Abstract
IntroductionThe aim of the study was to compare the effectiveness of cognitive behavioural therapy interventions for insomnia (CBT-I) to that of a sleep hygiene intervention in a randomized controlled design among shift workers. We also studied whether the features of shift work disorder (SWD) affected the results.MethodsA total of 83 shift workers with insomnia disorder were partially randomized into a group-based CBT-I, self-help CBT-I, or sleep hygiene control intervention. The outcomes were assessed before and after the interventions and at 6-month follow-up using questionnaires, a sleep diary, and actigraphy.ResultsPerceived severity of insomnia, sleep-related dysfunctional beliefs, burnout symptoms, restedness, recovery after a shift, and actigraphy-based total sleep time improved after the interventions, but we found no significant differences between the interventions. Mood symptoms improved only among the group-based CBT-I intervention participants. Non-SWD participants had more mental diseases and symptoms, used more sleep-promoting medication, and had pronounced insomnia severity and more dysfunctional beliefs than those with SWD. After the interventions, non-SWD participants showed more prominent improvements than those with SWD.ConclusionsOur results showed no significant differences between the sleep improvements of the shift workers in the CBT-I interventions and of those in the sleep hygiene control intervention. Alleviation of mood symptoms seemed to be the main added value of the group-based CBT-I intervention compared to the control intervention. The clinical condition of the non-SWD participants was more severe and these participants benefitted more from the interventions than the SWD participants did.Trial registrationClinicalTrials.gov, NCT02523079.
Highlights
The aim of the study was to compare the effectiveness of cognitive behavioural therapy interventions for insomnia (CBT-I) to that of a sleep hygiene intervention in a randomized controlled design among shift workers
In occupational health services (OHS), the recruitment and assessment process proceeded as follows: (1) A nurse met the interested subject, provided information on the study, and assessed inclusion/ exclusion criteria based on the candidate’s age, insomnia duration, working hours, and work situation; (2) suitable candidates kept a sleep diary for 2 weeks and replied to a modified semi-structured sleep and health questionnaire (Partinen and Gislason 1995) and a questionnaire with shift-specific questions on insomnia and sleepiness (SS-Q) (Vanttola et al 2018) and the Insomnia Severity Index (ISI) (Morin et al 2011); (3) the candidate attended an appointment with a physician who decided on inclusion/exclusion based on the clinical interview and examination, sleep diary, and questionnaire results
Neither the group-based CBT-I (gCBT-I) nor the self-help-based CBT-I (sCBT-I) intervention differed from the sleep hygiene (SH) control intervention in terms of the reduction of the main outcome of the study, i.e. the perceived severity of insomnia (ISI)
Summary
The aim of the study was to compare the effectiveness of cognitive behavioural therapy interventions for insomnia (CBT-I) to that of a sleep hygiene intervention in a randomized controlled design among shift workers. Methods A total of 83 shift workers with insomnia disorder were partially randomized into a group-based CBT-I, self-help CBT-I, or sleep hygiene control intervention. Results Perceived severity of insomnia, sleep-related dysfunctional beliefs, burnout symptoms, restedness, recovery after a shift, and actigraphy-based total sleep time improved after the interventions, but we found no significant differences between the interventions. Mood symptoms improved only among the group-based CBT-I intervention participants. Conclusions Our results showed no significant differences between the sleep improvements of the shift workers in the CBT-I interventions and of those in the sleep hygiene control intervention. Approximately one-fifth of the European Union (EU) employees work in shifts (Eurofound 2017), making shift workers a significant group of people whose potential insomnia should be managed using effective interventions
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