Tailoring cognitive behavioural therapy for insomnia across contexts, conditions, and individuals: What do we know, where do we go?

Understanding sleep health challenges of defence shift workers to design a digital, sleep and circadian management tool

Defence personnel need to be agile and responsive in their assessment of strategic and tactical tasks. Sleep and circadian disruptions, however, can compromise personnel's readiness. Digital health technologies have the potential to provide sleep and circadian health management advice but need to be designed with active involvement from stakeholders and communities. This study explored challenges with shift work in a cohort of defence personnel to identify end-user expectations for a sleep health smartphone application. Eight shift working Air Traffic Control personnel from the Australian Defence Force participated in 60-70-minute semi-structured online interviews. Informal discussions were also held with various defence stakeholders to determine requirements for an app. Defence personnel reported disruptions to their sleep, family, and social life due to environmental and operational circumstances, such as shift work, mental load, and unplanned schedules. They were highly receptive to a digital intervention and emphasised need for personalised support. Gamification, availability of the app via the defence forces, and high data security were recognised as key enablers. These insights should serve as theoretical foundation for further development, co-design, and testing of digital health tools in other shift worker cohorts, and to better examine and address the impacts of operational demands on their health and performance.

Treatment effect heterogeneity of cognitive behavioral therapy for insomnia - A meta-analysis

Investigation of the heterogeneity of the treatment effect (HTE) might guide the optimization of cognitive behavioral therapy for insomnia (CBT-I). This study examined HTE in CBT-I thereby analyzing if treatment setting, control group, different CBT-I components, and patient characteristics drive HTE. Randomized controlled trials investigating CBT-I were included. Bayesian random effect meta-regressions were specified to examine variances between the intervention and control groups regarding post-treatment symptom severity. Subgroup analyses analyzing treatment setting and control groups and covariate analysis analyzing treatment components and patient characteristics were specified. No significant HTE in CBT-I was found for the overall data set, settings and control groups. The covariate analyses yielded significant results for baseline severity and the treatment component relaxation therapy. Thus, this study identified potential causes for HTE in CBT-I for the first time, showing that it might be worthwhile to further examine possibilities for precision medicine in CBT-I.

Improving adolescent sleep in long-term Juvenile correctional settings: case examples with clinical, research, and policy implications

Poor sleep during adolescence is a public health concern that may be especially important to address among youth in juvenile correctional facilities, who tend to experience greater mental health challenges, substance use disorders, and traumatic stress exposure. However, evidence for addressing sleep in correctional settings is limited. Using de-identified composite clinical cases, this paper describes challenges and opportunities for addressing sleep disorders (i.e. insomnia) and promoting sleep health (i.e. improving duration, regularity, and behaviors) among adolescents in long-term juvenile correctional facilities. These clinical cases highlight common presenting problems and underscore the need for integrated sleep and mental health interventions as well as adaptations to enhance feasibility and efficacy of behavioral sleep treatment and sleep health promotion in juvenile correctional contexts. We conclude by summarizing clinical, research, and policy implications for addressing adolescent sleep problems and promoting sleep health and well-being in these contexts.