Background: Medical residents are vulnerable to poor sleep quality due to intense work shifts and academic load. Studies objectively quantified with sleep quantity and quality among resident physicians are limited. Meditation techniques have been shown to improve sleep but are rarely studied in this population. The aim of the present study is to evaluate sleep patterns of internal medicine residents and the effect of a structured Heartfulness meditation program to improve sleep quality. Methods: A total of 36 residents participated in a pre–post cohort study from January 2019 through April 2019. Sleep was monitored during a one-week outpatient rotation with two validated assessment tools, namely consensus sleep diary and actigraphy. After four intervening weeks, when the residents returned to the same rotation, Heartfulness meditation was practiced and the same parameters were measured. At the end of the study period, an anonymous qualitative feedback survey was collected to assess the feasibility of the intervention. Results: All 36 residents participated in the study (mean age 31.09 years, SD 4.87); 34 residents (94.4%) had complete pre–post data. Consensus sleep diary data showed decreased sleep onset time from 21.03 to 14.84 min ( P = .01); sleep quality and restfulness scores increased from 3.32 to 3.89 and 3.08 to 3.54, respectively ( P < .001 for both). Actigraphy showed a change in sleep onset time from 20.9 min to 14.5 min ( P = .003). Sleep efficiency improved from 83.5% to 85.6% ( P = .019). Wakefulness after initial sleep onset changed from 38.8 to 39.9 min ( P = .682). Sleep fragmentation index and the number of awakenings decreased from 6.16 to 5.46 ( P = .004) and 41.71 to 36.37 ( P = .013), respectively. Conclusions: Residents obtained nearly 7 h of sleep during outpatient rotation. Findings suggest a structured Heartfulness meditation practice to be a feasible program to improve subjective sleep onset time and several objective measures among resident physicians.

Introduction Insomnia is frequent in opioid use disorder patients on buprenorphine (OUDB) and increases risk of relapse. There is lack of data evaluating specific differences in hyperarousal and daytime sequelae between OUDBs as compared to individuals with insomnia disorder without (ID) or with comorbid psychiatric conditions (CID). Methods We studied 112 patients with ID (47.8±16.3y, 55% female, 13% minority) and 148 with CID (44.7±15.6y, 69% female, 16% minority) evaluated at the Behavioral Sleep Medicine program of Penn State Hershey Sleep Research & Treatment Center and 71 OUDB (37.8±11.2y, 51% female, 16% minority) evaluated at the Recovery, Advocacy, Empowerment and Service program and WellSpan Internal Medicine clinics (York, PA). Subjects completed the Insomnia Severity Index (ISI), Ford Insomnia Response to Stress (FIRST), Arousal Predisposition Scale (APS), Pre-sleep Arousal cognitive (PSAS-C) and somatic (PSAS-S) Scale, Dysfunctional Beliefs and Attitudes about Sleep Scale (DBAS) and Epworth Sleepiness Scale (ESS). Excessive daytime sleepiness (EDS) was defined as an ESS score ≥ 10. MANCOVA included age, sex, race/ethnicity and depression as covariates, while logistic regression further included ISI, APS and PSAS-S. Results No differences across groups were observed in PSAS-C or DBAS scores. Subjects with CID and OUDB had significantly higher PSAS-S (15.7±0.5 and 16.4±0.7, respectively) and APS (35.6±0.6 and 36±1, respectively) scores as compared to the ID group (14.2±0.6 and 33.2±0.7, respectively). Subjects with OUDB had significantly higher ESS score (9.8±0.6) as compared to the ID or CID groups (6.2±0.5 and 6.4±0.4, respectively). The odds of EDS were 2.7 times (95%CI=1.2-6.1) higher in the OUDB group as compared to the ID group. Conclusion OUDB may present with similar phenotypic insomnia symptoms as patients with ID or CID but report more sleep-disturbing somatic symptoms and EDS. These data have important implications for tailoring behavioral and pharmacological treatments of insomnia to this specific patient population. Support Junior Faculty Development Program, Penn State College of Medicine

Because of the opioid overdose epidemic, over the past decade, efforts have been made to reduce opioid prescribing. However, tapering patients off their chronic opioid medications can lead to opioid withdrawal and increased chronic pain, use of illicit opioids, mental health crisis, and opioid overdose. Strategies for safely tapering opioids are needed because of these risks. This case report describes a 57-year-old male suffering from chronic back pain who had been on high-dose opioids for over 20 years. Using shared decision-making, a simple pain assessment tool, and a patient-guided taper schedule, he was able to taper off his opioids completely. This case highlights a successful opioid taper and presents simple strategies that can be used by patients and clinicians who are working to reduce chronic high-dose opioid use.

Introduction Sleep disturbances and depression are highly prevalent in Opioid use disorder subjects treated with buprenorphine. However, the association between sleep disturbances such as insomnia/hypersomnia and depression in the above patient population is not known. The aim of the study is to examine the association between sleep disturbances including insomnia and hypersomnia with depressive disorders in buprenorphine treated opioid use disorder (OUDB) subjects. Methods We studied 92 OUDB (38±11.2y, 49% female, 9% minority) at the Recovery, Advocacy, Empowerment and Service program (RASE) and Internal Medicine clinics of Wellspan (York, PA). Subjects completed the Patient Health Questionaire-9 (PHQ-9), Insomnia Severity Index (ISI), Epworth sleepiness scale (ESS), and opioid craving scale (OCS). Depression was defined as a PHQ 9 score ≥ 10, insomnia with an ISI score of &gt;15 and excessive daytime sleepiness (EDS) with an ESS score of &gt;10. Binary logistic regression analysis evaluated the likelihood of OUDB subjects having depression in relation to insomnia, excessive daytime sleepiness (EDS), opioid craving, duration of opioid use, duration since last use of any illegal substance, number of rehabilitation treatments and buprenorphine dosage. Results No differences between in OUDB subjects with (n=47) and without (n=34) depression were observed in age, duration of opioid dependence, duration of buprenorphine treatment, number of rehabilitation treatments or time since last use of any illegal substance. Subjects with depression had significantly higher ISI (18.2±4.2 verus11.8±6.6, p&lt; 0.01), ESS (11.2±4.7 versus 8.2±4.1, p&lt; 0.01 ) scores and a trend towards higher OCS score (3.2±4.1 verus1.9±2.2, p=0.056) as compared to those without depression. The odds of depression associated with Insomnia and EDS were 8.5 (95%CI=2.3-31.2) and 4.4 (95%CI=1.1-17) times respectively in this patient population. Conclusion Insomnia and hypersomnia are highly associated with depression in buprenorphine treated OUDBs patients. Insomnia and hypersomnia needs to be evaluated early and receive targeted treatment during early abstinence in order to prevent relapse in this patient population. Support (if any) This project is supported by the Junior Faculty Development Program, Penn State College of Medicine