A step-by-step model for a brief behavioural treatment for insomnia in Australian general practice

Sweetman, Alexander; Zwar, Nicholas; Grivell, Nicole; Lovato, Nicole; Lack, Leon

doi:10.31128/ajgp-04-20-5391

Cited by 13 publications

(8 citation statements)

References 31 publications

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“…Sleep in military personnel has been recognised as a ‘vital health behaviour’ for which policies and guidelines must be developed 39. Cognitive–behavioural therapy for insomnia is regarded as an effective ‘first-line’ treatment, and a brief intervention has been described for use in Australian general practice 40. Our final model showed that distress had a negative association with health, psychological flexibility a positive relationship, with sleep most likely related to both of these variables.…”

Section: Discussionmentioning

confidence: 87%

Factors associated with self-reported health among New Zealand military veterans: a cross-sectional study

et al. 2022

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ObjectiveTo identify factors associated with better or poorer self-reported health status in New Zealand military Veterans.DesignA cross-sectional survey.ParticipantsThe participants of interest were the 3874 currently serving Veterans who had been deployed to a conflict zone, but all Veterans were eligible to participate.Study variablesThe EQ-5D-5L, asking about problems across five dimensions (mobility, self-care, usual activities, pain or discomfort and anxiety or depression), with five levels of severity (eg, no, slight, moderate, severe or extreme problems), also containing a Visual Analogue Scale (EQ-VAS) to self-assess health state, scaled from 0 (worst) to 100 (best) imagined health.Hypothetical relationships with better health were positive social support, sleep and psychological flexibility; with poorer health, post-traumatic stress, exposure to psychological trauma, distress and hazardous drinking.ResultsThe EQ5-D-5L was completed by 1767 Veterans, 1009 serving, a response rate of 26% from that group, 1767 completing the EQ5-D, 1458 who had deployed, 288 who had not and the 21 who did not provide deployment data. Of these, 247 were not used in the analysis due to missing values in one or more variables, leaving 1520 for analysis.A significantly higher proportion of Veterans reported ‘any problems’ rather than ‘no problems’ with four EQ-5D dimensions: mobility, self-care, usual activities and pain or discomfort, but no difference in anxiety or depression. Age, length of service, deployment, psychological flexibility and better sleep quality were associated with higher EQ-VAS scores; distress with lower EQ-VAS scores.ConclusionIn this sample of New Zealand Veterans, psychological flexibility and good sleep are associated with better self-rated health, and distress and poor sleep with diminished health. These factors might be used as sentinel health indicators in assessing Veteran health status, and cognitive–behavioural therapy encompassing these domains may be useful in improving the health of New Zealand Veterans.

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Section: Discussionmentioning

confidence: 87%

Factors associated with self-reported health among New Zealand military veterans: a cross-sectional study

et al. 2022

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“…From a history of anxiety, frustration, and activation of the 'fight-or-flight' reaction to a perceived threat while trying to initiate or fall back to sleep, the conditions in which sleep is attempted become triggers for alertness that inhibit sleep and reinforce the association between the bedroom conditions and the alerting response. The behavioral therapies restrict time in bed, increase sleep drive, and reduce time spent awake in bed trying to sleep [52]. Gradually time awake in bed reduces and changes the association between bed and wakefulness to that of bed and sleep.…”

Section: Cognitive Behavior Therapy For Insomniamentioning

confidence: 99%

“…Therapists and patients review self-reported sleep and wake parameters during each session to inform decisions to further restrict, maintain, or extend time in bed. After patients starts to sleep for approximately 85% or more of their time in bed, therapists and patients work together to gradually extend time in bed from week-to-week until a comfortable and satisfying equilibrium between sleep duration, time in bed and sleepiness is achieved [52]. CBT-i is associated with a small and short-term increase in daytime sleepiness in patients with un-treated OSA [11], with potential neurocognitive and alertness implications [12].…”

Section: Management Approachesmentioning

confidence: 99%

Co-morbid insomnia and sleep apnea (COMISA): recent research and future directions

Sweetman,

Osman,

Lack

et al. 2023

Current Opinion in Pulmonary Medicine

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Purpose of review Insomnia and obstructive sleep apnea have previously been viewed as completely independent conditions. However, there is now increasing recognition that insomnia and sleep apnea frequently co-occur. Co-morbid insomnia and sleep apnea (COMISA) is a highly prevalent condition that is associated with impairment of sleep, daytime function, mental health and physical health outcomes, and mortality risk. This review aims to provide an update on COMISA prevalence, consequences, treatment approaches, and future research directions. Recent findings People with COMISA experience worse sleep, mental health, physical health, quality of life and longevity compared to people with neither condition, and often compared to those with insomnia alone and sleep apnea alone. Emerging evidence suggests that cognitive behavioral therapy for insomnia is an effective treatment in the presence of treated and untreated sleep apnea, that may also improve manifestations and subsequent management of sleep apnea. Future research is required to understand the etiology of COMISA, and to develop and implement tailored treatment approaches. Summary It is important for sleep and respiratory technicians, researchers and clinicians to be aware of the high co-morbidity rates, consequences, and treatment requirements of patients with co-morbid insomnia and sleep apnea.

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“…14 Referral to a specialist 'sleep' psychologist may also be considered for a minority of patients who are currently pregnant or caring for very young infants, those with seizure disorders (which may be exacerbated by sleep deprivation resulting from sleep restriction therapy in some patients), severe or uncontrolled psychiatric disturbances, excessive daytime sleepiness, people who drive for work and shift workers. 14,44 The Australasian Sleep Association and the Australian Psychological Society are currently collaborating on a suite of education programs to increase the number of psychologists with training in insomnia assessment and CBT-i delivery.…”

Section: Treatmentmentioning

confidence: 99%

General practitioner management of comorbid insomnia and sleep apnoea

Sweetman,

Frank,

Stocks

et al. 2023

Aust J Gen Pract

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A step-by-step model for a brief behavioural treatment for insomnia in Australian general practice

Cited by 13 publications

References 31 publications

Factors associated with self-reported health among New Zealand military veterans: a cross-sectional study

Factors associated with self-reported health among New Zealand military veterans: a cross-sectional study

Co-morbid insomnia and sleep apnea (COMISA): recent research and future directions

General practitioner management of comorbid insomnia and sleep apnoea

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