Michael Lloyd Perlis
VerifiedUniversity of Pennsylvania · Rehabilitation Medicine
Active 1987–2025
About
Michael Lloyd Perlis, PhD, is an Associate Professor of Psychology in Psychiatry at the University of Pennsylvania. He serves as the Director of the Behavioral Sleep Medicine Program within the Department of Psychiatry. His educational background includes a BA in Religious Studies from Guilford College, an MA in Psychology from the University of Arizona, and a PhD in Clinical Psychology from the University of Arizona. Dr. Perlis's research focuses on sleep disorders, particularly insomnia, and he has contributed to understanding the perception and memory of sleep/wake states and their implications for insomnia treatment. His work includes investigating cognitive behavioral therapy for insomnia, pharmacologic treatments, and the natural history of insomnia, with numerous publications in sleep research and behavioral therapy.
Research topics
- Medicine
- Psychology
- Psychiatry
- Clinical psychology
- Physical therapy
Selected publications
1162 Sleep Disturbance in Individuals with and Without Minor Memory Complaints
SLEEP · 2025-05-01
articleOpen accessSenior authorAbstract Introduction Prior research indicates that individuals with Mild Cognitive Impairment (MCI) or Alzheimer’s Disease (AD) exhibit higher-than-normal levels of sleep disturbance. Epidemiologic studies suggest that poor sleep may be a risk factor for the progression of Alzheimer’s Disease and Related Dementias (ADRD). Despite these findings, the literature is non-specific regarding the types of sleep disturbances that present in this population. We aimed to assess the various forms of sleep disturbance in individuals with and without minor memory complaints (MMC). Methods Data were obtained from an online sleep and health survey, with participants directed to the site via advertisements on platforms such as Facebook, Google, TV, and local newspapers. The survey includes sections on general sleep, health conditions, and chronic diseases, and takes approximately 20 minutes to complete. In 2024, three questions regarding memory function were added: (1) recent memory issues, (2) use of supplements or over-the-counter medications for memory, and (3) diagnosis or treatment for memory problems. Two groups were formed based on reported memory problems, distinguishing those with minor memory complaints (MMC) from those without. Analyses focused on sleep patterns (e.g., Time in Bed, Wake After Sleep Onset, Sleep Efficiency), insomnia severity, and frequency of sleep disorders. Bivariate contrasts were conducted with an alpha level set at p< 0.01. Results The sample included 308 participants (mean age 46.0 ± 12.9, 64% female, 14% non-white). Of these, 134 had MMC and 174 did not. The groups did not differ demographically, but those with MMC exhibited a subtle sleep phase delay (~30 minutes), increased insomnia severity (related to daytime function), and a higher frequency of parasomnic behaviors (e.g., nightmares). Conclusion Subjects with MMC demonstrated more severe sleep disturbance, particularly with phase delays and parasomnias. These findings suggest that sleep disturbance may occur early in cognitive decline and could serve as a potential early indicator of MCI. Given the connection between sleep and memory function, these results may offer insight into the pathophysiology of ADRD. Analyses are ongoing. Support (if any)
SLEEP Advances · 2025-01-01
articleOpen accessChronic insomnia is a prevalent sleep disorder where <1% of patients receive the recommended first-line treatment; Cognitive Behavioural Therapy for Insomnia. Digital technologies and self-managed therapies are scalable solutions to address this critical gap in patient care, but it is presently difficult to know which therapies are best. This study will test the comparative efficacy and cost-benefits of Intensive Sleep Retraining administered by the THIM sleep tracker, Sleep Healthy Using the Internet (SHUTi) treatment program, and their combination (THIM then SHUTi) versus a waitlist control group. This study is a 4 (treatment: +/- THIM and +/- SHUTi) × 3 (time: pretreatment, posttreatment, and 2-month follow-up) randomized controlled trial. Participants who meet the diagnostic criteria for Chronic Insomnia Disorder will be randomized to one of four groups. Sleep and daytime functioning symptoms will be assessed via self-report daily and weekly questionnaires, and objective sleep trackers during treatment and for 2 weeks at pre-treatment, post-treatment, and 2-month follow-up. The primary outcome is total wake time, with a reduction of ≥30 minutes considered a clinically meaningful difference. For the primary analysis, the interaction between the treatment group and time on total wake time will be analyzed using repeated measures analyses of variance (ANOVA). This project was approved by the Southern Adelaide Clinical Human Research Ethics Committee (2021/HRE00414) and registered in the Australian and New Zealand Clinical Trials Registry (ACTRN12622000778785). As the first study to investigate the comparative efficacy of two different technology-enabled treatments for insomnia, this study will help inform clinicians and public health policy regarding the use cases for public and private health-funded technology-enabled options for insomnia.
medRxiv · 2025-01-05 · 2 citations
preprintOpen accessStudy Objectives: 1) To determine the efficacy of Cognitive Behavioral Therapy for Insomnia (CBT-I) for improving insomnia, alcohol-related outcomes, and daytime functioning at post-treatment and at 3- and 6-month follow-up, in a largely African American Veteran sample; 2) Evaluate whether improvement in insomnia is associated with a reduction in alcohol-related outcomes post-treatment. Methods: An RCT of CBT-I (n = 31) compared to Quasi-Desensitization therapy (QDT, n = 32), eight weekly in-person sessions, with assessments at baseline, end of treatment (8 weeks), and 3- and 6-months post-treatment. Primary outcomes were the Insomnia Severity Index (ISI) total score, and Percent Days Abstinent (PDA). Secondary outcomes were sleep diary variables, drinks per day, percentage non-heavy drinking days, Penn Alcohol Craving Scale, PCS and MCS scale (from the SF-12), BDI and STAI-Trait subscale total scores. Results: Post-treatment data were obtained from 88.9% of participants. Although CBT-I improved insomnia with effect sizes (E.S.) larger than the meta-analytic estimates, QDT was equally efficacious in improving insomnia (E.S. = -1.63 vs. -1.50), improving abstinence (E.S. = 1.54 vs. 1.91) and next-day functioning (E.S. = 0.26 vs. -0.17). Across treatment groups, remission from insomnia was associated with a lower post-treatment alcohol craving score (2.79, 95% CI 1.14, 4.44 vs. 9.51, 95% CI 6.06, 12.95 in non-responders), an effect that persisted for 6 months after treatment. Conclusions: CBT-I and QDT are equally effective for treating insomnia during early recovery from AUD. Reduced alcohol craving may be a mechanism by which a remission from insomnia improves drinking outcomes.
Is Objective Short Sleep a Proxy for Frequent Insomnia?
Journal of Sleep Research · 2025-06-15
articleOpen accessSenior authorThis study investigated the relationship between insomnia frequency and objective short sleep, a phenotype of insomnia. The hypothesis is that individuals with objective short sleep simply have more nights of insomnia per week. Data from a randomised controlled trial of Cognitive Behavioural Therapy for Insomnia combined with zolpidem and/or additional maintenance sessions were analysed. Insomnia frequency was derived from pre-treatment sleep diaries, using two definitions: nights with self-reported sleep latency (SL) or wake after sleep onset (WASO) > 30 min, and nights with self-reported sleep duration < 6 h. Objective short sleep was assessed via PSG sleep study, using < 6 h as the threshold. Results showed that objective short sleep was associated with more frequent insomnia when defined as nights with sleep duration < 6 h (8.1 ± 4.2 vs. 5.9 ± 3.7 nights/fortnight for short sleepers vs. normal sleepers, respectively), but not for nights with SL or WASO > 30 min. While insomnia frequency may partially explain objective short sleep, other factors likely influence this phenotype. Further studies are needed to explore the mechanisms underlying objective short sleep insomnia.
medRxiv · 2025-06-30
reviewOpen accessABSTRACT Background Insomnia is a highly prevalent and debilitating sleep-wake disorder, with growing evidence indicating that it is an independent risk factor for suicidal ideation and behaviors. Cognitive behavioral therapy for insomnia (CBT-I) is the recommended first-line treatment for chronic insomnia. However, its effect on suicidal ideation and behaviors in those with insomnia has not been well-characterized. Thus, the aim of the planned meta-analysis is to quantify the effects of CBT-I on suicidal ideation, suicidal behaviors and suicide deaths in adults with insomnia with and without comorbidities. Methods The planned study will include randomized controlled trials (RCTs) comparing CBT-I with a control condition with no presumed strong effect on insomnia in individuals with insomnia according to standardized diagnostic criteria or a clinically relevant screening score. Both published and unpublished RCTs will be retrieved through a systematic search in major databases and trial registries. The primary outcomes include 1) suicidal ideation, 2) suicidal behaviors, and 3) suicide deaths, assessed post-treatment and at follow-ups. We will only consider RCTs reporting suicide-related outcomes and/or enrolling participants with suicidal ideation or behaviors. For continuous data, a random-effects meta-analysis will be conducted to estimate (standardized) mean differences. In the case of categorical data, a random-effects logistic regression meta-analysis model will be used. The risk of bias of the primary outcomes will be evaluated using the Cochrane Risk of Bias 2 tool. The certainty of evidence will be assessed using GRADE. All analyses will be conducted in the R software. Discussion The planned meta-analysis will provide a synthesis of the effects of CBT-I on suicide-related outcomes in individuals with insomnia. The findings could have important implications for integrating sleep-focused interventions into suicide prevention strategies and inform clinical practice, particularly for individuals with comorbid insomnia and increased suicide risk. Systematic review registration PROSPERO-ID CRD420250628820 Review question How effective is cognitive behavioral therapy for insomnia (CBT-I) in reducing suicidal ideation, suicidal behaviors and suicide deaths among adults with insomnia with and without comorbidities?
1348 Exploratory Analysis of Patient Opinions, Preferences, and Experiences with Insomnia Treatment
SLEEP · 2025-05-01
articleOpen accessSenior authorAbstract Introduction Little is known about patient beliefs and preferences regarding treatment approaches for insomnia. Understanding of such inclinations will allow clinicians to better address these perspectives, and in so doing improve treatment adherence. In the present study, patient beliefs about the relevance of evidence-based treatment and preferences for and experiences with over-the-counter (OTCs), prescriptive medications (RXs), and behavioral treatments (BTs), were surveyed. Methods Four items were added to the Penn Behavioral Sleep Medicine online screener (sleeplessinphilly.com), which profiles sleep and general health of individuals seeking to participate in research. Two questions asked about the importance of safety and effectiveness information for OTCs and RXs (on a 0-5 scale, 0=not important, 5=very important). One question asked respondents to rank which of the treatment approaches (OTCs, RXs, BTs) were most and least preferable. One question asked respondents to indicate which of these treatments they had tried, and in what order. Examples were given for each treatment (e.g., BT was parenthetically defined as “4-10 week cognitive behavioral therapy for insomnia”). Results 181 patients completed the survey (82.3% female, mean±SD age of 48.2±12.2 years). The mean Insomnia Severity Index (ISI) for the group was 16.8±5.1. Roughly 80% of respondents scored evidence and safety information as important (responses of 4 or 5) for both OTCs (82.3%, 4.3±1.2) and RXs (80.7%, 4.3±1.2). The most frequently preferred first, second, and third choices were BTs (45.9%), OTCs (43.6%), and RXs (50.3%), respectively. Despite this stated preference, 71.8% of respondents tried OTCs first, 33.7% tried RXs second and 8.3% tried BTs third. Overall, just 8.8% tried BTs first, and 25.4% ever tried BTs. Conclusion Survey findings highlight that patients consider information on safety and effectiveness of insomnia treatment as important (equally so for Rx and OTC treatments), that they prefer behavioral and OTC care as compared to prescriptive medications. Interestingly, although the most patients stated a preference for behavioral therapies first, most reported trying OTCs first and only 8.8% had tried BTs first. This likely reflects the limited availability of BTs, particularly compared to the ease at which patients can access OTC therapies. Support (if any)
Nocturnal Wakefulness and the Mind After Midnight
Elsevier eBooks · 2025-11-29
book-chapterSenior authorSLEEP · 2025-05-01
articleOpen accessAbstract Introduction Poor sleep raises the risk for physical functioning difficulties and safety concerns, such as falls, in older adult populations. However, there is insufficient literature on sleep in older Veterans receiving care in VA inpatient rehabilitation settings during and after hospitalization. Furthermore, we do not sufficiently understand Veterans’ perceptions of the importance of their sleep and physical abilities during this recovery process. The present analysis assessed older Veterans’ perceptions of sleep, physical ability, and interest in pursuing non-pharmacological sleep interventions after completing their treatment at a VA subacute rehabilitation unit. Methods Veterans aged 60+ were approached ≤1 week prior to discharge from VA Boston’s subacute rehabilitation. Veterans completed a brief semi-structured interview. Using frequency analyses, we determined how many Veterans believed their sleep and physical abilities were important to their recovery, believed their sleep impacts their physical abilities, how many were interested in non-pharmacological sleep interventions, when this intervention should occur, and how many believed this sleep intervention should include physical activities. Results Fourteen Veterans (Mean age=75.4±6.6 years; 100% male; 93% White) completed the brief semi-structured interviews prior to discharge. All Veterans (100%) reported that their sleep and physical abilities were important to their overall recovery and that their sleep impacts their physical abilities. Most (71%) expressed interest in a non-pharmacological intervention to help them sleep. Veterans shared that the intervention should occur during (50%), after (7.1%) or both during and after (29%) subacute rehabilitation. The majority (71%) reported that physical activity should be incorporated into the sleep intervention. Conclusion This analysis highlighted Veterans’ perception regarding the importance of their sleep and physical functioning, particularly as it relates to their physical recovery process. This data also demonstrates a high level of Veteran interest in receiving non-pharmacological sleep interventions to promote their recovery. A natural next step would be to develop and study an intervention to support Veterans’ sleep and physical abilities during and/or after their discharge from subacute rehabilitation. Support (if any) IK1RX004762-01 (BOYLE PI); 1 150 RX003430-01 (BEAN PI); K24 AG069176 (BEAN PI)
Oxford University Press eBooks · 2025-05-22
book-chapterSenior authorAbstract The present chapter reviews the past and current theoretical conceptualizations of insomnia. As straightforward as it may seem, the definition of insomnia is complex and has evolved considerably over time. Several attempts have been made to refine the definition in terms of descriptive and diagnostic types and subtypes of insomnia. Alongside this pursuit, there have been advancements in understanding insomnia etiology and pathophysiology, resulting in 15 major human models of insomnia. The present chapter reviews (1) the definition of insomnia, (2) the major theoretical perspectives regarding the etiology and pathophysiology of insomnia, (3) the current evidence and implications of each perspective, and (4) promising directions for future research to better understand insomnia pathophysiology and its successful treatment.
SLEEP · 2025-05-01
articleOpen accessAbstract Introduction Approximately 20-60% of peri- and postmenopausal women in the US have insomnia symptoms that can be exacerbated by vasomotor symptoms [VMS], including nocturnal hot flashes (nHF). While cognitive behavioral therapy for insomnia (CBT-I) has been shown to be effective in decreasing insomnia in this population, it is unclear how nighttime (e.g., difficulty falling asleep) versus daytime (e.g., daytime sleepiness) symptoms are impacted. This study examined the effect of CBT for menopausal insomnia (CBT-MI) on insomnia severity and symptoms as well as VMS in a randomized clinical trial. Methods Peri-and postmenopausal participants with insomnia and nHF (53.6y) were assigned to receive CBT-MI (n=18) or Menopause Education Control (MEC; n=25). The Insomnia Severity Index (ISI) and Hot Flash Related Daily Interference Scale (HFDRIS) were administered at baseline and post-intervention. Three factor analysis was used to look at changes in insomnia symptom types including Factor 1–ISI Sleep Symptoms (items 1,2,3), Factor 2–ISI Daytime Symptoms related to Insomnia (items 5,6), and Factor 3–ISI Perception of Symptoms (items 4,7). Generalized linear regression was performed to find the differences from baseline to post-treatment between the treatment groups. Results At baseline, total ISI score was not significantly different between the groups (15.1±3.5 vs. 15.0±4.4; P=0.34). Following the intervention period, ISI scores were significantly lower in the CBTI-MI group than the MEC group (4.9±1.1 vs. 8.8±1.1; P=0.01). With respect to VMS, there were significant differences between treatment group ratings of hot flash interference (HFDRIS) at post-treatment (P=0.01). The changes from baseline in ISI Sleep Symptoms (P=0.005) and ISI Perception Symptoms (p=0.002) was significantly greater in the CBT-MI group compared to MEC, while the change from baseline of ISI Daytime Symptoms was not significantly different (P=0.1). Conclusion CBT-MI significantly decreases menopause insomnia severity and improves vasomotor symptoms in midlife women primarily due to attenuating sleep symptoms and perceptions of insomnia symptoms. CBT-MI did not significantly improve daytime symptoms associated with insomnia. Support (if any) This work is supported by NIH Grant #s K23NR014008 (Nowakowski). Additional support was provided by the Center for Innovations in Quality, Effectiveness and Safety (CIN 13-413).
Recent grants
NIH · $40k · 1998
NIH · $2.3M · 2013
NIH · $493k · 2020
NIH · $805k · 2020
Three Approaches to Maintenance Therapy for Chronic Insomnia in Older Adults
NIH · $2.5M · 2018–2024
Frequent coauthors
- 149 shared
Michael A. Grandner
University of Arizona
- 101 shared
Alexandria Muench
University of Pennsylvania
- 66 shared
Iván Vargas
Sarasota Memorial Hospital
- 59 shared
Wilfred R. Pigeon
United States Department of Veterans Affairs
- 46 shared
Subhajit Chakravorty
University of Pennsylvania
- 46 shared
Jason Ellis
Northumbria University
- 44 shared
Philip Gehrman
University of Pennsylvania
- 44 shared
Mark Seewald
California University of Pennsylvania
Labs
Behavioral Sleep Medicine Program, Department of Psychiatry, University of PennsylvaniaPI
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