The Sleep Condition Indicator (SCI) is an eight-item rating scale that was developed to screen for insomnia disorder based on DSM-5 criteria. It has been shown previously to have good psychometric properties among several language translations. We developed age- and sex-referenced values for the SCI to assist the evaluation of insomnia in everyday clinical practice. A random sample of 200 000 individuals (58% women, mean age: 31 ± 13 years) was selected from those who had completed the SCI via several internet platforms. Descriptive and inferential methods were applied to generate reference data and indices of reliable change for the SCI for men and women across the age deciles 16-25, 26-35, 36-45, 46-55, 56-65 and 66-75 years. The mean SCI score for the full sample was 14.97 ± 5.93. Overall, women scored worse than men (14.29 ± 5.83 versus 15.90 ± 5.94; mean difference: -1.60, η = 0.018, Cohen's d = 0.272) and those of older age scored worse than those younger (-0.057 points per year, 95% confidence interval (CI): -0.059 to -0.055) relative to age 16-25 years. The Reliable Change Index was established at seven scale points. In conclusion, the SCI is a useful instrument for clinicians and researchers that can help them to screen for insomnia, compare completers to individuals of similar age and sex and establish whether a reliable change was achieved following treatment.
Contemporary developments, such as digital Cognitive Behavioral Therapy (CBT) and wearable devices estimating sleep, could support the implementation of CBT for insomnia at a large scale. We assessed what characterizes those users who connected a wearable device to the program to estimate sleep diary variables, and whether connecting a wearable device affected insomnia symptom improvement, related well-being, and program interaction. In total, 3551 users (63% female, mean age 44.50 ± 14.78 years) of a dCBT program who completed a post-therapy survey, including 378 users (10.6%) who used a device, were selected. Within-subject, pre-therapy to post-therapy, the Sleep Condition Indicator (SCI, 7 Items) was used to assess insomnia. Two-item measures (depression, anxiety) and single item measures (perceived stress, life satisfaction, work productivity) of well-being were analyzed, in addition to program interaction. For all participants, insomnia symptoms significantly improved following dCBT (t(3504) = 83.33,
p
< 0.001; Cohen’s
d
= 1.45), as did depression and anxiety symptoms, perceived stress, life satisfaction and work productivity. Those who did not connect a device reported better sleep and less affected work productivity (all
p
< .001) than those who did connect a device at baseline and post-treatment; nevertheless treatment effects were largely similar for the two groups. Those who connected a device interacted more with additional program components. In conclusion, improvements in insomnia after completing dCBT are similar in persons choosing to wear a wearable device to estimate sleep and persons completing a subjective sleep diary. Potentially, use of wearable devices can facilitate treatment for those who struggle to complete daily diaries.
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