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Digital cognitive behavioral therapy for insomnia promotes later health resilience during the coronavirus disease 19 (COVID-19) pandemic.
Cheng, P, Casement, MD, Kalmbach, DA, Castelan, AC, Drake, CL
Sleep. 2021;44(4)
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Plain language summary
The 2019 coronavirus disease (COVID-19) pandemic has had health consequences that extend well-beyond symptoms of the virus. Mental health problems are already being observed in the context of COVID-19 and have also been documented during previous epidemics. The aim of this study was to evaluate the effect of prior digital cognitive-behavioural therapy for insomnia (dCBT-I) versus sleep education on health resilience during the COVID-19 pandemic. This study is a follow up study based on a previous randomised controlled trial [SPREAD trial] for which the enrolled participants were divided into two groups: 358 in the dCBT-I condition and 300 in the control condition. For this follow-up study 208 participants (dCBT-I: n = 102; control: n = 106) out of the total 658 participants were enrolled. Results indicate that 67.3% of the sample reported direct impact from the coronavirus, and 26.4% reported living alone during the shelter-in-place orders. Furthermore, those who received dCBT-I reported less insomnia, stress, depression, and better global physical health compared to those who received a sleep education control. Authors conclude that future research should examine the mechanisms by which insomnia treatment may enhance resilience, and the role of dCBT-I in mitigating the adverse health consequences of the COVID-19 pandemic.
Abstract
STUDY OBJECTIVES Stressful life events contribute to insomnia, psychosocial functioning, and illness. Though individuals with a history of insomnia may be especially vulnerable during stressful life events, risk may be mitigated by prior intervention. This study evaluated the effect of prior digital cognitive-behavioral therapy for insomnia (dCBT-I) versus sleep education on health resilience during the COVID-19 pandemic. METHODS COVID impact, insomnia, general- and COVID-related stress, depression, and global health were assessed in April 2020 in adults with a history of insomnia who completed a randomized controlled trial of dCBT-I (n = 102) versus sleep education control (n = 106) in 2016-2017. Regression analyses were used to evaluate the effect of intervention conditions on subsequent stress and health during the pandemic. RESULTS Insomnia symptoms were significantly associated with COVID-19 related disruptions, and those who previously received dCBT-I reported less insomnia symptoms, less general stress and COVID-related cognitive intrusions, less depression, and better global health than those who received sleep education. Moreover, the odds for resurgent insomnia was 51% lower in the dCBT-I versus control condition. Similarly, odds of moderate to severe depression during COVID-19 was 57% lower in the dCBT-I condition. CONCLUSIONS Those who received dCBT-I had increased health resilience during the COVID-19 pandemic in adults with a history of insomnia and ongoing mild to moderate mental health symptoms. These data provide evidence that dCBT-I is a powerful tool to promote mental and physical health during stressors, including the COVID-19 pandemic. CLINICAL TRIAL REGISTRATION NCT02988375.
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Autogenic Training as a behavioural approach to insomnia: a prospective cohort study.
Bowden, A, Lorenc, A, Robinson, N
Primary health care research & development. 2012;13(2):175-85
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Plain language summary
Insomnia, which may include difficulty falling asleep, waking up frequently and feeling un-refreshed on waking, is a common problem and is often associated with anxiety. Current NICE guidelines for treating insomnia in primary care recommend that behavioural approaches should be considered before prescribing medication. Autogenic Training (AT) is a stress management technique which has been shown to improve sleep problems, anxiety and depression. This prospective cohort study examined the effectiveness of AT as a self-management, non-drug approach to sleep disorders within an NHS outpatient clinic in patients with chronic ill health. 153 participants who completed an 8 week AT course with weekly 2h group sessions, which had no specific focus on sleep, and daily home practice. Primary outcome assessed was impact on sleep, secondary outcomes were symptoms and wellbeing (measured by Measure Your Medical Outcome Profile, MYMOP, questionnaire) and anxiety and depression (measured by the Hospital Anxiety and Depression Scale, HADS). Outcomes were measured 2.5 months prior to AT course, at the start and at the end of the AT course; and at follow-up. 73% of participants reported sleep problems. Significant improvements were seen for time taken to fall asleep, difficulty getting back to sleep, energy levels, dream recall and feeling refreshed upon waking, between before and at the end of AT. Anxiety/depression was reported by 64% of participants as their most important current health problem, and significant improvements seen in both anxiety and depression. Overall wellbeing, as assessed by MYMOP, also increased significantly. The authors conclude that AT can improve sleep patterns in patients with a wide range of health conditions and may reduce depression and anxiety, which can both result from and cause insomnia, and may offer an alternative to drug treatment.
Abstract
BACKGROUND Insomnia is commonly associated with chronic health problems. Behavioural and cognitive factors often perpetuate a vicious cycle of anxiety and sleep disturbance, leading to long-term insomnia. National Institute for Health and Clinical Excellence currently recommends behavioural approaches before prescribing hypnotics. Behavioural approaches aim to treat underlying causes, but are not widely available. Research usually includes patients diagnosed with insomnia rather than secondary, co-morbid sleep- related problems. AIM: To examine the effectiveness of autogenic training (AT) as a non-drug approach to sleep-related problems associated with chronic ill health. DESIGN Prospective pre- and post-treatment cohort study. SETTING AT centre, Royal London Hospital for Integrated Medicine, University College London Hospitals NHS Foundation Trust. METHODS All patients referred for AT from April 2007 to April 2008 were invited to participate. Participants received standard 8-week training, with no specific focus on sleep. Sleep questionnaires were administered at four time points, 'Measure Your Medical Outcome Profile' (MYMOP) and Hospital Anxiety and Depression Scale, before and after treatment. Results before and after treatment were compared. Camden and Islington Community Local Research and Ethics Committee approved the study. RESULTS The AT course was completed by 153 participants, of whom 73% were identified as having a sleep-related problem. Improvements in sleep patterns included: sleep onset latency (P = 0.049), falling asleep quicker after night waking (P < 0.001), feeling more refreshed (P < 0.001) and more energised on waking (P = 0.019). MYMOP symptom, well-being, anxiety and depression scores significantly improved (all P < 0.001). CONCLUSION This study suggests that AT may improve sleep patterns for patients with various health conditions and reduce anxiety and depression, both of which may result from and cause insomnia. Improvements in sleep patterns occurred despite, or possibly due to, not focusing on sleep during training. AT may provide an approach to insomnia that could be incorporated into primary care.