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Journal of Clinical Sleep Medicine is dedicated to advancing the science of clinical sleep medicine. In order to provide subscribers with access to new scientific developments as early as possible, accepted papers are posted prior to their final publication in an issue. These papers are posted as received-without copyediting or formatting by the publisher. In some instances, substantial changes are made during the copyediting and formatting processes; therefore, the final version of the paper may differ significantly from this version.Unless indicated otherwise, all papers are copyright of the American Academy of Sleep Medicine. No paper in whole or in part may be used in any form without written permission from the American Academy of Sleep Medicine.

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While the COVID-19 has dramatically altered our lifestyle and sleep practices, the links between sleep, individual characteristics, personal experiences and mental health during the pandemic require further examination. This cross-sectional, multi-methods study examined differences in language used to describe personal experiences, and mental health, based on sleep quality during the early stages of the pandemic. N = 1745 participants (mean age 42.97 ± 14.46 years) from 63 countries responded to the survey. Sleep quality was assessed using the Pittsburgh Sleep Quality Index and mental health was examined using the Patient Health Questionnaire-9, the State Trait Anxiety Inventory, the Perceived Stress Scale and the UCLA-Loneliness Scale. Quantitative analysis of qualitative, language content of personal experiences was conducted using free-text responses and comments to a question on the survey. Almost 50% of the participants reported poor sleep quality, which was linked to a more negative emotional tone and greater mentions of money or finance related words. Good sleepers reported more positive emotional tone in their experiences. Greater reports of clinical state anxiety, moderate depression and moderate stress were observed in poor sleepers, even after accounting for demographics and pandemic-related factors such as loneliness, financial concerns and risk of contracting COVID-19 disease. Results from this study highlight an urgent need for sleep-related public health interventions. Practitioner education, sleep screening for those with mental health conditions, and encouraging people to adopt digital tools may help to reduce the burden of poor sleep on mental health. While the pandemic itself is a stressful and uncertain time, improving sleep can support positive emotion regulation, improving mood and consequential action.

Study design Prospective, double-blind, randomised, placebo-controlled, cross-over trial of nasal decongestion in tetraplegia. Objectives Tetraplegia is complicated by severe, predominantly obstructive, sleep apnoea. First-line therapy for obstructive sleep apnoea is nasal continuous positive airway pressure, but this is poorly tolerated. High nasal resistance associated with unopposed parasympathetic activation of the upper airway contributes to poor adherence. This preliminary study tested whether reducing nasal decongestion improved sleep. Setting Participants' homes in Melbourne and Sydney, Australia. Methods Two sleep studies were performed in participants' homes separated by 1 week. Participants were given a nasal spray (0.5 mL of 5% phenylephrine or placebo) in random order and posterior nasal resistance measured immediately. Outcomes included sleep apnoea severity, perceived nasal congestion, sleep quality and oxygenation during sleep. Results Twelve middle-aged (average (SD) 52 (12) years) overweight (body mass index 25.3 (6.7) kg/m 2) men (C4-6, AIS A and B) participated. Nasal resistance was reduced following administration of phenylephrine (p = 0.02; mean between treatment group difference −5.20: 95% confidence interval −9.09, −1.32 cmH 2 O/L/s). No differences were observed in the apnoea hypopnoea index (p

Objective: Poor sleep can significantly impact mental health. Despite this, sleep education is absent from the curriculum of many psychology training programs. The current study examined the amount of sleep education delivered within postgraduate psychology programs in Australia. It also developed a new survey tool to capture postgraduate psychology students' experience of sleep education. Method: Two cross-sectional sleep education surveys were emailed to postgraduate psychology programs across Australia via the Heads of Department and Schools of Psychology Association. The first survey explored sleep education from postgraduate psychology program coordinators' perspectives (n = 35; survey response rate = 73%), while the second custom-designed survey examined postgraduate psychology students' perspectives (n =152). Results: Program coordinators reported a median of 2.00 hours (range 0-9) of didactic sleep education delivered within postgraduate psychology programs. Postgraduate students, however, reported receiving a median of only 1.00 hour (range 0-40) of sleep education, with 47% of students reporting no sleep education. Most students acknowledged already working with clients experiencing sleep disturbances (68%), yet they disclosed low confidence and self-efficacy to manage sleep disturbances in psychology practice. Despite delivering minimal sleep education, thematic analysis indicated that program coordinators viewed sleep education as an important topic for trainee psychologists. Program coordinators preferred sleep education to supplement the postgraduate curriculum, preferably online (63%), whereas students chose clinical supervision (61%). Conclusions: Postgraduate psychology training programs deliver minimal sleep education to trainee psychologists in Australia. Enhanced integration of sleep education within the postgraduate psychology curriculum is required to improve mental health outcomes.

Despite the strong links between sleep, circadian rhythms, and mental health, sleep education has been neglected in mental healthcare provider training programs. The current pilot study examined the potential efficacy and acceptability of a sleep education workshop for trainee psychologists, called the Sleep Psychology Workshop. Eleven students completing their Master of Psychology degrees (90% female, 24.4 ± 1.6 years old) attended the Sleep Psychology Workshop as part of their Health Psychology course, delivered as three, two-hour lectures (total six hours). Trainees' sleep psychology knowledge quiz scores (% correct) demonstrated significant improvement from pre-(M = 60%, SD = .09) to post-workshop (M = 79%, SD = .08), t (6) = -5.18, p = .002. Trainees also reported increased self-efficacy to use common sleep-related assessment instruments and empirically supported interventions to manage sleep and circadian rhythm disturbances, along with increased confidence to manage insomnia disorder in clinical practice (all p <.02). Trainees also endorsed the workshop as an acceptable sleep education program for trainee psychologists via a postworkshop feedback survey, focus group, and six-month follow-up survey. This pilot study provides preliminary evidence for the Sleep Psychology Workshop as an effective and acceptable sleep education program for trainee psychologists.

Background/objectives Emerging research suggests that face-to-face group mindfulness-based therapies are an effective intervention for insomnia. This pilot study examined the effectiveness of a mindfulness-based smartphone application for improving objectively-measured sleep, self-reported sleep, insomnia severity, pre-sleep arousal and daytime mood. Method A community sample of 23 adults with subclinical to moderately severe symptoms of insomnia were randomized to either a mindfulness or progressive muscle relaxation (PMR) smartphone application for 40 or 60 days. Objective sleep outcomes assessed using actigraphy, and self-report measures of total wake time, cognitive and somatic pre-sleep arousal, and daytime positive and negative affect were assessed for 14 nights at baseline and post-intervention. Insomnia severity was recorded at baseline and post-intervention. Results A greater reduction in sleep onset latency was observed in the mindfulness group over time, relative to the PMR group. The mindfulness group also reported medium effect size improvements for sleep efficiency. No significant interaction effects were found for self-reported sleep measures, however, main effects of time were found for both groups for total wake time, insomnia severity, cognitive pre-sleep arousal, and daytime positive and negative affect. Conclusions These preliminary findings suggest that both mindfulness and PMR smartphone applications have the potential to improve symptoms of insomnia. In particular, this mindfulness-based smartphone application may improve sleep onset latency and reduce the duration of night-awakenings. Further research exploring digital therapeutics as a self-help option for those with insomnia is needed.