognitive behavioral therapy for insomnia (CBTI). A significant barrier to wide dissemination of CBTI is the lack of qualified practitioners. We describe challenges and decisions made when developing a CBTI dissemination program in the Veterans Health Administration (VHA). The program targets mental health clinicians from different disciplines (psychiatry, psychology, social work, and nursing) with varying familiarity and experience with general principles of cognitive behavioral therapies (CBT). We explain the scope of training (how much to teach about the science of sleep, comorbid sleep disorders, other medical and mental health comorbidities, and hypnotic-dependent insomnia), discuss adaptation of CBTI to address the unique challenges posed by comorbid insomnia, and describe decisions made about the strategy of training (principles, structure and materials developed/recommended). Among these decisions is the question of how to balance the structure and flexibility of the treatment protocol. We developed a case conceptualization-driven approach and provide a general session-by-session outline. Training licensed therapists who already have many professional obligations required that the training be completed in a relatively short time with minimal disruptions to training participants' routine work responsibilities. These "real-life" constraints shaped the development of this competency-based, yet pragmatic training program. We conclude with a description of preliminary lessons learned from the initial wave of training and propose future directions for research and dissemination.

    View details for DOI 10.5664/jcsm.1786

    View details for Web of Science ID 000302862200017

    View details for PubMedID 22505869

  • CBT for Insomnia in Patients with High and Low Depressive Symptom Severity: Adherence and Clinical Outcomes JOURNAL OF CLINICAL SLEEP MEDICINE Manber, R., Bernert, R. A., Suh, S., Nowakowski, S., Siebern, A. T., Ong, J. C. 2011; 7 (6): 645-652

    Abstract

    To evaluate whether depressive symptom severity leads to poorer response and perceived adherence to cognitive behavioral therapy for insomnia (CBTI) and to examine the impact of CBTI on well-being, depressive symptom severity, and suicidal ideation.Pre- to posttreatment case replication series comparing low depression (LowDep) and high depression (HiDep) groups (based on a cutoff of 14 on the Beck Depression Inventory [BDI]).127 men and 174 women referred for the treatment of insomnia.Seven sessions of group CBTI.Improvement in the insomnia severity, perceived energy, productivity, self-esteem, other aspects of wellbeing, and overall treatment satisfaction did not differ between the HiDep and LowDep groups (p > 0.14). HiDep patients reported lower adherence to a fixed rise time, restricting time in bed, and changing expectations about sleep (p < 0.05). HiDep participants experienced significant reductions in BDI, after removing the sleep item. Levels of suicidal ideation dropped significantly among patients with pretreatment elevations (p < 0.0001).Results suggest that pre- to post CBTI improvements in insomnia symptoms, perceived energy, productivity, self-esteem, and other aspects of well-being were similar among patients with and without elevation in depressive symptom severity. Thus, the benefits of CBTI extend beyond insomnia and include improvements in non-sleep outcomes, such as overall well-being and depressive symptom severity, including suicidal ideation, among patients with baseline elevations. Results identify aspects of CBTI that may merit additional attention to further improve outcomes among patients with insomnia and elevated depressive symptom severity.

    View details for DOI 10.5664/jcsm.1472

    View details for Web of Science ID 000300161900012

    View details for PubMedID 22171204

  • New developments in cognitive behavioral therapy as the first-line treatment of insomnia. Psychology research and behavior management Siebern, A. T., Manber, R. 2011; 4: 21-28

    Abstract

    Insomnia is the most common sleep disorder. Psychological, behavioral, and biological factors are implicated in the development and maintenance of insomnia as a disorder, although the etiology of insomnia remains under investigation, as it is still not fully understood. Cognitive behavioral therapy for insomnia (CBTI) is a treatment for insomnia that is grounded in the science of behavior change, psychological theories, and the science of sleep. There is strong empirical evidence that CBTI is effective. Recognition of CBTI as the first-line treatment for chronic insomnia (National Institutes of Health consensus, British Medical Association) was based largely on evidence of its efficacy in primary insomnia. The aim of this article is to provide background information and review recent developments in CBTI, focusing on three domains: promising data on the use of CBTI when insomnia is experienced in the presence of comorbid conditions, new data on the use of CBTI as maintenance therapy, and emerging data on the delivery of CBTI through the use of technology and in primary care settings.

    View details for DOI 10.2147/PRBM.S10041

    View details for PubMedID 22114532

  • Insomnia and Its Effective Non-pharmacologic Treatment MEDICAL CLINICS OF NORTH AMERICA Siebern, A. T., Manber, R. 2010; 94 (3): 581-?

    Abstract

    Emerging data underscores the public health and economic burden of insomnia evidenced by increased health risks; increased health care utilization; and work domain deficits (absenteeism and reduced productivity). Cognitive behavioral therapy for insomnia (CBTi) is a brief and effective non-pharmacologic treatment for insomnia that is grounded in the science of sleep medicine and the science of behavior change and psychological theory, and in direct comparisons with sleep medication in randomized control trials that demonstrate that CBTi has comparable efficacy with more durable long-term maintenance of gains after treatment discontinuation. The high level of empirical support for CBTi has led the National Institutes of Health Consensus and the American Academy of Sleep Medicine Practice Parameters to make the recommendation that CBTi be considered standard treatment. The aim of this report is to increase awareness and understanding of health care providers of this effective treatment option.

    View details for DOI 10.1016/j.mcna.2010.02.005

    View details for Web of Science ID 000278853600011

    View details for PubMedID 20451034

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