RCT of the effectiveness of stepped-care sleep therapy in general practice: The RESTING study protocol

Manber, Rachel; Tully, Isabelle; Palaniappan, Latha; Kim, Jane; Simpson, Norah; Zulman, Donna M.; Goldhaber-Fiebert, Jeremy D.; Rangel, Elizabeth Ferreira; Dietch, Jessica R.; Rosas, Lisa G.

doi:10.1016/j.cct.2022.106749

Cited by 11 publications

(4 citation statements)

References 59 publications

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“…This underscores the importance of weekly monitoring in treatment and raises the possibility that an adaptive, flexible intervention with the capability of being tailored during treatment to nonresponders may show greater benefit to subsequent depression reduction. Research is underway evaluating so-called ‘just in time adaptive interventions’ [86] and/or stepped-care approaches with flexible delivery of CBT-I treatment [87,88] to evaluate this possibility.…”

Section: Discussionmentioning

confidence: 99%

Recent advances in sleep and depression

Mirchandaney

Asarnow

Kaplan

2022

Current Opinion in Psychiatry

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Purpose of reviewThere is increasing interest in the connection between sleep disturbances and mood disorders. The purpose of this review is to summarize and evaluate current research on the role of sleep disturbance in the development of depression, as well as to describe recent advances in treatments that improve both sleep and depression symptoms. Recent findingsRelevant publications included in this review cover a wide range of topics related to sleep and depression. Data from large longitudinal studies suggest that insomnia and evening circadian preference are unique risk factors for depression. Depression treatment studies indicate poorer outcomes for those with comorbid sleep disturbances. A few recent trials of cognitive behavioral therapy for insomnia and triple chronotherapy in unipolar depression have shown promising results. SummarySleep disturbance is a modifiable risk factor in the development and maintenance of depression. In the context of current depression, although the data is mixed, some evidence suggests treating sleep disturbance can improve overall outcomes. Recent evidence also suggests that treating sleep disturbance may prevent the future depressive episodes.

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Section: Discussionmentioning

confidence: 99%

Recent advances in sleep and depression

Mirchandaney

Asarnow

Kaplan

2022

Current Opinion in Psychiatry

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“…Interventions targeted to the severity of insomnia or insomnia refractory to initial intervention may also be useful (Manber et al, 2015; Savard et al, 2022), cost-effective, and favored by participants (Koffel et al, 2021). Although these approaches are under investigation (Manber et al, 2022; Spiegelhalder et al, 2022), to our knowledge, no studies have addressed these approaches among adults with chronic HF. Given the high prevalence and negative consequences of insomnia in this population, these questions warrant further study.…”

Section: Discussionmentioning

confidence: 99%

Focus Group Study of Heart Failure Nurses’ Perceptions of the Feasibility of Cognitive Behavioral Therapy for Insomnia

O’Connell,

Feder,

Nwanaji-Enwerem

et al. 2023

Nursing Research

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Background People with heart failure (HF) often report insomnia with daytime consequences, including fatigue and decreased functional performance. Cognitive behavioral therapy for insomnia is an efficacious treatment, but few have access due to a shortage of trained sleep specialists. Access may be improved by offering it where people with HF receive care. Objectives The purpose of this study was to explore the perceptions of nurses who specialize in HF regarding the value of cognitive behavioral therapy for insomnia to their patients, the feasibility of offering it in HF clinical settings, its delivery by nurses, and preferences for modes of delivery. Methods We used a descriptive qualitative study design. We recruited focus group participants via email to American Association of Heart Failure Nurses members and through requests for nurse collaborators to distribute within their networks. We conducted focus groups via Zoom. After describing cognitive behavioral therapy for insomnia and its efficacy for people with HF, we elicited perceptions about its value if provided in the HF outpatient clinical setting, facilitators and barriers to implementation, and other ways to increase access. We audio-recorded and transcribed the discussions. Two researchers coded the data and performed thematic analysis. Results Four focus groups included 23 registered nurses and advanced practice nurses employed in outpatient HF clinics. We identified five themes: “Insomnia Overlooked,” “Cognitive Behavioral Therapy for Insomnia Works,” “Nurses’ Role,” “Barriers and Supports,” and “Modes of Delivery.” Nurses endorsed the importance of insomnia to people with HF and the value of providing cognitive behavioral therapy. They expressed interest in evaluating and addressing sleep, the need for increased resources to address it, and multiple modes of delivery. All nurses believed they had a role in promoting sleep health but differed in their views about providing cognitive behavioral therapy for insomnia. Discussion Nurses specializing in HF support the implementation of cognitive behavioral therapy for insomnia. Implementation studies are needed to identify effective methods to increase access to this efficacious treatment in outpatient HF clinical settings, including support and training for nurses who are interested and able to deliver it.

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“…There is signi cant evidence for Cognitive Behaviour Therapy for insomnia (CBTi) as the rst-line treatment for insomnia (2,11), as recommended by both the American Academy of Sleep Medicine (AASM) and the Australasian Sleep Association (ASA), as CBTi has extensive Level I evidence for longitudinal gains in insomnia resolution (8,12). Internet-delivered CBTi has been extensively investigated in the clinical literature, with systematic reviews and meta-analyses demonstrating that these rst-line interventions are just as effective as face-to-face modalities in the general population for those with insomnia of low to moderate severity(6, [13][14][15][16][17][18]. "Stepped care" refers to a service delivery model allowing a relatively scarce healthcare resource to be applied in a cost-effective way to achieve timely and effective clinical care (15,19).…”

Section: Introductionmentioning

confidence: 99%

“…Internet-delivered CBTi has been extensively investigated in the clinical literature, with systematic reviews and meta-analyses demonstrating that these rst-line interventions are just as effective as face-to-face modalities in the general population for those with insomnia of low to moderate severity(6, [13][14][15][16][17][18]. "Stepped care" refers to a service delivery model allowing a relatively scarce healthcare resource to be applied in a cost-effective way to achieve timely and effective clinical care (15,19). CBTi is a well validated intervention with demonstrated amenability to a Stepped Care model, where patients are assessed for entry to rst-line manualised and online treatment programs, increasing to progressively more time, cost and expertise intensive levels 'upstream' where there is an incomplete therapeutic response to a rst-line intervention, or when clinical complexity demands a more intensive intervention step within the care pathway.…”

Section: Introductionmentioning

confidence: 99%

Direct to Psychology Stepped Care Model in the Multidisciplinary Sleep Service: Study protocol

Winter,

Crocker,

Rolls

et al. 2024

Preprint

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Background: Sleep disorders are common and costly to society. Guidelines from the American Academy of Sleep Medicine (AASM) and the Australasian Sleep Association (ASA) recommend Cognitive Behaviour Therapy for Insomnia (CBTi) as the best treatment modality for insomnia disorder in the long term, however, access issues due to medical first referral pathways and reduced availability of psychologists in the community results in increased wait times, reduces efficient care for patients, and adds burden to specialist medical services. Method: This phase of a broader single-site, multiphase, mixed methods project will implement, and evaluate a service model of care re-design incorporating a new Direct to Psychology referral pathway for insomnia presentations and a Stepped Care treatment approach in the multidisciplinary sleep service. The RE-AIM framework and Standards for intervention Reporting Implementation Studies(StaRI) will be used to guide the development, implementation, evaluation and reporting of this service change. Quantitative data measuring outcomes of the new models of care on key indices of patient clinical outcomes, patient/clinician service satisfaction, and service efficiencies will be collected pre- and post-service change. Discussion: The overarching aim of this project is implement and evaluate a model of care change to the service model in a public tertiary hospital multidisciplinary sleep service. The new Direct to Psychology Stepped Care Model incorporates a Direct to Psychology Insomnia referral pathway along with a Stepped Care approach to treatment, flexibly delivered across the continuum of care. The project will measure the impact of the service change in our target population. The new model of care will be compared to the old service model for key outcomes. We anticipate that the new Model of Care will be acceptable to stakeholders, will produce non-inferior patient outcomes, and will improve patient flow and service efficiency. Trial Registration: The Protocol was registered on 5/08/2022 with the Australian and New Zealand Clinical Trials Registry (ACTRN12622001086752).

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RCT of the effectiveness of stepped-care sleep therapy in general practice: The RESTING study protocol

Cited by 11 publications

References 59 publications

Recent advances in sleep and depression

Recent advances in sleep and depression

Focus Group Study of Heart Failure Nurses’ Perceptions of the Feasibility of Cognitive Behavioral Therapy for Insomnia

Direct to Psychology Stepped Care Model in the Multidisciplinary Sleep Service: Study protocol

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