Behavioral Sleep Intervention Research Articles

Collateral Child and Parent Effects of Behavioral Sleep Interventions for Children with Rare Genetic Neurodevelopmental Conditions

Abstract Objectives This study, following Woodford et al. (2024), investigated the collateral child and parent effects of function-based behavioral sleep interventions for 21 children with rare genetic neurodevelopmental conditions (RGNC). Methods Measures completed by parents at pre- and post-intervention assessed change in children’s internalizing and externalizing symptoms, health-related quality of life, behavioral strengths and difficulties, as well as parental sleep, relationship quality, and mental health symptoms. Data were analysed using modified Brinley plots and effect size estimates. Results Results demonstrate modest collateral benefits across child emotional and behavioral difficulties and health-related quality of life, and maternal anxiety and stress symptoms and sleep quality. There was minimal improvement in parent ratings of child externalizing symptoms and physical health-related quality of life, parent relationship satisfaction and all paternal outcome measures. There was no statistically significant relationship between changes in collateral outcomes and sleep problem severity. Conclusions Findings underscore the diverse potential benefits of improved sleep and highlight the need for further prioritisation of sleep services and research in RGNC.

Behavioral Sleep Interventions for Children with Rare Genetic Neurodevelopmental Conditions: A Retrospective Analysis of Overall Outcomes for 26 Cases

Abstract Objectives Sleep difficulties are highly prevalent among children with rare genetic neurodevelopmental conditions (RGNC) such as Angelman and Smith-Magenis syndromes. Behavioral interventions are commonly used in the treatment of sleep difficulties in children; however, research is limited in children with RGNC. This study evaluated the overall effectiveness and acceptability of function-based behavioral sleep interventions for children with RGNC. Methods Data was collated from a series of experimental single-case research studies with 26 children (18 months to 19 years of age) with a range of RGNC, who received a behavioral sleep intervention. Intervention strategies included circadian (e.g., sleep/wake rescheduling), antecedent (e.g., sleep hygiene), and/or consequence (e.g., positive reinforcement of sleep-conducive behavior and modified extinction) modifications implemented by parents. Clinicians provided support for parents mostly via telehealth methods. Overall outcomes were examined using modified Brinley plots and effect size estimates. The effect of age, gender, and a range of psychological variables on intervention response was also examined. Results Improvements in sleep problem severity were observed for 24/26 participants, and gains were maintained at long-term follow-up for 13/16. Interestingly, 50% of the children achieved clinically significant change with less restrictive strategies (e.g., circadian, antecedent and positive reinforcement strategies), suggesting extinction procedures may be used as the last option in a sequence of interventions. Parents generally perceived interventions to be acceptable. There was minimal evidence of any differential response to intervention as a function of age, gender, or psychological variables. Conclusions Results suggest function-based behavioral interventions offer an effective and socially valid method for treating sleep disturbance in children with RGNC.

0798 Feasibility & Acceptability of SAFE: A Brief Trauma-Informed Behavioral Sleep Intervention for Youth in Foster Care

0798 Feasibility & Acceptability of SAFE: A Brief Trauma-Informed Behavioral Sleep Intervention for Youth in Foster Care

Child routines moderate a brief behavioral intervention to enhance sleep in school-aged children.

To examine whether child routines (the consistency or variation in children's daily routines, household responsibilities, discipline routines, and homework routines) moderated the effectiveness of a brief behavioral intervention to enhance sleep in school-aged children. Secondary analysis was conducted with a subset of 66 families with short sleeping (≤9.5 hr/day) children, 8-11 years old (female = 68%; mean age = 9.76, SD = 1.02) who completed the Child Routines Inventory at baseline and were then randomized to receive a behavioral sleep intervention (n = 32) or to control (n = 34). Sleep period was objectively measured using wrist actigraphy at baseline and 2 months post-randomization. Moderation analysis was performed using ordinary least squares regression using the PROCESS macro for SPSS. Controlling for sleep period at baseline, treatment condition was significantly related to the sleep period at 2 months post-randomization, with the intervention group achieving a longer sleep period compared to the usual sleep period group (control) (b = 46.30, p < .01). Intervention response was moderated by child routines (b = 1.43, p < .05). Specifically, the intervention produced the greatest change in sleep period for children who engaged in greater routine behaviors at baseline than those who engaged in fewer routine behaviors. Families that engage in routine behaviors may be better equipped to adopt the behavioral modifications required to get a good night's sleep. The findings highlight the importance of working with families to establish routine behaviors to improve responses to behavioral sleep interventions.

An Open-Label Pilot Trial of a Brief, Parent-Based Sleep Intervention in Children With ADHD.

To assess the effects of a brief parent-based behavioral sleep intervention in children with ADHD. Families with a child with ADHD and parent-reported sleep problems received a brief parent-based sleep intervention, which involved two one-to-one consultation sessions and one telephone follow-up with the parent/caregiver. Child's sleep and clinical symptoms, and parental sleep and daytime functioning were assessed at baseline, 2-week post-intervention, and 3-month follow-up. Sixty eligible families (mean age of the child: 9.4 ± 1.5 years; boys: 75%) were recruited, and 43 (72%) completed the whole intervention. The intervention resulted in significant improvements in the child's sleep, clinical symptoms, and parental sleep and parenting stress, and these improvements were generally maintained at 3-month follow-up. The findings supported the promising effects of a brief parent-based sleep intervention on improving sleep and clinical symptoms in children with ADHD and parental sleep and parenting stress. Further randomized clinical trials with long-term follow-up are needed to test the robustness of the effectiveness of the intervention.

Lifestyle Behavioral Interventions and Health-Related Outcomes Among People with Epilepsy: A Review of Randomized Controlled Trials.

To gather and assess current literature on the prevalence and efficacy of lifestyle behavioral interventions (sleep, nutrition, physical activity) for health outcomes, including QOL, psychological well-being, behavioral changes, and seizure frequency, among PWE. A review was conducted of English-language articles identified from PubMed, Scopus, and Embase between January 2013 to January 2023. Inclusion criteria were randomized controlled trials (RCT) with human subjects diagnosed with epilepsy who participated in a lifestyle behavioral intervention. Two researchers independently completed the title, abstract, and full-text reviews. Information extracted includes study population, duration, type of intervention, findings, and outcomes. Data was narratively synthesized to show level of evidence and degree of consistency in findings. Results: 4001 studies identified, 66 full texts reviewed, and 24 included. A majority (n = 16) of studies utilized diet specific RCTs, and some focused on physical activity (n = 7) and sleep (n = 1). Diet-specific RCTs (eg, ketogenic, Modified Atkins) reported reduced seizure frequency with adverse effects, such as gastrointestinal complications. Physical activity-based interventions found that maintained levels of exercise improved QOL and psychological well-being. However, physical activity and diet-based interventions did not have lasting effects after study conclusion. Only the behavioral sleep intervention reported that sleep quality improved significantly and was maintained post-intervention. Future research is needed to establish the relationship between lifestyle behavioral interventions on QOL and other health outcomes (eg, seizure frequency).

Characterizing sleep in adults with Type 1 and Type 2 diabetes

ObjectiveTo characterize sleep/insomnia and sleep habits among adults with type 1 (T1D) and type 2 (T2D) diabetes. MethodsAdults with T1D or T2D were invited to complete an anonymous cross-sectional online survey containing validated self-reported measures on sleep quality, sleep health, insomnia severity, and questions on sleep habits. Multivariate linear and logistic regression analyses were performed. ResultsA total of 303 adults (20–86 years; 75.3 % female) with T1D (n = 121) and T2D (n = 182) completed the whole survey. Sleep quality was associated with type of diabetes (β=1.27; 95 % CI: 0.28, 2.27) and income (β=-1.18; 95 % CI: -2.11, -0.26) when adjusted for sex and age. Adults with T2D and with a lower income reported poorer sleep quality. Sleep timing variability (rs=0.25–0.33; p < 0.05) and caffeine consumption before bedtime (rs=0.14–0.17; p < 0.05) were the sleep habits that were correlated with sleep quality, sleep health, and insomnia severity when adjusted for sex, age, and income. Sleep timing variability ≥3 times/week was associated with age (OR=0.97; 95 % CI: 0.94, 0.99). Caffeine consumption before bedtime ≥3 times/week was associated with sex × age (p = 0.0165). Younger males were the most likely to indicate adopting this sleep habit. ConclusionsAdults with T2D and those reporting a lower income seem at high risk for poor sleep quality. Adults with diabetes mentioning sleep issues, especially those with T2D and with a lower income, should have access to inexpensive behavioral sleep interventions. Younger adults with diabetes should receive counseling promoting healthy sleep habits, especially males in the case of caffeine consumption before bedtime.

An evaluation of a stepped-care telehealth program for improving the sleep of autistic children

BackgroundSleep problems are prevalent in Autistic children, adversely affecting their development, well-being and quality of life. Traditional face-to-face behavioral interventions are hindered by accessibility. Using a single-case design, this study evaluated the efficacy of a stepped-care telehealth-delivered behavioral sleep intervention (TDBSI). MethodSeven Autistic children (aged 4–8) and their parents participated in a 12-week program consisting of baseline plus three sequential intervention phases: (1) self-directed online parent psychoeducation, (2) small group parent coaching via video conferencing, and (3) individualized parent coaching via video conferencing. Parent strategy selection and implementation fidelity were closely monitored and rated across intervention phases. Child sleep outcomes were assessed through daily parent-reported sleep diaries and the Children's Sleep Habits Questionnaire. ResultsFive of seven parents used online parent education to independently select antecedent strategies (e.g., sleep hygiene, stimulus control) and/or rewards that were appropriate for their child’s sleep and implemented them with high fidelity. This resulted in reductions in sleep onset latency, night wakings, early wakings, and bedsharing for their children. Parent implementation fidelity and child sleep outcomes were further improved for all participants with group or individualized coaching, and results were maintained at 12 weeks and six months post-intervention. ConclusionsTDBSIs show promise in addressing sleep difficulties in Autistic children, warranting further investigation and replication.

Mechanisms of sleep disturbances in long-term cancer survivors: a childhood cancer survivor study report.

Sleep problems following childhood cancer treatment may persist into adulthood, exacerbating cancer-related late effects and putting survivors at risk for poor physical and psychosocial functioning. This study examines sleep in long-term survivors and their siblings to identify risk factors and disease correlates. Childhood cancer survivors (≥5 years from diagnosis; n = 12 340; 51.5% female; mean [SD] age = 39.4 [9.6] years) and siblings (n = 2395; 57.1% female; age = 44.6 [10.5] years) participating in the Childhood Cancer Survivor Study completed the Pittsburgh Sleep Quality Index (PSQI). Multivariable Poisson-error generalized estimating equation compared prevalence of binary sleep outcomes between survivors and siblings and evaluated cancer history and chronic health conditions (CHC) for associations with sleep outcomes, adjusting for age (at diagnosis and current), sex, race/ethnicity, and body mass index. Survivors were more likely to report clinically elevated composite PSQI scores (>5; 45.1% vs 40.0%, adjusted prevalence ratio [PR] = 1.20, 95% CI = 1.13 to 1.27), symptoms of insomnia (38.8% vs 32.0%, PR = 1.26, 95% CI = 1.18 to 1.35), snoring (18.0% vs 17.4%, PR = 1.11, 95% CI = 1.01 to 1.23), and sleep medication use (13.2% vs 11.5%, PR = 1.28, 95% CI = 1.12 to 1.45) compared with siblings. Within cancer survivors, PSQI scores were similar across diagnoses. Anthracycline exposure (PR = 1.13, 95% CI = 1.03 to 1.25), abdominal radiation (PR = 1.16, 95% CI = 1.04 to 1.29), and increasing CHC burden were associated with elevated PSQI scores (PRs = 1.21-1.48). Among survivors, sleep problems were more closely related to CHC than diagnosis or treatment history, although longitudinal research is needed to determine the direction of this association. Frequent sleep-promoting medication use suggests interest in managing sleep problems; behavioral sleep intervention is advised for long-term management.

The Lighter Touch: Less-Restriction in Sequentially Implemented Behavioral Sleep Interventions for Children with Rare Genetic Neurodevelopmental Conditions.

The prevalence of sleep difficulties among children with rare genetic neurodevelopmental conditions (RGNC) is high. Behavioral interventions are commonly used in the treatment of sleep difficulties in children with neurodevelopmental conditions such as autism, however, research is scarce in children with RGNC. The range of co-occurring complexities within this population, means there is a need for research to not only determine the effectiveness of behavioral sleep interventions, but also which components might be the least restrictive (i.e., intensive/aversive) and minimally sufficient. This study used a single-case multiple baseline design to investigate the effectiveness and acceptability of behavioral sleep interventions, indicated within a Functional Behavior formulation in eight children with RGNC (M = 7.3years). Intervention components were sequentially administered across up to three phases, based on the principle of less restriction (from least to relatively more intensive) to determine what might be minimally sufficient. Results showed an improvement in sleep onset latency, night wakings, early morning waking and unwanted bed-sharing for 7/7, 6/7, 3/3 and 3/3 children respectively. Improvement was observed for most participants following the less restrictive phases of intervention (circadian modifications, antecedent modifications and positive reinforcement), however, more restrictive, albeit modified, extinction procedures were still implemented for five participants. Improvements were maintained at follow-up and interventions were deemed acceptable to parents. Less restrictive function-based behavioral strategies are an effective, and in some cases sufficient, contribution to a sequence of interventions for a range of sleep difficulties. They should be implemented first, before more restrictive strategies.

Predictors of behavioral sleep problems and intervention outcomes in early childhood

Predictors of behavioral sleep problems and intervention outcomes in early childhood

Pain in your day? Get sleep treatment anyway! The role of pain in insomnia treatment efficacy in women veterans.

Insomnia and pain disorders are among the most common conditions affecting United States adults and veterans, and their comorbidity can cause detrimental effects to quality of life among other factors. Cognitive behavioural therapy for insomnia and related behavioural therapies are recommended treatments for insomnia, but chronic pain may hinder treatment benefit. Prior research has not addressed how pain impacts the effects of behavioural insomnia treatment in United States women veterans. Using data from a comparative effectiveness clinical trial of two insomnia behavioural treatments (both including sleep restriction, stimulus control, and sleep hygiene education), we examined the impact of pain severity and pain interference on sleep improvements from baseline to post-treatment and 3-month follow-up. We found no significant moderation effects of pain severity or interference in the relationship between treatment phase and sleep outcomes. Findings highlight opportunities for using behavioural sleep interventions in patients, particularly women veterans, with comorbid pain and insomnia, and highlight areas for future research.

DESIGN, DELIVERY, AND EVALUATION OF DYADIC INTERVENTIONS WITH OLDER ADULTS

Abstract With increasing evidence of the interpersonal context of health and illness, there is growing interest in interventions that target the needs of the family care dyad. Yet, there are often specific challenges to the design, delivery and evaluation of dyadic interventions that are not often disseminated. This session includes four papers that will discuss the benefits (but also challenges and lessons learned) of four different dyadic interventions targeted at older adults and their care partners in both cognitive impairment and chronic illness contexts. First, Dr. Rashelle Hoffman and colleagues will present results from focus groups with rural MCI care dyads that inform the adaptation of an existing efficacious telerehabilitation physical activity intervention (TPAB). Second, Dr. Glenna Brewster and colleagues will discuss recruitment and delivery challenges, and the benefits of a pilot behavioral sleep intervention for adults with cognitive impairment and their care partners. Third, Dr. Lyndsey Miller and colleagues will report the feasibility, acceptability and preliminary efficacy of a program to support preparation for future care needs and improved well-being in care dyads living with dementia. Finally, Dr. Karen Lyons and colleagues will present findings from a pilot communication-based intervention for couples living with heart failure. The presentation will discuss the individual versus dyadic benefits of the program and challenges related to recruitment and retention. Speakers and Discussant, Dr. Kalisha Bonds Johnson, will share challenges and best-practices in designing, delivering, and evaluating interventions to optimize the health and well-being of the older adult care dyad.

A Pilot Study of a Cognitive-Behavioral Sleep Intervention Specifically for Adolescents With ADHD and Sleep Problems: A Qualitative and Quantitative Evaluation

The current pilot study evaluates a cognitive behavioral (CBT) sleep intervention specifically developed for adolescents with ADHD – Sleep IntervEntion as Symptom Treatment for ADHD (SIESTA). Based on a qualitative and quantitative evaluation, the final aim is to fine-tune SIESTA and the assessment protocol to the target population. Eight adolescents (13–17 years old) with ADHD and sleep problems completed SIESTA. Separate focus groups with adolescents and parents were conducted to evaluate their experience with SIESTA and the assessment protocol. These were analyzed using thematic analysis. Additionally, individual reliable change indices were computed from pretest to posttest for sleep hygiene practices. Thematic analysis showed that adolescents and parents reported both positive aspects and points of improvement of SIESTA and the assessment protocol during the focus groups. Reliable change indices showed that all adolescents significantly improved on at least one of the subscales of the revised Adolescent Sleep Hygiene Scale. Preliminary qualitative findings indicate satisfaction with SIESTA and the assessment protocol, with some suggestions for further improvements, and quantitative findings indicate significant improvement in sleep hygiene. The next step is to test the effectiveness of SIESTA in a randomized controlled trial, based on the adaptations after this pilot study.

A Dyadic Behavioral Sleep Intervention Program for Persons Living With Dementia and Their Family Caregivers: A Pilot Randomized Controlled Trial

AbstractBackgroundUntreated sleep problems in persons living with dementia (PLWD) and their caregivers impact health outcomes of both individuals and impair quality of care for caregivers. This study pilot tested preliminary effects of a dyadic sleep intervention program among this group.MethodThirty PLWD/caregiver dyads were randomized to a 5‐session treatment (n = 15 dyads) or a similarly structured information‐only control group (n = 15 dyads) via in‐person or video‐telehealth. Treatment was a manual‐based program incorporating key components of cognitive behavioral therapy for insomnia (CBTI), daily light exposure and walking, and a problem‐solving approach for dementia‐related behaviors and caregiving challenges. Sleep outcomes included actigraphy‐measured sleep efficiency (SE) and total awake time (TWT) at night for dyads, and Pittsburgh Sleep Quality Index (PSQI) for caregivers. Outcomes were measured at baseline, post‐treatment, and 3‐months follow‐up (main outcome time point). Recommendation adherence in the treatment group was computed and a 2 (group) by 3 (time) mixed model analysis of variance was used to test the treatment effects (p&lt;0.20 as the threshold).ResultTwo dyads in treatment and one control dyad did not complete all five sessions. Of 13 dyads who completed all sessions of the treatment program, average % days that the dyads met their sleep schedules were 76% bedtime and 83% get‐up time for PLWD and 81% bedtime and 68% get‐up time for caregivers. From baseline to 3‐month follow‐up, SE increased by 3.2% more for PLWD in the treatment group (n = 9) compared to control (n = 9, p = 0.48) and by 3.7% more for caregivers in the treatment group (n = 12) compared to control (n = 9, p = 0.17). TWT also reduced by 19 minutes more for PLWD and 14 minutes more for caregivers in the treatment group compared to control at the 3‐month follow‐up although this was not statistically significant. Caregivers in treatment also showed non‐significant improvement on the PSQI (p&gt;0.20).ConclusionA dyadic approach to sleep improvement showed evidence of benefit among PLWD and caregivers. A larger study is needed to fully evaluate these effects and compare in‐person to telehealth modalities.

A non-inferiority randomized controlled trial comparing behavioral sleep interventions in women veterans: An examination of pain outcomes

ObjectiveInsomnia is known to exacerbate pain symptoms. The purpose of the present study was to compare the secondary effects of cognitive behavioral therapy for insomnia (CBTI) against a novel treatment for insomnia called acceptance and behavioral changes for insomnia (ABC-I) among individuals with comorbid pain. Differences in the potential mechanisms through which these treatments impact pain were also examined. MethodsData consisted of a secondary analysis from a randomized comparative effectiveness trial of CBT-I and ABC-I among women veterans with insomnia and comorbid pain. Pain outcomes, beliefs about sleep, and psychological flexibility were assessed at baseline, post-treatment, and at three-months follow-up. ResultsAt baseline, 93 women veterans reported comorbid insomnia and pain (mean age = 46.7; 33.3% Black, 24.7% Hispanic/Latina). Both CBT-I (n = 48) and ABC-I (n = 45) were associated with decreased pain intensity (p < .001, Cohen's d = 0.41–0.67) and pain interference (p < .001, Cohen's d = 0.71–0.77) at post-treatment and three-months follow-up, with results indicating that ABC-I was non-inferior to CBT-I for pain improvement. Both conditions were associated with greater psychological flexibility post-treatment, and CBT-I resulted in larger reductions in dysfunctional beliefs about sleep (p = .01, Cohen's d = 0.59). ConclusionCBT-I and ABC-I both had positive secondary effects on pain with ABC-I being non-inferior to CBT-I with respect to its impact on pain. The mechanisms of change associated with these treatments may differ with CBT-I leading to greater reductions in dysfunctional beliefs. Hybrid treatments which incorporate an acceptance and commitment approach to both insomnia and pain warrant further examination.

In-person versus online delivery of a behavioral sleep intervention (Sleeping Sound©) for children with ADHD: protocol for a parallel-group, non-inferiority, randomized controlled trial

BackgroundChildren with Attention-Deficit/Hyperactivity Disorder (ADHD) often experience sleep difficulties such as difficulty initiating and maintaining sleep. Problem sleep may impact children’s daily functioning and behaviors and exacerbate ADHD symptoms. Most effective behavioral interventions to improve sleep are conducted in person, limiting accessibility to treatment for individuals in remote or rural communities or those who are unable to attend a clinic. This trial aims to assess the efficacy of delivering an established behavioral intervention online, Sleeping Sound with ADHD©, compared to a face-to-face delivery mode.MethodsThis parallel group, non-inferiority, randomized controlled trial (RCT) will include at least 68 children, aged 5–12 years old with ADHD. Families of children will be recruited from private developmental and psychological clinics and social media, within the state of Western Australia (WA). Once written informed consent and baseline questionnaires are completed, families are randomized to receive the behavioral intervention either in-person or online via Telehealth services. The intervention targets the assessment and management of reported sleep problems, through two individual consultations and a follow-up phone call with a trained clinician. The sleep outcomes assessed consist of a parent-reported sleep questionnaire and actigraphy.DiscussionTo the best of our knowledge, this is the first RCT to investigate sleep treatment modality for children with ADHD. If effective, clinicians can provide an evidence-based sleep intervention in an accessible manner.Trial registrationANZCTR, ACTRN12621001681842. Registered 9 December 2021—Retrospectively registered.

Sleep, Poverty, and Biological Stress: Mitigating Sleep Health Disparities in Early Childhood

In the first years of life, poverty increases the risk of sleep problems such as late bedtimes and frequent night awakenings. In turn, children with sleep problems are more likely to go on to have poor physical and mental health outcomes as adults. The development of sleep and biological stress systems is connected, so that sleep problems can lead to abnormal function of the stress hormone cortisol and contribute to enduring socioeconomic health disparities. Sleep also is critical to brain and cognitive development. Sleep practices such as inconsistent bedtime and absence of a bedtime routine are more common in families experiencing poverty and stress. To address early childhood sleep problems, there is an urgent need for policies that help low-income families to access behavioral sleep interventions; provide families with affordable healthcare, housing, and nutrition; and adjust childcare and school practices to support healthy sleep.

Comparison Trial of Two Behavioral Sleep Interventions to Improve Sleep-Related Outcomes and Reduce Technology Usage Among College Students

Abstract Over 60% of college students are poor-quality sleepers, and many have inconsistent weekday and weekend sleep patterns. Technology usage (e.g., cellphone, computer, television) may contribute to poor sleep, but there is limited experimental research. In a comparison trial, 60 college students (mean age = 18.76, 86.7% female, 53.3% White) were randomly assigned to a 4-week sleep hygiene and stimulus control (SHSC) intervention or an enhanced intervention including technology stimulus control instructions (SHSC-E). Both groups showed improvements in sleep hygiene practices, perceived barriers to stimulus control, sleep quality, general technology usage, and technology usage before bed. However, the SHSC-E group did not have greater improvements compared to SHSC group as hypothesized, which suggests that the combination of sleep hygiene and stimulus control is a robust enough method for reducing self-reported technology usage. A longer intervention period might be necessary to observe the benefits of technology stimulus control procedures.

Patient reported preferences for sleep interventions among women receiving buprenorphine for opioid use disorder.

Among individuals receiving medication for OUD (MOUD), insomnia is highly prevalent and increases the risk for negative OUD outcomes. However, little is known about MOUD patient-reported preferences for insomnia treatments among women with OUD. This mixed-methods study explored acceptability of and patient preferences for sleep interventions among women in OUD treatment. This is an analysis from an ongoing cross-sectional survey and interview study investigating the relationship between sleep and OUD recovery. The parent study is actively enrolling non-pregnant women between 18-45 years stabilized on buprenorphine from an outpatient program. Participants complete measures including the Insomnia Severity Index (ISI), with scores of ≥10 identifying clinically significant insomnia symptoms. A sub-sample who met this threshold completed semi-structured interviews. Descriptive statistics were generated for survey responses, and applied thematic analysis was used for interview data. Participants selected for the qualitative interview (n = 11) highlighted prior positive and negative experiences with sleep treatments, challenges with employing non-pharmacological sleep strategies, and preferences for both medical and behavioral sleep interventions while in recovery. Women emphasized the need for flexibility of sleep therapy sessions to align with ongoing social determinants (e.g., caregiving responsibilities) as well as for sleep medications without sedating effects nor risk of dependency. Many women receiving MOUD have concomitant insomnia symptoms, and desire availability of both pharmacologic and behavioral sleep interventions within the OUD treatment setting. Qualitative findings underscore the need for evidence-based sleep interventions that account for the unique socioenvironmental factors that may impact strategy implementation in this population.