Study Objectives Insomnia is diagnosed based on self-reported sleep complaints. There are often differences between objectively recorded and self-reported sleep (sleep-wake state discrepancy), which is well-documented but not well understood. This two-arm, parallel-group, single-blind, superiority randomised controlled trial examined whether monitoring sleep using wearable sleep-measurement devices and providing feedback with support for helpful interpretation of objective sleep data improved insomnia symptoms. Methods 113 (age M=47.53, SD=14.37, 64.9% female) individuals with insomnia symptoms (Insomnia Severity Index >= 10; ISI) from the community were randomised (permuted block randomization) to receive 5 weeks of (a) Feedback (n=57): feedback about objectively recorded sleep (actigraphy and optional EEG headband) with guidance for data interpretation and ongoing monitoring; (b) No-Feedback (n=56): sleep hygiene. Both conditions received one individual session and two check-in calls. The ISI (primary outcome), PROMIS Sleep Disturbance (SD), Sleep-Related Impairment (SRI), Depression, and Anxiety were assessed at baseline and post-intervention. Results 103 (91.2%) participants completed the study. Preliminary intention-to-treat multiple regression showed that after controlling for baseline symptoms, the Feedback condition (n=52) had lower ISI (p=.0069, d=0.53) and SD (p=.033, d=0.38), but differences in SRI, Depression and Anxiety were not meaningful (p-values>.37) compared to No-Feedback condition (n=51). Conclusion Providing feedback and guidance about objectively recorded sleep reduced insomnia severity and sleep disturbance in individuals with insomnia symptomology. With increasing access to wearable sleep-measurement devices, these findings explore how objective sleep measures, in combination with data interpretation guidance, could supplement and enhance current insomnia treatment. Australian New Zealand Clinical Trials Registry: ACTRN12619001636145.
Study Objectives Insomnia is a disorder diagnosed based on self-reported sleep complaints. Differences between self-reported and sensor-based sleep parameters (sleep-wake state discrepancy) are common but not well-understood in individuals with insomnia. This two-arm, parallel-group, single-blind, superiority randomised controlled trial examined whether monitoring sleep using wearable devices and providing support for interpretation of sensor-based sleep data improved insomnia symptoms or impacted sleep-wake state discrepancy. Methods 113 (age M=47.53; SD=14.37, 64.9% female) individuals with significant insomnia symptoms (Insomnia Severity Index >=10; ISI) from the community were randomised 1:1 (permuted block randomization) to receive 5-week (a) Intervention (n=57): feedback about sensor-based sleep (Fitbit and EEG headband) with guidance for data interpretation and ongoing monitoring; (b) Control (n=56): sleep education and hygiene. Both groups received one individual session and two check-in calls. The ISI (primary outcome), Sleep Disturbance (SDis), Sleep-Related Impairment (SRI), Depression, and Anxiety were assessed at baseline and post-intervention. Results 103 (91.2%) participants completed the study. Intention-to-treat multiple regression with multiple imputations showed that after controlling for baseline values, compared to the Control group (n=51), the Intervention group (n=52) had lower ISI (p=.011, d=0.51) and SDis (p=.036, d=0.42) post-intervention, but differences in SRI, Depression, Anxiety, and sleep-wake state discrepancy parameters (TST, SOL, WASO) were not meaningful (p-values>.40). Conclusions Providing feedback and guidance about sensor-based sleep parameters reduced insomnia severity and sleep disturbance but did not alter sleep-wake state discrepancy in individuals with insomnia more than sleep hygiene and education. The role of sleep wearable devices among individuals with insomnia require further research.
Introduction Individuals attending sleep services commonly present with comorbid psychiatric symptoms. This study reports our ongoing effort to characterise presenting psychiatric symptom profiles of individuals seeking treatment at a sleep clinic and classify heterogenous subgroups within a large sample. Method Data were collected at a university-based multidisciplinary sleep clinic via opt-out consent. Prior to treatment, individuals completed the Cross-Cutting Symptom Measure (CCSM), which provides a transdiagnostic symptom profile by measuring 13 domains of mental health (e.g., anger, anxiety, depression, psychosis, mania, memory). Additional questions on demographics and the Morningness-Eveningness Questionnaire Reduced (rMEQ) were also administered. Results 1263 participants (52.9% male; age M±SD= 43.53±16.06) completed the CCSM and were analysed. Latent class analysis revealed 3 distinct profiles: Low-Symptom subgroup (n=655, 51.9%) reported mild affective and somatic symptoms; Psychopathology subgroup (n=342, 27.1%) reported moderate to severe psychopathology including psychosis, dissociation, and suicidality, in conjunction with severe affective, obsessive-compulsive, and somatic symptoms, and significant interference with memory and personality functioning; Affective-Disturbance subgroup (n=266, 21.1%) reported moderate affective and somatic symptoms, and some interference with memory and personality functioning. The three subgroups did not differ significantly on key demographics or the rMEQ. Discussion There was heterogeneity in psychiatric symptoms experienced by sleep clinic patients. Affective and somatic disturbances were common across subgroups whilst severe psychopathology appeared in a sizeable (one in four) proportion of patients. These findings solidified the need for careful assessment of a wide range of psychiatric symptoms to inform treatment planning in sleep services.
Introduction One third of birthing parents experience insomnia symptoms during perinatal periods. Cognitive Behavioural Therapy for Insomnia (CBT-I) is effective for perinatal insomnia. However, it is unclear how adherence to and perceived usefulness of individual CBT-I components predict treatment efficacy. Methods 76 nulliparous birthing parents (age M±SD=33.07±3.10) with prenatal insomnia received CBT-I from two randomised controlled trials. Insomnia symptoms, sleep-related impairment, dysfunctional beliefs and attitudes about sleep (DBAS), and adherence and usefulness were self-reported at 30 and 35-weeks gestation, and 2 and 6-months postpartum. Linear regressions assessed whether adherence and usefulness predicted sleep-related outcomes, controlling for age, mental health history and social support. Results Adherence and perceived usefulness decreased over time across all components. “Cognitive restructuring” and “sleep hygiene” had the highest usefulness and adherence ratings, while “relaxation and mindfulness” was the least useful and adhered to. Controlling for covariates, higher adherence to “sleep hygiene” predicted lower DBAS at 35-weeks gestation (p=.024). At 6-months postpartum, higher usefulness of “relaxation and mindfulness” predicted lower DBAS (p=.032), and higher usefulness/adherence to “managing sleep deprivation, sleepiness, and fatigue” predicted lower insomnia symptoms (usefulness p=.003; adherence p=.029) and lower sleep-related impairment (usefulness p=.007). No significant relationships were found between sleep-related outcomes and usefulness/adherence to other CBT-I components (i.e., psychoeducation, cognitive restructuring, and stimulus control). Conclusion Individual CBT-I components play different roles in treatment efficacy as birthing parents navigate diverse sleep challenges in perinatal periods. Strategies to enhance adherence to and perceived usefulness of relevant treatment components for specific perinatal milestones may enhance efficacy.
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