Effectiveness of an Online CBT-I Intervention and a Face-to-Face Treatment for Shift Work Sleep Disorder: A Comparison of Sleep Diary Data

Abstract

In western societies, about one in six employees works in shifts. Shiftwork is associated with a number of poor somatic and psychological health outcomes, especially sleep issues. Higher rates of absenteeism and accidents in the workplace are possible consequences. Still, prevention programs and treatment options that are specifically tailored to shift-workers’ needs are rare. We devised a 4-week online cognitive behavioral therapy for insomnia (CBT-I) intervention (n = 21) and compared sleep outcomes to a face-to-face outpatient treatment for shift-workers (n = 12) using a sleep diary and the Epworth Sleepiness Scale (ESS). In the online sample, measures also included the World Health Organization wellbeing questionnaire (WHO-5) and the Insomnia Severity Index (ISI). In the outpatient sample, the Beck Depression Inventory (BDI-II), the Montgomery–Åsberg Depression Rating Scale (MADRS), and the Pittsburgh Sleep Quality Index (PSQI) were administered. Results showed significant improvements in sleep efficiency by 7.2% in the online sample and 7.7% in the outpatient sample. However, no significant difference was found in the rate of improvement in sleep efficiency across four weeks of treatment between the samples. In the online sample, the wellbeing (WHO-5) and insomnia symptoms (ISI) scores were significantly improved following the CBT-I intervention (p < 0.004 and p < 0.002 respectively). In the outpatient sample, symptoms of depression (BDI-II and MADRS scores) and insomnia symptoms (PSQI scores) improved significantly following the CBT-I intervention. In summary, CBT-I significantly improved sleep efficiency in both the online and outpatient samples, in addition to wellbeing, symptoms of insomnia, and depression. The findings of this study demonstrate online CBT-I as a feasible approach for treating insomnia in shift-workers. Future randomized controlled trials are needed.

Cognitive behavioural therapy interventions for insomnia among shift workers: RCT in an occupational health setting

“…The main difference between the studied interventions appeared in the outcomes related to mental health. The gCBT-I of our study was effective in improving the mental health of shift workers, as also observed in earlier studies (Jarnefelt et al 2012;Okajima et al 2011;Peter et al 2019). The trait of worry had decreased substantially at 6-month follow-up, the interaction effect showing a larger reduction after the gCBT-I than SH control intervention.…”

“…However, our previous non-randomized study showed no difference between the improvements among day and shift media workers after CBT-I (Jarnefelt et al 2014). In addition, a non-randomized study by Peter et al (2019) showed improvement in ISI among shift workers after online CBT-I. Regardless of the intervention, ISI improved moderately in our current study, and sleep-related dysfunctional beliefs along with burnout and stress symptoms showed small improvements lasting up to the 6-month follow-up after all three interventions.…”

“…However, only a few CBT-I effectiveness studies have been conducted among shift workers. Earlier non-randomized studies have shown that CBT-I may also be effective among shift workers (Jarnefelt et al 2012;Peter et al 2019). On the other hand, one study found that CBT-I implemented at the workplace was only effective when shift workers were not included in the analyses (Schiller et al 2018).…”

Sleep Regularity Index in Patients with Alcohol Dependence: Daytime Napping and Mood Disorders as Correlates of Interest

“…Additionally, improved SRI from week 1 to week 3 was associated with fewer naps. Data such as these have important implications for targeted therapies such as cognitive behavioral therapy for insomnia (CBT-I), which typically include reducing naps and/or sleep restriction as major components [38]. Such behavioral modifications could impact the SRI.…”

Sleep and Wellbeing, Now and in the Future

“…Sleep medicine has come a long way due to increased public awareness, as highlighted by the study of Savic et al (2019), who reported that the nurses in their study had already adopted health-promoting coping strategies with their night shifts [32], including health practices of physical activity, healthy eating, engaging with social support and leisure, mindfulness, managing time, and work-related coping strategies. Nevertheless, the online platforms of mHealth [33] and cognitive behavioural therapy for insomnia (CBTi) [34] are resourceful, easily accessible materials for shift workers. Forest therapy (originating in the 1980s in Japan for stress reduction) that improved sleep efficiency in cancer patients [35] may be explored in shift workers in future studies.…”