Is cognitive behavioral therapy for insomnia (CBTi) efficacious for treating insomnia symptoms in shift workers? A systematic review and meta-analysis

Reynolds, Amy; Sweetman, Alexander; Crowther, Meagan E.; Paterson, Jessica L.; Scott, Hannah; Lechat, Bastien; Wanstall, Sian; Brown, B; Lovato, Nicole; Adams, Robert; Eastwood, Peter R.

doi:10.1016/j.smrv.2022.101716

Cited by 18 publications

(21 citation statements)

References 49 publications

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“…Third, future research should investigate the prevalence and management of COMISA among different shift work populations including military personnel and first‐responders (e.g., paramedics, fire‐fighters, etc.). Sleep disorders are prevalent in shift workers, and management of insomnia with standardised CBTi protocols may have a blunted effect in this population (Reynolds et al, 2022). Adaptations to existing CBTi protocols, and incorporation of chronotherapies, changes to shift‐scheduling, break times, and potentially hypnotic therapy may be required, depending on the nature, duration, and type of shift work/industry.…”

Section: Discussionmentioning

confidence: 99%

“…Although it is important to note that the majority of sleep restriction protocols set a minimum sleep window of 5 h (Kyle et al, 2015). Additionally, patients with untreated OSA who are expected to commence PAP therapy soon after CBTi effect in this population (Reynolds et al, 2022). Adaptations to existing CBTi protocols, and incorporation of chronotherapies, changes to shift-scheduling, break times, and potentially hypnotic therapy may be required, depending on the nature, duration, and type of shift work/ industry.…”

Section: Discussionmentioning

confidence: 99%

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The effect of cognitive behavioural therapy for insomnia in people with comorbid insomnia and sleep apnoea: A systematic review and meta‐analysis

Sweetman

Farrell

Wallace

et al. 2023

Journal of Sleep Research

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SummaryComorbid insomnia and sleep apnoea (COMISA) is a highly prevalent and debilitating sleep disorder. Cognitive behavioural therapy for insomnia (CBTi) may be an appropriate treatment for COMISA; however, no previous study has systematically reviewed and meta‐analysed literature reporting on the effect of CBTi in people with COMISA. A systematic literature search was conducted across PsychINFO and PubMed (n = 295). In all, 27 full‐text records were independently reviewed by at least two authors. Forward‐ and backward‐chain referencing, and hand‐searches were used to identify additional studies. Authors of potentially eligible studies were contacted to provide COMISA subgroup data. In total, 21 studies, including 14 independent samples of 1040 participants with COMISA were included. Downs and Black quality assessments were performed. A meta‐analysis including nine primary studies measuring the Insomnia Severity Index indicated that CBTi is associated with a large improvement in insomnia severity (Hedges’ g = −0.89, 95% confidence interval [CI] −1.35, −0.43). Subgroup meta‐analyses indicated that CBTi is effective in samples with untreated obstructive sleep apnoea (OSA) (five studies, Hedges’ g = −1.19, 95% CI −1.77, −0.61) and treated OSA (four studies, Hedges’ g = −0.55, 95% CI −0.75, −0.35). Publication bias was evaluated by examining the Funnel plot (Egger's regression p = 0.78). Implementation programmes are required to embed COMISA management pathways in sleep clinics worldwide that currently specialise in the management of OSA alone. Future research should investigate and refine CBTi interventions in people with COMISA, including identifying the most effective CBTi components, adaptations, and developing personalised management approaches for this highly prevalent and debilitating condition.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The effect of cognitive behavioural therapy for insomnia in people with comorbid insomnia and sleep apnoea: A systematic review and meta‐analysis

Sweetman

Farrell

Wallace

et al. 2023

Journal of Sleep Research

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“…An American Academy of Sleep Medicine (AASM) task force recently made recommendations for the use of psychological treatments for insomnia (Edinger et al, 2020(Edinger et al, , 2021. While the review highlighted the overwhelming evidence for CBT-I and its main behavioural components (SCT and Sleep Restriction Therapy, noting that evidence with some insomnia populations are still lacking [Reynolds et al, 2023]), ISR was amongst a considerable number of novel psychological treatments for which further efficacy evidence is required. Given that CBT-I may be infeasible or ineffective with some patients or in some contexts, more effective and practical options for insomnia treatment are needed.…”

Section: Discussionmentioning

confidence: 99%

“…CBT-I inherently requires behavioural interventions which may be more challenging for shift workers to apply, depending on their work-rest schedules. Up to 25% of the population are shift workers (Reynolds, Lechat, et al, 2022), and young workers are particularly impacted as early adulthood is a period where the most prevalent sleep disorder is insomnia (Appleton et al, 2022;McArdle et al, 2020). One night of ISR may be acceptable and efficacious for shift workers if this can be conducted safely, and between shifts when schedules are consistent and predictable (much like using the weekend, or days off, for workers on day schedules).…”

Section: Research Question 3: What Is the Optimal Isr Protocol?mentioning

confidence: 99%

“…It is not yet clear if ISR could offer improvements in insomnia for shift workers, for whom benefits from CBT-I are blunted relative to broader insomnia populations (Reynolds, Sweetman, et al, 2022). CBT-I inherently requires behavioural interventions which may be more challenging for shift workers to apply, depending on their work-rest schedules.…”

Section: Research Question 3: What Is the Optimal Isr Protocol?mentioning

confidence: 99%

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The efficacy of intensive sleep retraining for insomnia: A systematic review and research agenda

Scott

Bensen-Boakes

Lovato

et al. 2023

Journal of Sleep Research

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SummaryIntensive sleep retraining (ISR) is a brief behavioural treatment for sleep onset insomnia, administered in just a single overnight treatment session. This systematic review evaluates existing trials about the efficacy of intensive sleep retraining for treating insomnia, to inform whether there is enough evidence to recommend its use for clinical practice. A systematic literature search was conducted across three databases, yielding 108 results. Of these studies, three were deemed suitable for inclusion in this review. The included studies consistently reported significant reductions in insomnia symptoms following intensive sleep retraining, particularly decreases in sleep diary‐derived sleep latency and increases in total sleep time. Based on these inconclusive but promising findings, a research agenda is proffered to test intensive sleep retraining as a treatment for insomnia. Large randomised controlled trials are needed to elucidate the potential benefits of intensive sleep retraining for different populations with insomnia, as are mechanistic trials to test which components underlie its seemingly therapeutic effects. Since more practical modalities of intensive sleep retraining administration have been developed, such trials are more feasible to conduct now than ever before.

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Evidence summary on the non-pharmacological management of sleep disorders in shift workers

Wu,

Li,

Shuai

et al. 2023

Sleep Breath

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Purpose This study aimed to evaluate, and integrate the relevant evidence on the non-pharmacological management of sleep disorders in shift workers to provide a reference for improving sleep of shift workers. Methods According to the “6S” pyramid model of evidence, a comprehensive search was conducted in evidence-based databases, including BMJ-Best Practice, UpToDate, DynaMed, Cochrane Library, and Joanna Briggs Institute (JBI); clinical practice guideline websites, such as the Guidelines International Network; professional association websites, such as the World Sleep Society; and literature databases, including PubMed, Embase, CINAHL, China National Knowledge Infrastructure (CNKI), Wanfang Database, and Chinese Biology Medicine disc (CBM) from inception to November 30, 2022. Two researchers independently evaluated the literature in accordance with the evaluation standards; conducted the extraction, classification, and synthesis of the evidence; and evaluated its grade and recommendation grade. Results A total of 18 studies were included, including 2 clinical decisions, 2 guidelines, 3 expert consensuses, and 11 systematic reviews. In total, 25 pieces of evidence were summarized from 6 aspects: sleep assessment, sleep scheduling, sleep hygiene, light therapy, workplace intervention, and other managements. Conclusion This study summarized the best evidence for the non-pharmacological management of sleep disorders in shift workers. Shift workers should reasonably arrange their sleep time and develop good sleep hygiene. Additionally, work organizations should jointly promote sleep to improve the sleep conditions of shift workers and promote their physical and mental health.

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Is cognitive behavioral therapy for insomnia (CBTi) efficacious for treating insomnia symptoms in shift workers? A systematic review and meta-analysis

Cited by 18 publications

References 49 publications

The effect of cognitive behavioural therapy for insomnia in people with comorbid insomnia and sleep apnoea: A systematic review and meta‐analysis

The effect of cognitive behavioural therapy for insomnia in people with comorbid insomnia and sleep apnoea: A systematic review and meta‐analysis

The efficacy of intensive sleep retraining for insomnia: A systematic review and research agenda

Evidence summary on the non-pharmacological management of sleep disorders in shift workers

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