Efficacy of sleep education program based on principles of cognitive behavioral therapy to alleviate workers’ distress

Abstract

We conducted a randomized controlled trial to investigate the efficacy of the sleep education program based on the principles of cognitive behavioral therapy for insomnia (CBT-I) in reducing psychological distress among workers with insomnia. Total of 130 daytime office workers in Japan with insomnia complaints were randomly assigned to an intervention or to a control group. Intervention consisted of a 60 min group session and a 30 min individual session for sleep hygiene, stimulus control, sleep restriction, and relaxation training. The occupational health physician of the workers’ office led both sessions. The primary outcome was change in the K6 score for psychological distress between baseline and 3 months after the intervention. The secondary outcome was change in severity of insomnia measured with the insomnia severity index (ISI). Data were analyzed using linear mixed models with baseline value as covariates. A subgroup analysis was conducted among participants with clinically significant psychological distress at baseline (K6 score ≥5). Intention-to-treat (ITT) analysis with multiple imputation showed that the effect size of the intervention was very small (0.10 for psychological distress and 0.20 for insomnia, respectively). However, subgroup analyses of high-stress individuals showed significant improvement in psychological distress (effect size = 0.37) and insomnia (effect size = 0.39). Our results suggest that 90 min sleep education program based on CBT-I principles led by an occupational health physician alleviated psychological distress in workers with insomnia complaints and high stress levels. Brief sleep education can be widely implemented to reduce distress in workers with insomnia.