Abstract Study Objectives There is little research on sleep health interventions in Africa. We assessed the feasibility and acceptability of a tiered sleep health intervention among Ugandan adolescents. The intervention, delivered in two secondary schools, comprised universal components (sleep education sessions, structural changes to light, temperature and school-timings) plus targeted psychologist-delivered group cognitive behaviour therapy for insomnia (CBT-I) for students with moderate/severe insomnia (Insomnia Severity Index >15). Methods Feasibility and acceptability were assessed through semi-structured interviews immediately after the intervention (T1) and 3 months later (T2) among students with baseline (T0) insomnia, teachers and dormitory matrons, along with structured implementation trackers. We conducted a quantitative survey at baseline to assess prevalence of dimensions of sleep and mental health, and for those with insomnia only, repeated this at T1 and T2. Results The intervention was feasible and acceptable. High fidelity, dose and reach were achieved through integration of sleep education to the school schedule, structural changes to light, temperature and wake-up time for boarding students, effective small group delivery of CBT-I sessions and good retention despite fatigue due to extended sessions. Acceptability was reflected in high student engagement and positive feedback on the relevance of both universal and targeted components. Among 36 students with baseline insomnia, prevalence of moderate/severe insomnia decreased to 19.4% (7/36) post-intervention and further to 3.6% (1/28) at three months, indicating strong potential for impact. Conclusions Multi-level, school-based sleep interventions can be successful in low-income settings. Large-scale cluster-randomized controlled trials are needed to estimate impact and cost-effectiveness.

Prolonged benzodiazepine (BZD) prescribing in primary care represents a persistent gap between clinical guidelines and real-world practice, with significant implications for cognitive health and dependence. This narrative review aimed to analyze the neurobiological mechanisms underlying tolerance and dependence, evaluate long-term cognitive consequences—including the debated association with dementia—and examine clinical and systemic factors sustaining chronic use in general practice. A structured search was conducted in PubMed, Scopus, and the Cochrane Library for peer-reviewed studies published between 2004 and 2024, prioritizing systematic reviews, meta-analyses, cohort studies, and clinical guidelines. Evidence consistently demonstrates that chronic BZD exposure induces neuroadaptive changes in GABA-A receptors, leading to tolerance and physical dependence. Long-term use is associated with impairments in episodic memory, attention, and psychomotor speed, while data on dementia risk remain inconclusive due to potential reverse causation and confounding by indication. Contributing factors to chronic prescribing include patient fear of withdrawal, physician time constraints, and systemic practices such as automatic prescription renewals. Gradual tapering, shared decision-making, substitution strategies when appropriate, and integration of non-pharmacological interventions—particularly cognitive behavioral therapy for insomnia—are essential for safe deprescribing. Strengthening clinician education and public health policies is crucial to reduce iatrogenic harm and promote rational pharmacotherapy in primary care.

Is a full psychotherapy program necessary to reduce benzodiazepine dependence for insomnia? A Randomized Controlled Trial Comparing Drug Tapering with Single-Session CBT vs. Full Acceptance and Commitment Therapy.

Digital insomnia therapeutic as a workplace performance solution for improving productivity.

Effects of a partner-assisted insomnia intervention on couples' relationships: A qualitative study.

Efficacy of digital cognitive behavioral therapy for insomnia in hypnotic reduction among patients with insomnia: A randomized controlled trial.

Go! to sleep SM: a randomized, controlled trial for the treatment of chronic insomnia in adults epilepsy.

Pharmacological management of insomnia with a focus on GABAA receptor positive allosteric modulators and orexin receptor antagonists.

Predictors of cognitive-behavioral therapy for insomnia (CBT-I) outcomes in individuals with psychiatric disorders: A retrospective observational cohort study.

While symptoms of insomnia are common in older adults with mild cognitive impairment (MCI) and predict future cognitive decline, a robust evidence base for treating insomnia in MCI is lacking. This study investigated the feasibility of recruiting and delivering a digital cognitive behavioural therapy for insomnia (dCBT-I) in this group. In a parallel open-label randomised-controlled feasibility trial, participants were recruited and screened via the internet and assessed for MCI using videoconference methods. Eligible participants were randomised to dCBT-I (Sleepio, 6 weekly sessions) or control (3 online modules of sleep health education) over a 12-week period. Inclusion criteria included adults aged ≥ 50 years, Insomnia Severity Index (ISI) > 10, and clinical criteria of MCI on a neuropsychological battery. The primary outcomes were the proportion of participants who met screening and randomisation criteria, and their recruitment pathway (clinic vs. online). A secondary outcome was the effect size of the difference in ISI between groups at week 12. Recruitment occurred March-August 2023 (dCBT-I = 19; control = 21; 30 females; mean [SD] age = 59.7 years [7.3]; ISI = 17.0 [3.7]). 37% of participants issued a pre-screening number (n = 246) were eligible to attend online screening. 47% of those issued a screening number (n = 90) were eligible to be randomised (n = 42), with 2 not proceeding (final n = 40). dCBT-I improved 12 weeks ISI compared to control (Cohen's d [95% CI] -1.6 [-2.4 to -0.8]). 79% of participants completed ≥ 4 sessions. This population can be recruited through online pathways and follow the protocol as well as adhere to the intervention of this remotely conducted trial. Trials Registration: ClinicalTrials.gov Registry: (NCT05568381 registered 03/10/2022).

Patients undergoing abdominoperineal or intersphincteric resection for low rectal cancer experience profound physiological and psychological stress. Conventional Enhanced Recovery After Surgery (ERAS) protocols mainly address surgical and metabolic factors but rarely target the host's psychosocial and immunometabolic recovery. In this single-center randomized controlled trial, 240 patients with stage II-III low rectal cancer (September 2019-September 2021) were randomized (1:1) to receive either standard ERAS care or an integrated perioperative intervention combining resilience-based psychosocial support, cognitive behavioral therapy for insomnia, and Prognostic Immune Nutritional Index (PINI)-guided nutritional optimization. The primary outcomes were global quality of life (EORTC QLQ-C30) and sleep quality (Pittsburgh Sleep Quality Index). The secondary outcomes included postoperative recovery, inflammatory and nutritional indices, and 3-year disease-free and overall survival. At 12months, the intervention group showed greater improvement in quality of life (mean difference = 12.3, 95% CI 8.6-16.0; p < 0.001) and sleep quality (-3.1, 95% CI -4.5 to -1.8; p < 0.001). Serum interleukin-6 declined more rapidly (-1.9pg/mL vs -0.8; p < 0.001), accompanied by improved PINI (-0.7; p < 0.01) and higher fecal short-chain fatty acid levels (+ 10.6mmol/kg; p < 0.001). Three-year disease-free survival favored the intervention (HR 0.69, 95% CI 0.51-0.93; p = 0.015). No intervention-related serious adverse events occurred. Integrating psychosocial, sleep, and immunonutritional components into perioperative care enhanced functional and physiological recovery after low rectal cancer surgery. These findings support extending ERAS toward targeted modulation of host response to improve both short- and long-term outcomes.

Patients with insomnia have difficulty in both falling asleep and maintaining sleep. Individuals with long-term sleep deprivation are prone to poor concentration and impaired memory; however, these problems can be alleviated following brief behavioral treatment for insomnia (BBT-I). This study involved the design of an app called "Sleep Well" that enables individuals with insomnia to easily record their sleep behavior. The app guides users to recall and record sleep-related information, acquire sleep hygiene knowledge, and communicate with therapists online. This study examined how specific sleep diary interface design features in a brief cognitive behavioral therapy for insomnia (BBT-I) app influence users' attention and short-term memory. Using a combination of objective eye-tracking measures and subjective attention assessments, the study compared 3 interface designs to determine how visual layout, input modality, and interaction style interact with insomnia symptoms to affect attentional performance, memory accuracy, and user preference. Three sleep diary interfaces were designed, varying background mode (day vs night), color scheme (blue vs green), box shape (circular, rounded rectangular, or rectangular), and input method (slide-in, tap, or type-in). A total of 33 participants completed standardized diary-entry tasks while eye movements were recorded using an eye tracker to capture gaze trajectories and visual attention patterns during app interaction. User experience, subjective attention, and interface preferences were assessed using structured questionnaires. Data were analyzed using descriptive statistics, nonparametric tests, Pearson correlation analysis, cross-tabulation analysis, and exploratory factor analysis to examine associations among interface design, attentional performance, memory accuracy, and user characteristics. A total of 33 participants (n=13, 39.4% male and n=20, 60.6% female) aged 20 to 64 years completed this study. Based on the Insomnia Severity Index, 6 of 33 (18.2%) participants had clinical insomnia and 13 of 33 (39.4%) reported insomnia symptoms. Most participants reported staying up late (22/33, 66.7%), and more than half of participants reported drinking tea (17/33, 51.5%). Interface design significantly influenced objective attentional performance, as measured by eye-tracking indicators of task efficiency and visual allocation. Sleep quality and insomnia symptoms were consistently associated with attentional and short-term memory outcomes, with memory accuracy varying across interfaces and showing particular sensitivity to sleep maintenance difficulties. Subjective attentional control was strongly associated with both eye-tracking metrics and memory performance, and interface preferences differed by insomnia status. Interface design significantly modulates attention and short-term memory performance in users with insomnia. Eye-tracking revealed that insomnia symptoms and sleep quality influence visual attention and task efficiency, whereas subjective attentional control showed stronger and more consistent associations with memory accuracy than physiological eye-movement indicators. These findings suggest that cognitive processing during sleep diary completion relies more on internal attentional states than on observable gaze behavior. Designing low-load, attention-supportive interfaces may therefore improve usability and data accuracy in digital BBT-I interventions.

Mental disorders are the leading cause of reduced quality of life due to illness worldwide. Most patients with mental disorders report difficulties initiating or maintaining sleep (insomnia). Current guidelines recommend cognitive behavioral therapy for insomnia (CBT-I) as the first-line treatment, including for patients with comorbid mental disorders. Particularly, data on the management of insomnia in inpatient psychiatric care remain scarce. This clinical practice evaluation examined the management of insomnia in inpatient psychiatric care through two complementary approaches. The project comprised a survey on insomnia management in 80 mental health professionals and data extraction of nighttime medication from 245 inpatients. Reports from the survey indicate that 95% of mental health professionals regularly care for patients with insomnia. 56% correctly identified CBT-I and 48% incorrectly identified benzodiazepines or benzodiazepine-receptor agonists as the first-line treatment for insomnia. 65% reported that CBT-I is not or rarely offered. The main reported challenges to implementing CBT-I were limited knowledge about CBT-I, patient expectations for pharmacological treatment, and time constraints in clinical practice. Data extracted from 245 patient records indicated that 40% of the patients took benzodiazepines, 9% melatonin, 7% benzodiazepine receptor agonists, 5% clomethiazole, 4% antihistamines, and 2% phytotherapy. The results indicate that insomnia is a prevalent health problem in inpatient psychiatric care. Implementation of CBT-I or adaptations remains insufficient, and treatment with hypnotics is common. Future work is needed to further adapt and test CBT-I in inpatient psychiatric care to improve sleep and health.

Perinatal depression poses substantial risks to both mothers and their offspring. Given its chronic and recurrent nature, developing effective prevention strategies is crucial. Internet-based cognitive-behavioural therapy (iCBT) has shown promise. However, the efficacy of specific CBT skills and the influence of individual differences remain unclear. This protocol describes two harmonised multicentre, open-label, six-arm randomised controlled trials. Across both trials, a total of 2400 pregnant women between 10 and 20 weeks of gestation will be enrolled. After completing psychoeducation (PE), participants will be randomised to either the control condition (PE only) or one of five CBT programmes: behavioural activation (BA), assertion training, BA+cognitive restructuring, BA + problem solving or BA + behaviour therapy for insomnia. The objectives of the study are: (1) to ascertain that the iCBT approach is effective in perinatal depression, (2) to identify active CBT skills for perinatal women and (3) to examine interactions between these CBT skills and individuals' baseline characteristics to find personalised and optimised therapy for individual women. The primary outcome is the point prevalence of depression at 1 month postpartum, defined as scoring of 9 or higher on the Edinburgh Postnatal Depression Scale. The study has been approved by the Kyoto University Graduate School of Medicine Ethics Committee (C1710) and Nagoya City University Certified Review Board (2024A007). Anonymised study results will be presented at conferences and published by the investigators in peer-reviewed journals. jRCTs042240162 (hospital-based, on-site trial) and jRCT1050250074 (nationwide online trial).

Nocturia (i.e., waking to void during the primary sleep period) of two or more times per night affects nearly one-third of older adults and can have a severe impact on sleep, contributing to insomnia symptoms. Current treatment approaches for nocturia often overlook non-lower urinary tract factors that may contribute to nighttime awakenings. Nocturia management, for example, may benefit from more effective integration of cognitive behavioral therapy for insomnia (CBT-I) principles that address other factors underlying insomnia symptoms, and early evidence suggests it also reduces nocturia and the bother it causes. Because nocturia treatment crosses specialties, coordinated delivery of urological and sleep therapies is a treatment barrier. The overall purpose of this trial is to determine whether a promising coordinated, integrated behavioral, non-pharmacological, non-surgical treatment that simultaneously addresses both the urological and insomnia factors contributing to nocturia is efficacious for improving nocturia, sleep, and daytime function. This multicenter parallel-group randomized, efficacy trial compares a 5-week integrated behavioral treatment program delivered by a single interventionist (psychologist, nurse practitioner, or physician assistant) to a health education control program in adults aged 60years or older (proposed n = 192) recruited from sites in Atlanta and Los Angeles, who report typically getting up to urinate two or more times per night (International Consultation on Incontinence Questionnaire-Overactive bladder [ICIQ-OAB] nocturia item) and insomnia symptoms (Insomnia Severity Index > 7). The integrated program includes components of CBT-I and pelvic floor muscle exercise-based behavioral therapy for nocturia. The primary outcome is ICIQ-OAB-measured nocturia frequency 4months after randomization. Secondary outcomes are sleep diary-measured wake after sleep onset (mean minutes) and Insomnia Severity Index total score. The interdisciplinary trial team has developed a program aimed at improving nocturia symptoms and overall sleep of older adults in an efficient and safe manner. The integrated behavioral program has the potential to address nocturia, which is a challenging symptom because it has many etiologies that cross multiple specialties. Findings will provide rigorous evidence of the efficacy of the integrated behavioral treatment program to reduce nocturia frequency as well as sleep disturbance in older adults. Clinicaltrials.gov NCT06110091, registered 10/25/2023.

Chronic Insomnia Disorder (ID) is characterized by hyperarousal, a key pathophysiological feature. While Cognitive-Behavioral Therapy for Insomnia (CBT-I) is the first-line treatment, its physiological effects on sleep-related hyperarousal remain underexplored. This study assessed the impact of CBT-I on cortical hyperarousal using quantitative EEG (qEEG) during non-REM (NREM) sleep, with the delta/beta ratio as the primary outcome. Secondary aims included evaluating changes in sleep stability and exploring phenotypic differences in treatment response. Ninety-eight ID patients across five centers completed a 6-8-week CBT-I program. Pre-and post-treatment assessments included polysomnography (PSG), sleep diaries, and Insomnia Severity Index (ISI). Cortical hyperarousal was indexed by the NREM delta/beta ratio; sleep stability (Sstab) was derived from a transition probability matrix. Patients were categorized as insomnia with short (ISSD) or normal sleep duration (INSD) based on PSG-derived total sleep time (median TST = 347.3 min). CBT-I significantly improved ISI and sleep parameters (sleep onset latency, wake after sleep onset, time in bed, sleep efficiency) in both self-reported and PSG, with smaller effects in the latter. qEEG analyses revealed a significant increase in the delta/beta ratio post-CBT-I (baseline:13.4 ± 4.9, end-of-treatment:14.6 ± 5.9; p = 0.002), indicating reduced cortical hyperarousal, with no center effects. Sstab improved significantly (p = 0.005), though it was not correlated with delta/beta changes. ISSD showed greater delta/beta improvements than INSD (p = 0.014), suggesting phenotypic differences. CBT-I reduces cortical hyperarousal in ID, as reflected by increased delta/beta ratio. The dissociation from sleep stability suggests distinct mechanisms. These findings support qEEG biomarkers as valuable tools for understanding the neurophysiological mechanisms of insomnia treatment and guiding precision medicine approaches.

Post-traumatic stress disorder (PTSD) represents one of the most debilitating psychiatric conditions. Posttraumatic stress disorder is frequently accompanied by sleep disturbances, including insomnia and trauma-related nightmares, affecting up to 90% of individuals with this condition. This literature review examines the bidirectional relationship between sleep disturbances and PTSD symptoms, focusing on the role of sleep as both a symptom and a maintaining factor of the disorder. A review of empirical studies, meta-analyses, and clinical trials published between 2010 and 2025 indicates that disrupted sleep architecture contributes to impaired emotional regulation, deficits in memory consolidation, and heightened threat sensitivity, thereby exacerbating daytime PTSD symptoms. Evidence demonstrates that sleep-focused interventions, such as cognitive-behavioral therapy for insomnia (CBT-I), imagery rehearsal therapy (IRT), and pharmacological treatments, effectively reduce sleep problems and lead to improvements in core PTSD symptoms. The findings suggest that early and integrated treatment of sleep disturbances may enhance overall PTSD recovery and improve the outcomes of trauma-focused therapies.

Borderline personality disorder (BPD) is often associated with insomnia, which may contribute to a vicious cycle of reciprocal exacerbation of sleep disturbance and BPD symptoms. Online cognitive behavioral therapy for insomnia (iCBT-I) has shown promise for treating insomnia in BPD patients. This study evaluated the key determinants, underlying processes, and change mechanisms of successful implementation of guided iCBT-I in BPD patients. In the context of our clinical trial, we conducted this mixed-method process evaluation in 30 patients with BPD and comorbid insomnia complaints (mean age 29.5 years ± 8.72) that received guided iCBT-I. Our process evaluation was guided by four dimensions of the theoretical RE-AIM framework: Reach (e.g., reason participation), Effectiveness (e.g., perceived symptom reduction), Implementation (e.g., treatment delivery), Maintenance (e.g., sustained adherence). We combined insights from quantitative patient-reported evaluation of treatment satisfaction and adherence and therapist log data, with qualitative exploration of patient experiences through in-depth interviews in a subsample of five patients. 21 patients (70%) completed the intervention. Patients appreciated the online modality and emphasized the importance of responsive and personalized (videocall) therapist guidance and active reminders. Patients found behavioral strategies, such as fixed bedtimes and an evening winding-down routine particularly helpful, while more introspective and cognitive techniques were often perceived as challenging. Qualitative effectiveness evaluations aligned with clinical trial outcomes on BPD, insomnia and arousal-related symptoms. Finally, patients expressed a strong desire for more and well-integrated sleep treatment into regular BPD care trajectories. Guided iCBT-I proved a feasible and promising intervention for patients with BPD, with successful implementation contingent upon personalized guidance, focus on behavioral strategies tailored to individual needs, and solid integration into BPD care.

The most effective treatments of prolonged grief disorder (PGD) result in clinically relevant effects in only about half of the patients and can be emotionally taxing. This points to the importance of improving currently available treatment options. One promising target for enhancing the efficacy of the treatment of PGD is insomnia. Sleep disturbances are very common in bereavement and are proposed to play a causal role in maintaining PGD symptoms. Therefore, targeting sleep problems may be an effective treatment for people with PGD and insomnia disorder. This protocol presents a study, registered in the Dutch Trial Register (NL86238.042.24) that will evaluate the effects of cognitive behavioral therapy for insomnia (CBT-I) in individuals with comorbid PGD and insomnia using a replicated single-case experimental design (R-SCED). Twenty adults meeting diagnostic criteria for both disorders will be randomized to complete baseline between 5 and 14 weeks, after which they will receive CBT-I. Weekly PGD and insomnia symptom measures will be administered throughout the baseline (5–14 weeks), intervention (7–8 weeks) and post-intervention phase (4–13 weeks). Outcomes will be examined using visual inspection, Tau-U indices, and randomization tests. Results: We expect CBT-I to reduce both insomnia and PGD symptoms. This study will form the first systematic evaluation of CBT-I for PGD. Findings may help establish a novel, less emotionally demanding treatment option for bereaved individuals.

Many patients at risk for suicide present in primary care where insomnia and other suicide risk factors are prevalent. Addressing insomnia in this milieu may augment suicide prevention strategies. A randomized clinical trial was conducted to test the effectiveness of brief cognitive behavioral therapy for insomnia (bCBTi) for primary care patients at risk for suicide recruited from three U.S. Veterans Health Administration practices. The 194 participants (77% male; mean age 51.5+/-13.6 years) with insomnia, co-occurring depression and/or posttraumatic stress disorder (PTSD) and recent death or suicide ideation were randomized to receive four 30-minute sessions of bCBTi or Sleep Hygiene over six weeks. Blinded assessments occurred every 6 weeks from baseline to 30 weeks. Change in Insomnia Severity Index (ISI) across 30 weeks was the primary outcome with co-secondary outcomes measured by the Scale for Suicidal Ideation (SSI), Patient Health Questionnaire-9 (PHQ-9) and PTSD Checklist (PCL). Mixed level modeling showed a significant condition effect at posttreatment (6-weeks) for ISI favoring bCBTi (t(df) = -4.58(153); p < .0001) which was maintained through 30-weeks (t(df) = 0.35(141); p >.05). PHQ-9 was lower at 6 weeks in the bCBTi condition (t(df) = -2.07(155); p = .04) maintained through 30 weeks (t(df) = -0.47(137); p > .05). No PCL differences and no difference in SSI at posttreatment. However, a significant timexcondition effect from 6 to 30 weeks existed for SSI favoring bCBTi (t(df) = -2.60(118); p = 0.01). The bCBTi intervention designed for primary care settings effectively reduces insomnia severity with modest effects for depression and suicidal thoughts, offering an adjuvant to suicide prevention strategies.