Impacts of cognitive-behavioural interventions on sleep effort, objective and subjective sleep quality among adults with insomnia.

Ong, Sze Chyen Glenneze (2022) Impacts of cognitive-behavioural interventions on sleep effort, objective and subjective sleep quality among adults with insomnia. Doctoral thesis, University of East Anglia.

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Background: Insomnia is a highly prevalent sleep disorder that negatively impacts overall health-related quality of life. Cognitive-behavioural interventions including cognitive behavioural therapy for insomnia (CBT-I) and paradoxical intention therapy (PI) have been developed to improve insomnia. Research suggests mixed findings on the impacts of CBT-I on objective and self-reported measures of sleep. Moreover, existing studies examining the effectiveness of PI among adults with high sleep effort are lacking.

Methods: This thesis portfolio aimed to address gaps within current literature around CBT-I and PI. First, a systematic review was carried out to describe and synthesise studies that assessed the effectiveness of CBT-I on both objective and self-reported sleep measures. Second, a two-arm, randomised controlled trial was conducted to determine the feasibility and preliminary efficacy of PI among adults with insomnia and high sleep effort.

Results: The systematic review identified 15 eligible studies. Most studies found significant improvements in sleep diary parameters (e.g., sleep efficiency, sleep onset latency, wake after sleep onset) and subjective sleep-related questionnaires following CBT-I. Conversely, mixed findings were found on objective sleep measures whereby the direction, magnitude and significance of change varied across studies. The feasibility study indicated that PI shows good potential as a standalone psychological intervention for adults with insomnia. Significant improvements were reported on self-reported sleep efficiency, sleep onset latency and wake after sleep onset. PI also improved sleep effort, overall subjective sleep quality and depression symptoms across time. Notably, there was a lack of agreement between actigraphy and sleep diary outcomes.

Conclusion: CBT-I and PI show effectiveness in improving self-reported sleep quality. However, there remains scope for research to investigate the effectiveness of these interventions, with considerations to objective/self-reported discrepancies and symptom presentations of adults with insomnia (e.g., presence of high sleep effort and/or depressive symptoms). Implications and directions for future research are discussed.

Item Type: Thesis (Doctoral)
Faculty \ School: Faculty of Medicine and Health Sciences > Norwich Medical School
Depositing User: Chris White
Date Deposited: 01 Dec 2022 09:21
Last Modified: 01 Dec 2022 09:21


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