About

Monica R. Kelly is an Assistant Professor-in-Residence in the Department of Medicine at UCLA. She holds a PhD in Clinical Psychology from the University of Arizona, Tucson, obtained in August 2018, and completed a Geriatrics Fellowship at the Greater Los Angeles Healthcare System in June 2021. Her research focuses on sleep disorders, particularly insomnia, and their relationship with mental health conditions such as posttraumatic stress disorder, depression, and anxiety. She investigates behavioral sleep interventions, including cognitive behavioral therapy for insomnia, and their effects on sleep outcomes, mental health symptoms, and inflammatory gene expression. Her work also explores sleep-related beliefs, sleep-disordered breathing, and the impact of sleep on various populations, including veterans and individuals with spinal cord injury. Dr. Kelly's contributions include evaluating sleep staging algorithms, studying sleep and daytime function, and examining the efficacy of behavioral treatments in clinical settings.

Research topics

• Medicine
• Psychiatry
• Clinical psychology
• Endocrinology
• Biology
• Internal medicine
• Psychology
• Neuroscience

Selected publications

• Experiential Avoidance is Associated with Insomnia Symptoms and Related Consequences Among Veterans with Posttraumatic Stress Disorder

  Behavioral Sleep Medicine · 2026-04-15

  articleOpen access

  OBJECTIVES: Experiential avoidance is the unwillingness to come into contact with aversive internal experiences. Trauma exposure is associated with greater experiential avoidance and insomnia symptoms. Experiential avoidance may perpetuate insomnia symptoms in patients with posttraumatic stress disorder (PTSD). We examined the relationship between experiential avoidance and insomnia symptoms among veterans with PTSD (based on the Clinician-Administered PTSD Scale for DSM-5). METHOD: = 54.7 years; 86.0% male) who attributed their sleep disturbance onset to experiences of trauma on the CAPS-5. Experiential avoidance, insomnia, sleep disturbance, daytime sleepiness, and daytime consequences were measured with the Brief Experiential Avoidance Questionnaire (BEAQ), Insomnia Severity Index (ISI), Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), and International Classification of Sleep Disorders (ICSD) items. We conducted multiple linear regressions with age, sex, and BEAQ as the independent variables and sleep variables as the dependent variables. RESULTS: There were significant positive associations between the BEAQ and the ISI, PSQI daily disturbance factor, ESS, and ICSD daytime consequences. CONCLUSIONS: Greater experiential avoidance was associated with worse insomnia symptoms and consequences, particularly daytime dysfunction. Experiential avoidance may be an overlooked, but relevant treatment target for patients with comorbid insomnia and PTSD.

  PublisherOA PDFDOI

• Sleep and daytime function in people with spinal cord injury

  Journal of Clinical Sleep Medicine · 2025-07-01 · 1 citations

  articleOpen accessSenior author
  PublisherOA PDFDOI

• 0746 Values Expressed by Women Veterans Initiating Treatment for Sleep Apnea

  SLEEP · 2025-05-01

  articleOpen access

  Abstract Introduction Women with sleep apnea report poorer sleep and have lower positive airway pressure (PAP) adherence rates than men. Within the Veterans Health Administration, there is a movement toward a Whole Health approach to care, shifting the focus from “what’s the matter with the patient” to “what matters to the patient.” We asked women veterans initiating sleep apnea treatment to describe their personal values and the impact of sleep apnea on these values. Methods Within a larger randomized controlled trial (NCT03377452), 44 women veterans (mean age = 53.7 years; 65.9% White, 34.1% married, 47.7% employed) diagnosed with sleep apnea were randomly assigned to a behavioral treatment for sleep apnea called “Acceptance and the Behavioral Changes to Treat Sleep Apnea” (ABC-SA; compared to an education control condition). In the first ABC-SA session, participants were asked to “list three of the things you most care about in your life” (i.e., values) and “the ways having sleep apnea impacts what you care about most” (i.e., impacts). Value and impact responses were coded into five categories with 100% agreement among three raters after independent coding and adjudication: work/education, relationships, personal care/health, leisure, and pets. Values were further coded into 14 subcategories based on the Valued Living Questionnaire. Results The frequencies of value and impact categories were: relationships (value n = 40; impact n = 25), personal care/health (value n = 39; impact n = 43), work/education (value n = 22; impact n = 11), leisure (value n = 13; impact n = 12), and pets (value n = 7; impact n = 2). The most frequently endorsed value subcategories were physical health (n = 32), family (other than marriage/parenting; n = 30), and friends/social life (n = 20). Conclusion Health and relationships are highly important to women veterans with sleep apnea. Research has focused on the health benefits of PAP, but fewer studies have explored interpersonal factors. The perceived impacts of PAP on relationships may serve as a barrier and/or motivator of PAP use. Support (if any) VA HSR IIR 16-244, VA RCS-20-191, NIH/NHLBI K24 HL143055 (Martin); VA CDA 20-227 (Carlson); NIH/NHLBI K23HL157754 (Kelly); VAGLAHS GRECC CSHIIP

  PublisherOA PDFDOI

• 1166 A Cross-Study Analysis on the Impact of Behavioral Insomnia Treatment on Pain Severity in U.S. Veterans

  SLEEP · 2025-05-01

  articleOpen access

  Abstract Introduction Insomnia disorder and chronic pain are highly comorbid, and share underlying mechanisms that impact their severity. Literature regarding the impact of behavioral insomnia treatments like cognitive behavioral therapy for insomnia (CBT-I) on pain severity, especially in veterans, has been mixed. Methods We harmonized datasets from four randomized clinical trials, yielding a sample of 469 veterans (mean age 63 years, 65.7% male, 56.7% white, 70% not working) who engaged in structured behavioral insomnia treatments (4-5 sessions). All veterans in the sample completed baseline, posttreatment, and at least one follow-up assessment (e.g., 3-, 6-, 9-, or 12-month follow-up). Pain severity was operationalized by harmonizing items from the Brief Pain Inventory and Geriatric Pain Measure related to average pain severity the day of assessment and average pain severity in general. Pain ratings range from 0 (no pain) to 10 (severe pain). Other measures included the Insomnia Severity Index (ISI) and Pittsburgh Sleep Quality Index (PSQI). Analyses included mixed effects modeling to evaluate treatment impact. Results Baseline pain was mild-to-moderate across the sample (m = 4.3, SD = 2.7). Across pain variables, there was no meaningful effect of behavioral insomnia treatment on pain severity outcomes (-.02 ≤ b ≤.09, p >.05). This lack of effect is present despite significant improvement in both ISI (-.5.9 ≤ b ≤ -7.39, p<.001) and PSQI (-3.45 ≤ b ≤ -4.58, p<.001) at posttreatment and follow-up periods. No differences in effect were observable when examining demographic breakdowns of age, sex, or race. Conclusion Though behavioral insomnia treatments do significantly improve insomnia and sleep-related outcomes, they do not appear to meaningfully improve perceived pain severity in a sample of US veterans. This is consistent with similar literature showing a lack of meaningful improvement in pain severity, yet continues to open the door for further research into facets of pain beyond severity (e.g., interference in day-to-day living) that could be impacted by improving sleep. Support (if any) VA SWI 24-001, VA OAA (Erickson); RCS-20-191, NIH K24 HL143055 (Martin); VAGLAHS CSHIIP GRECC

  PublisherOA PDFDOI

• 0527 Differences in Subjective and Objective Measures of Sleep by Marital Status in a Sample of US Veterans

  SLEEP · 2025-05-01

  articleOpen access

  Abstract Introduction Marriage confers a degree of benefit for a range of health factors, including sleep behaviors and outcomes. Veterans are more likely to report sleep difficulties (e.g., insomnia) and have less social support than the general population. As such, it is important to examine associations between marital status and the occurrence of sleep issues among veterans. Methods This study utilizes baseline visit data from veterans in Los Angeles reporting sleep concerns who were enrolled across four structured cognitive behavioral therapy for insomnia intervention trials. Measures included the Pittsburgh Sleep Quality Index (PSQI) total and factor scores, Insomnia Severity Index (ISI), sleep efficiency (measured with actigraphy), and the Patient Health Questionnaire (PHQ-9). Overall, 1,411 veterans had available data (74.1% male; mean age: 63.4 years; 43.3% married/living as married, 21.9% separated, 17.0% single/never married, 10.5% divorced, 7.2% widowed). Multilevel models were constructed to evaluate associations between marital status and sleep measures after controlling for sex, age, and depressive symptoms. Individuals were nested within the four different sleep trials and “married” served as the reference group. Results Multilevel modeling showed that separated individuals had scores indicative of worse sleep compared to married individuals (PSQI total score: β = 0.18, p <.01, N = 1,181; PSQI Sleep Efficiency factor score: β = 0.18, p =.017, N = 1,188; sleep efficiency per actigraphy: β = -0.23, p = 0.014, N = 845). Differences by marital status were not found for the PSQI Perceived Sleep Quality factor, PSQI Daily Disturbances factor, or ISI. Divorced, widowed, and single/never married compared to married did not show differences for any of the sleep measure outcomes. Conclusion Using cross-sectional data, we found that veterans who are separated have more severe sleep concerns compared to veterans who are married/living as married. Given this difference, separated veterans may represent a group that are particularly at-risk for sleep difficulties and they may benefit from evaluation of sleep concerns and management of sleep disorders. Findings align with past work showing that marital status can impact measures of health. Support (if any) VA OAA (Gold); VA SWI 24-001, VA OAA (Erickson), RCS-20-191, NIH K24 HL143055 (Martin); VAGLAHS CSHIIP and GRECC

  PublisherOA PDFDOI

• 0733 Insomnia Severity Predicts Increased PAP Side Effects and Use in Women Veterans with Newly Diagnosed Apnea

  SLEEP · 2025-05-01

  articleOpen access1st authorCorresponding

  Abstract Introduction Despite positive airway pressure (PAP) being the gold-standard treatment for sleep disordered breathing (SDB), treatment adherence remains a challenge for providers and patients. Women with SDB are understudied, and understanding the difficulties associated with PAP use in this population is crucial to promoting treatment adherence. We aimed to assess the role of demographics and insomnia symptoms in PAP side effects and PAP use for women veterans. Methods We analyzed data from a randomized controlled trial of an Acceptance and Commitment Therapy-based intervention to promote PAP adherence vs. a sleep education control condition for women veterans newly diagnosed with SDB (NCT03377452). Data included demographics (age; body mass index, BMI; race/ethnicity), baseline assessment Insomnia Severity Index (ISI), PAP use data (days used, hours used at 30-, 60- and 90-days post-PAP initiation), and the PAP side effects subscale of the Calgary Sleep Apnea Quality of Life Index (SAQLI). Analyses included Pearson correlations and t-tests. Results Of the 90 participants (Mean age = 53.2±12.8), 83 (92.2%) attempted to use PAP and completed the questionnaires. The most common PAP side effects included: upper respiratory symptoms (stuffed/congested nose = 60.2%, excessive dryness of nose/throat = 55.4%, soreness = 39.8%), mask-related issues (discomfort = 56.6%, air leak =47.0%) and insomnia-like symptoms (waking frequently = 36.6%, difficulty returning to sleep = 31.3%). There was no relationship between age, BMI, or race/ethnicity and number of PAP-related side effects, nor was there a correlation between number of PAP side effects and PAP use variables. Elevated ISI prior to initiating PAP was associated with greater number of PAP side effects, F(1, 81)=5.29, p=0.02. Worse ISI was associated with fewer days of PAP use at 90 days post-PAP initiation, F(1, 88)=4.55, p=0.04. Conclusion Insomnia symptom severity prior to initiating PAP treatment for SDB is a significant contributing factor to increased endorsement of PAP-related side effects. Pre-existing insomnia symptoms prior to PAP initiation may play a role in fewer days of PAP use in the long term. Future research should explore the impact of insomnia treatment in PAP side effects and use in women. Support (if any) VA/HSR IIR-16-244; VA/HSR RCS20-191; NIH/NHLBI K24HL143055; NIH/NHLBI K23HL157754; VA/HSR CDA 20-227

  PublisherOA PDFDOI

• 1176 Identifying Gaps in Evaluation and Treatment of Insomnia, OSA, and PTSD in Women Veterans

  SLEEP · 2025-05-01

  articleOpen access

  Abstract Introduction Insomnia disorder, obstructive sleep apnea (OSA), and posttraumatic stress disorder (PTSD) are highly comorbid conditions among veterans. There are clear clinical practice guidelines for the assessment/treatment of these conditions, but sleep disorders remain under documented in electronic health records (EHR) and it is unclear if women veterans are being appropriately assessed and treated for these conditions. Methods We sent recruitment letters to 361 veterans potentially eligible for a clinical trial of cognitive behavioral therapy for insomnia (CBT-I) for women veterans with PTSD (NCT05683132). Eighty-one women completed telephone screening which included the Insomnia Severity Index (ISI), STOP, and Primary Care PTSD Screen for DSM-5 (PC-PTSD-5). Clinical cutoff scores were used to determine probable insomnia (ISI ≥ 11), high OSA risk (STOP ≥ 2), and probable PTSD (PC-PTSD-5 ≥ 4). Prior engagement in first-line treatments was assessed for insomnia (CBT-I), OSA (positive airway pressure [PAP]), and PTSD (Cognitive Processing Therapy [CPT], Prolonged Exposure [PE], and Eye Movement Desensitization and Reprocessing [EMDR]). Results Among women screened, 90.1% (n = 73) had probable insomnia, 59.3% (n = 48) were at high risk for OSA, and 71.6% (n = 58) had probable PTSD. 55.6% (n = 45) had both probable insomnia and increased risk for OSA. 46.9% (n = 38) were high risk for OSA and had both probable insomnia and PTSD. Among those with probable insomnia, seven (9.6%) had received CBT-I. Among those at increased risk for OSA, 32 (66.7%) had underwent a sleep evaluation, 22 (45.8%) were diagnosed with sleep apnea and prescribed PAP, and seven (14.6%) reported PAP use in the last week. Among those with probable PTSD, 40 (69.0%) received non-medication treatment for PTSD, including 11 (19.0%) who received CPT, PE, or EMDR. Conclusion Few women veterans with probable insomnia received CBT-I. One third of women with high OSA risk were not previously evaluated. Most women prescribed PAP were not currently using treatment. Few women with probable PTSD received first-line non-medication treatments for PTSD. Challenges remain in increasing access to evidence-based treatments for women veterans. Support (if any) VA CDA 20-227 (Carlson); VA RCS-20-191, NIH/NHLBI K24 HL143055 (Martin); NIH/NHLBI K23 HL157754 (Kelly), VAGLAHS CSHIIP GRECC

  PublisherOA PDFDOI

• Trauma-Informed Cognitive Behavioral Therapy for Insomnia in Women Veterans: An Intervention Development Study

  Cognitive and Behavioral Practice · 2025-03-28

  articleOpen access
  PublisherOA PDFDOI

• Insomnia Symptom Improvement as a Mediator for Mental Health Symptom Reduction Following Behavioral Insomnia Treatment Among Women Veterans

  Behavior Therapy · 2025-02-20

  articleOpen access
  PublisherOA PDFDOI

• Black Women Benefit From Psychotherapies for Insomnia, but Experience Adherence Challenges: Results of a Comparative Effectiveness Trial in Women Veterans

  Women s Health Issues · 2025-10-15

  articleOpen access

  BACKGROUND: Black women and veterans experience disproportionally high rates of insomnia. Few studies have examined how treatment adherence and outcomes vary by racial identity. We found that cognitive behavioral therapy for insomnia (CBT-I) and an acceptance and commitment therapy (ACT)-based insomnia treatment similarly improve sleep outcomes for women veterans, and this analysis examined differences in adherence and outcomes of these treatments based on racial identity groups. PURPOSE: Analyses examined differences in adherence and treatment outcomes in Black compared with white women veterans who engaged in CBT-I or an ACT-based insomnia treatment (i.e., acceptance and the behavioral changes to treat insomnia [ABC-I]). METHODS: As part of a larger clinical trial (NCT02076165), 40 Black and 51 white women veterans with insomnia disorder completed five sessions of CBT-I or ABC-I. The Insomnia Severity Index (ISI) and sleep diaries were completed at baseline, posttreatment, and 3-month follow-up. The Credibility and Expectancy Questionnaire was completed at the end of the first treatment session. Multiple and fractional regression models were used to evaluate the association between race group and change in ISI, sleep diary sleep efficiency, and adherence to weekly sleep schedule prescriptions in CBT-I and ABC-I. RESULTS: Treatment benefits were comparable between Black and white women veterans; however, Black women had transiently lower adherence to sleep restriction time in bed recommendations in the week immediately after sleep restriction therapy was introduced in both treatments. There were no other differences between the groups. CONCLUSIONS: Future research is needed to understand potential barriers to early adherence to recommendations experienced by Black women veterans and to identify treatment adaptations to meet their needs.

  PublisherDOI

Recent grants

• Insomnia Treatment and Cardiometabolic Health in Older Adults with Posttraumatic Stress Disorder

  NIH · $999k · 2022–2027

Frequent coauthors

• Jennifer L. Martin

  Captain James A. Lovell Federal Health Care Center

  200 shared

• Cathy A. Alessi

  VA NY Harbor Healthcare System

  161 shared

• Michael N. Mitchell

  Geriatric Research Education and Clinical Center

  122 shared

• Elizabeth M. Yano

  UCLA Health

  109 shared

• Constance H. Fung

  Center for the Study of Healthcare Provider Behavior

  101 shared

• Yeonsu Song

  Geriatric Research Education and Clinical Center

  100 shared

• Donna L. Washington

  VA Greater Los Angeles Healthcare System

  97 shared

• Karen Josephson

  VA Greater Los Angeles Healthcare System

  77 shared

Labs

• Monica Kelly | UCLA ProfilesPI