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Yap Y, Tung NYC, Shen L, Bei B, Phillips A, Wiley JF. Daily Associations between Salivary Cortisol and EEG-Assessed Sleep: A 15-Day Intensive Longitudinal Study. Sleep 2024:zsae087. [PMID: 38587464 DOI: 10.1093/sleep/zsae087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Indexed: 04/09/2024] Open
Abstract
STUDY OBJECTIVES Current evidence suggests that cortisol levels are bi-directionally associated with sleep. However, the daily, naturalistic cortisol-sleep associations remain unclear, as current evidence is mostly cross-sectional. This study tested whether pre-sleep cortisol predicts sleep duration and quality, and whether these sleep parameters predict the following day's diurnal cortisol slope using a 15-day intensive longitudinal design with electroencephalographic measures and saliva sampling. METHODS Ninety-five young adults (Mage=20.48±1.59 years) provided saliva samples at awakening and pre-sleep over 14 consecutive days, providing 2,345 samples (85% viable). The Z-Machine Insight+ was used to record over 900 nights of total sleep time (TST) and sleep efficiency (SE). Multilevel models tested these data at the between- and within-person levels. RESULTS Higher pre-sleep cortisol predicted shorter TST (p<.001) and lower SE (p<.001) at the within-person level. Individuals with shorter average TST (p =.007) or lower average SE (p<.001) had flatter diurnal cortisol slope, compared to those with longer average TST or higher average SE. Follow up analyses showed that individuals with shorter average TST (vs. longer average TST) had higher pre-sleep cortisol levels (p=.01). CONCLUSION Our findings provide evidence that pre-sleep cortisol is associated with sleep duration and quality at the within-individual level. Furthermore, individuals with short or poor sleep had flatter diurnal cortisol slope. Although the effect sizes are small, these findings show the naturalistic associations between sleep and cortisol in a relatively healthy sample. These findings suggest that sleep maintains the regulation of the stress-response system, which is protective against mental and physical disorders.
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Affiliation(s)
- Yang Yap
- School of Health and Biomedical Sciences, RMIT University, Melbourne, Australia
| | | | - Lin Shen
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia
| | - Bei Bei
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia
| | - Andrew Phillips
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia
| | - Joshua F Wiley
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia
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Song J, Jang E, Astbury L, Bei B, Suh S. Effects of paternal involvement in nighttime childcare on child and maternal sleep: exploring the roles of relationship satisfaction and maternal competence about child sleep. J Clin Sleep Med 2024. [PMID: 38456816 DOI: 10.5664/jcsm.11114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Abstract
STUDY OBJECTIVES Supportive co-parenting between couples has been shown to have positive effects on the dyadic relationship, child development, and parental and child sleep. This study aimed to investigate the association between paternal involvement in nighttime childcare and child and maternal sleep, while exploring relationship satisfaction, and maternal competence about child sleep as mediators. METHODS The sample consisted of 290 mothers (Mage±SD=34.8±4.1) with children (50.7% male) aged 6 - 36 (M±SD=22.7±8.6) months. Participants reported their paternal involvement in nighttime childcare and completed the following questionnaires: Brief Infant Sleep Questionnaire-Revised, Dyadic Adjustment Scale-4 items, and Insomnia Severity Index. Path analysis was conducted to examine the impact of paternal involvement on child and maternal sleep through relationship satisfaction and maternal competence. RESULTS Among the sample, 74.8% responded that paternal participation in nighttime childcare was less than 25%. Path analysis showed that paternal involvement had a significant direct effect on maternal insomnia (β=-.15, p<.05), but not on child sleep. Direct pathways from paternal involvement to relationship satisfaction (β=.17), from relationship satisfaction to maternal competence (β=.19), from maternal competence to child's sleep (β=-.57), and from child sleep to maternal insomnia (β=.48) were significant (ps<.01). Relationship satisfaction mediated the associations between paternal involvement and child (β=-.08, p<.05) and maternal sleep (β=-.04, p<.05). CONCLUSIONS Paternal nighttime childcare involvement was low in South Korea. The results highlight the importance of considering paternal supportive participation and relationship satisfaction in future research on child and maternal sleep.
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Affiliation(s)
- Jiwun Song
- Department of Psychology, Sungshin University, Seoul, Republic of Korea
| | - Eunyeong Jang
- Department of Psychology, Sungshin University, Seoul, Republic of Korea
| | - Laura Astbury
- Faculty of Medicine, Turner Institute for Brain and Mental Health, School of Psychological Sciences, Nursing and Health Sciences, Monash University, Victoria, Australia
| | - Bei Bei
- Faculty of Medicine, Turner Institute for Brain and Mental Health, School of Psychological Sciences, Nursing and Health Sciences, Monash University, Victoria, Australia
- Centre for Women's Mental Health, Royal Women's Hospital, Victoria, Australia
| | - Sooyeon Suh
- Department of Psychology, Sungshin University, Seoul, Republic of Korea
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Spina MA, Bei B, Rajaratnam SW, Krystal A, Edinger JD, Buysse DJ, Thase M, Manber R. Cognitive behavioural therapy for insomnia reduces actigraphy and diary measured sleep discrepancy for individuals with comorbid insomnia and major depressive disorder: A report from the TRIAD study. Sleep Med 2024; 114:137-144. [PMID: 38183804 DOI: 10.1016/j.sleep.2023.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 11/27/2023] [Accepted: 12/17/2023] [Indexed: 01/08/2024]
Abstract
OBJECTIVE/BACKGROUND Discrepancies between sleep diaries and actigraphy occur among individuals with insomnia. Cognitive behavioural therapy for insomnia (CBT-I) improves insomnia but the impact on discrepancy is unclear. This study examined CBT-I's effects on actigraphy-diary discrepancy and explored sleep-related beliefs and attitudes as a mediator. PATIENTS/METHODS Participants were 108 (age M±SD = 47.23 ± 12.42, 67.60 % female) adults with insomnia and major depressive disorder from the Treatment of Insomnia and Depression study. They were randomized to 7 sessions of CBT-I or sham Quasi-Desensitization Therapy for Insomnia (DTI), plus 16 weeks of antidepressants. Two weeks of actigraphy and sleep diary were collected at baseline, mid-treatment, end-treatment. Differences between sleep diary and actigraphy total sleep time (TST), sleep onset latency (SOL), wake after sleep onset (WASO), and sleep efficiency (SE) were calculated. Participants completed Dysfunctional Beliefs and Attitudes about Sleep Scale (DBAS) at baseline and mid-treatment. RESULTS At baseline, diary (versus actigraphy) TST was shorter (1.1 ± 1.41h), whilst SOL (21.64 ± 41.25min) and WASO (17.45 ± 61.99min) were longer. Mixed effects models using daily data showed that after adjusting for age and sex, participants in the CBT-I group (versus DTI) showed greater reduction in all actigraphy-diary discrepancy domains (all p-values<.01), reductions evident from mid-treatment. Group differences on actigraphy-diary discrepancy reductions in TST, SOL, and SE (not WASO) were mediated by changes in DBAS from baseline to mid-treatment (all p-values<.05). Changes in discrepancy did not mediate insomnia symptom changes (p-values>.39). CONCLUSIONS CBT-I reduced actigraphy-diary discrepancy in individuals with comorbid insomnia and depression; this reduction was associated with improved sleep-related attitudes, a therapeutic target of CBT-I. CLINICAL TRIAL REGISTRATION TRIAD (Treatment of Insomnia and Depression): Improving Depression Outcome by Adding Insomnia Therapy to Antidepressants. Prospectively registered with Clinical Trials (NCT00767624). SUPPORT (IF ANY) MH078924, MH078961, MH079256.
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Affiliation(s)
- Marie-Antoinette Spina
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, Australia
| | - Bei Bei
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, Australia.
| | - Shanthakumar W Rajaratnam
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, Australia
| | - Andrew Krystal
- School of Medicine, University of California, San Francisco, CA, USA
| | - Jack D Edinger
- Department of Medicine, National Jewish Health, Denver, CO, USA
| | | | - Michael Thase
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
| | - Rachel Manber
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA, USA
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Drummond SPA, Bei B. Defining and empirically testing a two-stage build-maintain model of cognitive behavioural therapy for insomnia. Sleep Med 2024; 113:92-94. [PMID: 37995474 DOI: 10.1016/j.sleep.2023.11.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/29/2023] [Accepted: 11/15/2023] [Indexed: 11/25/2023]
Abstract
Cognitive Behavioural Therapy for Insomnia is the front-line intervention for Insomnia Disorder. However, few studies have reported data on how CBT-I implementation evolves over the course of therapy or the time course of client response. This is due, in part, to no formal framework for defining stages of CBT-I. Here, we follow Spielman's original conceptualisation of Sleep Restriction Therapy (SRT) to report a two-stage model for defining stages of CBT-I, based on progression through the phases of SRT. Using data from a prior randomized clinical trial, we show the model helps identify patterns of treatment progression, which are in turn associated with baseline insomnia severity. The reported model is parsimonious and easy to implement and it holds potential for further examining and understanding a variety of CBT-I processes currently not fully understood, such as adherence and the optimal order of various CBT-I treatment components.
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Affiliation(s)
| | - Bei Bei
- School of Psychological Sciences, Monash University, Australia
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5
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Verma S, Varma P, Brown A, Bei B, Gibson R, Valenta T, Pietsch A, Cavuoto M, Woodward M, McCurry S, Jackson ML. Multi-modal sleep intervention for community-dwelling people living with dementia and primary caregiver dyads with sleep disturbance: protocol of a single-arm feasibility trial. PeerJ 2023; 11:e16543. [PMID: 38107589 PMCID: PMC10725664 DOI: 10.7717/peerj.16543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 11/08/2023] [Indexed: 12/19/2023] Open
Abstract
Background Disturbed sleep is common among people living with dementia and their informal caregivers, and is associated with negative health outcomes. Dyadic, multi-modal interventions targeting caregiver and care-recipient sleep have been recommended yet remain limited. This protocol details the development of a single-arm feasibility trial of a multi-modal, therapist-led, six-week intervention targeting sleep disturbance in dyads of people living with dementia and their primary caregiver. Methods We aim to recruit 24 co-residing, community-dwelling dyads of people living with dementia and their primary informal caregiver (n = 48) with sleep concerns (Pittsburgh Sleep Quality Index ≥5 for caregivers, and caregiver-endorsed sleep concerns for the person living with dementia). People who live in residential care settings, are employed in night shift work, or are diagnosed with current, severe mental health conditions or narcolepsy, will be excluded. Participants will wear an actigraph and complete sleep diaries for two weeks prior, and during the last two weeks, of active intervention. The intervention is therapist-led and includes a mix of weekly small group video sessions and personalised, dyadic sessions (up to 90 min each) over six weeks. Sessions are supported by a 37-page workbook offering strategies and spaces for reflections/notes. Primary feasibility outcomes are caregiver: session attendance, attrition, and self-reported project satisfaction. Secondary outcomes include dyadic self-reported and objectively-assessed sleep, depression and anxiety symptoms, quality of life, and social support. Self-report outcomes will be assessed at pre- and post-intervention. Discussion If feasible, this intervention could be tested in a larger randomised controlled trial to investigate its efficacy, and, upon further testing, may potentially represent a non-pharmacological approach to reduce sleep disturbance among people living with dementia and their caregivers. ANZCTR Trial registration ACTRN12622000144718: https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=382960&showOriginal=true&isReview=true.
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Affiliation(s)
| | | | - Aimee Brown
- Monash University, Clayton, Victoria, Australia
- Monash-Epworth Rehabilitation Centre, Richmond, Victoria, Australia
| | - Bei Bei
- Monash University, Clayton, Victoria, Australia
| | - Rosemary Gibson
- Health and Ageing Research Team, School of Psychology, Massey University, Palmerston North, New Zealand
| | - Tom Valenta
- Independent Researcher, Melbourne, Victoria, Australia
| | - Ann Pietsch
- Independent Researcher, Adelaide, South Australia, Australia
| | | | - Michael Woodward
- Aged and Continuing Care Services, Austin Health, Heidelberg, Victoria, Australia
| | - Susan McCurry
- School of Nursing, University of Washington, Washington, United States of America
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Ng ASC, Massar SAA, Bei B, Chee MWL. Assessing 'readiness' by tracking fluctuations in daily sleep duration and their effects on daily mood, motivation, and sleepiness. Sleep Med 2023; 112:30-38. [PMID: 37804715 DOI: 10.1016/j.sleep.2023.09.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 09/19/2023] [Accepted: 09/25/2023] [Indexed: 10/09/2023]
Abstract
STUDY OBJECTIVES Consumer sleep trackers issue daily guidance on 'readiness' without clear empirical basis. We investigated how self-rated mood, motivation, and sleepiness (MMS) levels are affected by daily fluctuations in sleep duration, timing, and efficiency and overall sleep regularity. We also determined how temporally specific these associations are. METHODS 119 healthy university students (64 female, mean age = 22.54 ± 1.74 years) wore a wearable sleep tracker and undertook twice-daily smartphone-delivered ecological momentary assessment of mood, motivation, and sleepiness at post-wake and pre-bedtime timings for 2-6 weeks. Naps and their duration were reported daily. Nocturnal sleep on 2471 nights were examined using multilevel models to uncover within-subject and between-subject associations between sleep duration, timing, efficiency, and nap duration on following day MMS ratings. Time-lagged analyses examined the temporal specificity of these associations. Linear regression models investigated associations between MMS ratings and sleep variability, controlling for sleep duration. RESULTS Nocturnal sleep durations were short (6.03 ± 0.71 h), and bedtimes were late (1:42AM ± 1:05). Within-subjects, nocturnal sleep longer than a person's average was associated with better mood, higher motivation, and lower sleepiness after waking. Effects of such longer sleep duration lingered for mood and sleepiness till the pre-bedtime window (all Ps < .005) but did not extend to the next day. Between-subjects, higher intraindividual sleep variability, but not sleep duration, was associated with poorer mood and lower motivation after waking. Longer average sleep duration was associated with less sleepiness after waking and lower motivation pre-bedtime (all Ps < .05). Longer naps reduced post-nap sleepiness and improved mood. Controlling for nocturnal sleep duration, longer naps also associated with lower post-waking sleepiness on the following day. CONCLUSIONS Positive connections between nocturnal sleep and nap duration with MMS are temporally circumscribed, lending credence to the construction of sleep-based, daily 'readiness' scores. Higher sleep duration variability lowers an individual's post waking mood and motivation. CLINICAL TRIAL ID ClinicalTrials.gov NCT04880629.
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Affiliation(s)
- Alyssa S C Ng
- Sleep and Cognition Laboratory, Centre for Sleep and Cognition, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Stijn A A Massar
- Sleep and Cognition Laboratory, Centre for Sleep and Cognition, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Bei Bei
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Australia
| | - Michael W L Chee
- Sleep and Cognition Laboratory, Centre for Sleep and Cognition, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
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Crowther ME, Saunders WJ, Sletten TL, Drummond SPA, Bei B. Tailoring cognitive behavioural therapy for insomnia across contexts, conditions, and individuals: What do we know, where do we go? J Sleep Res 2023; 32:e14023. [PMID: 37641983 DOI: 10.1111/jsr.14023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 08/03/2023] [Indexed: 08/31/2023]
Abstract
Cognitive behavioural therapy for insomnia (CBT-I) is considered the front-line treatment for insomnia. Despite the demonstrated effectiveness of CBT-I, it is necessary to consider how CBT-I may be tailored to different individuals. The purpose of the present review is to provide a summary of literature on tailoring CBT-I to different individuals and provide directions for future research. This review focused on the following domains of adaptation: (i) tailoring CBT-I components to individuals with comorbid mental or physical health conditions such as comorbid depression and pain; (ii) adapting CBT-I delivery for different contexts in which individuals exist, such as inpatient, educational, and different social/cultural settings, (iii) adapting CBT-I to specific individuals via case-formulation in clinical settings. We highlight current gaps in the exploration of tailored CBT-I, including a lack of research methodology to evaluate tailored interventions, a need for the integration of ongoing individualised assessment to inform treatment, and the necessary involvement of consumers and stakeholders throughout the research and treatment development process. Together, this review showed abundant adaptations in CBT-I already exist in the literature. Future research is needed in understanding when and how to apply adaptations in CBT-I and evaluate the benefits of these adaptations.
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Affiliation(s)
- Meagan E Crowther
- School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia
| | - William J Saunders
- School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia
| | - Tracey L Sletten
- School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia
| | - Sean P A Drummond
- School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia
| | - Bei Bei
- School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia
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Smith IS, Bind MA, Weihs KL, Bei B, Wiley JF. Targeting emotional regulation using an Internet-delivered psychological intervention for cancer survivors: A randomized controlled trial. Br J Health Psychol 2023; 28:1185-1205. [PMID: 37437963 PMCID: PMC10710879 DOI: 10.1111/bjhp.12679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 06/09/2023] [Accepted: 06/22/2023] [Indexed: 07/14/2023]
Abstract
OBJECTIVES This trial assessed the efficacy of an emotion-focused, modular, Internet-delivered adaptation of the Unified Protocol (UP) in improving cancer survivors' emotion regulation strategies. DESIGN A two-arm randomized controlled trial (1:1) was used to compare the efficacy of two Internet-based interventions: UP-adapted CanCope Mind (CM) and lifestyle-focused active control CanCope Lifestyle (CL). METHODS N = 224 cancer survivors randomized to CM or CL were assessed at baseline, between-modules, at post-intervention and 3-month follow-up on emotion regulation outcomes targeted by each CM module (Module 1: beliefs about emotions; Module 2: mindfulness; Module 3: cognitive reappraisal skills, catastrophizing, refocus on planning; Module 4: experiential avoidance). Primary analyses were intention-to-treat linear regressions using Fisher randomization tests for p-values and intervals were used to compare groups with standardized mean difference (SMD) effect sizes. RESULTS CanCope Mind participants (n = 61 completers) experienced moderate-to-large improvements (SMDs from .44-.88) across all outcomes at post-intervention. CM's effects were larger than CL's (n = 75 completers) immediately post-intervention and at 3-month follow-up for beliefs about emotions, mindfulness, cognitive reappraisals and experiential avoidance (all p's < .05). CM experienced greater improvements in catastrophizing immediately post-intervention, with a trending effect at follow-up. However, we could not reject the null hypothesis of identical between-group effects for refocusing on planning both immediately post-intervention and at follow-up. Exploratory analyses revealed inconsistent between-module effects. CONCLUSIONS In its entirety, CM is a promising intervention for improving and maintaining cancer survivors' adaptive emotion regulation, especially for mindfulness and experiential avoidance. This may have important clinical implications for promoting cancer survivors' emotional functioning and general well-being.
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Affiliation(s)
- Isabelle S. Smith
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia
| | - Marie-Abèle Bind
- Biostatistics Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Karen L. Weihs
- Department of Psychiatry, College of Medicine, University of Arizona, Tucson, Arizona, USA
- University of Arizona Cancer Center, Tucson, Arizona, USA
| | - Bei Bei
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia
| | - Joshua F. Wiley
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia
- Peter MacCallum Cancer Centre, Melbourne, Australia
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Chachos E, Shen L, Yap Y, Maskevich S, Stone JE, Wiley JF, Bei B. Vulnerability to sleep-related affective disturbances? A closer look at dysfunctional beliefs and attitudes about sleep as a moderator of daily sleep-affect associations in young people. Sleep Health 2023; 9:672-679. [PMID: 37640630 DOI: 10.1016/j.sleh.2023.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 06/28/2023] [Accepted: 07/16/2023] [Indexed: 08/31/2023]
Abstract
STUDY OBJECTIVES Sleep and affect are closely related. Whether modifiable cognitive factors moderate this association is unclear. This study examined whether Dysfunctional Beliefs and Attitudes about Sleep moderate the impact of sleep on next-day affect in young people. METHODS Four hundred and sixty-eight young people (205 adolescents, 54.1% female, M ± SDage=16.92 ± 0.87; 263 emerging adults, 71.9% female, M±SDage=21.29 ± 1.73) self-reported sleep and affect, and wore an actigraph for 7-28 days, providing >5000 daily observations. Linear mixed-effects models tested whether Dysfunctional Beliefs and Attitudes about Sleep moderated daily associations between self-reported and actigraphic sleep duration, sleep efficiency, and next-day affect on between- and within-person levels. Both valence (positive/negative) and arousal (high/low) dimensions of affect were examined. Covariates included age, sex, race/ethnicity, day of week, and previous-day affect. RESULTS Dysfunctional Beliefs and Attitudes about Sleep significantly moderated sleep and high arousal positive affect associations on between- but not within-person levels. Individuals with higher Dysfunctional Beliefs and Attitudes about Sleep (+1 SD) and lower average sleep duration (actigraphic: p = .020; self-reported: p = .047) and efficiency (actigraphic: p = .047) had significantly lower levels of high arousal positive affect. After adjusting for multiple comparisons, Dysfunctional Beliefs and Attitudes about Sleep did not moderate relationships between sleep duration and low arousal positive affect (p ≥ .340). CONCLUSIONS Young people with more unhelpful beliefs about sleep and shorter, or poorer, sleep may experience dampened levels of high arousal positive affect. DBAS may constitute a modifiable factor increasing affective vulnerability on a global but not day-to-day level. Intervention studies are needed to determine if changing Dysfunctional Beliefs and Attitudes about Sleep may reduce sleep-related affect disturbances in young people.
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Affiliation(s)
- Evangelos Chachos
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia
| | - Lin Shen
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia
| | - Yang Yap
- School of Health and Biomedical Sciences, RMIT University, Melbourne, Victoria, Australia
| | - Svetlana Maskevich
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia
| | - Julia E Stone
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia
| | - Joshua F Wiley
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia
| | - Bei Bei
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia.
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10
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Spina MA, Andrillon T, Quin N, Wiley JF, Rajaratnam SMW, Bei B. Does providing feedback and guidance on sleep perceptions using sleep wearables improve insomnia? Findings from "Novel Insomnia Treatment Experiment": a randomized controlled trial. Sleep 2023; 46:zsad167. [PMID: 37294865 PMCID: PMC10485571 DOI: 10.1093/sleep/zsad167] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 05/08/2023] [Indexed: 06/11/2023] Open
Abstract
STUDY OBJECTIVES Insomnia is a disorder diagnosed based on self-reported sleep complaints. Differences between self-reported and sensor-based sleep parameters (sleep-wake state discrepancy) are common but not well-understood in individuals with insomnia. This two-arm, parallel-group, single-blind, superiority randomized-controlled trial examined whether monitoring sleep using wearable devices and providing support for interpretation of sensor-based sleep data improved insomnia symptoms or impacted sleep-wake state discrepancy. METHODS A total of 113 (age M = 47.53; SD = 14.37, 64.9% female) individuals with significant insomnia symptoms (Insomnia Severity Index(ISI) ≥10) from the community were randomized 1:1 (permuted block randomization) to receive 5 weeks (1) Intervention (n = 57): feedback about sensor-based sleep (Fitbit and EEG headband) with guidance for data interpretation and ongoing monitoring, and (2) Control (n = 56): sleep education and hygiene. Both groups received one individual session and two check-in calls. The ISI (primary outcome), sleep disturbance (SDis), sleep-related impairment (SRI), depression, and anxiety were assessed at baseline and post-intervention. RESULTS In total, 103 (91.2%) participants completed the study. Intention-to-treat multiple regression with multiple imputations showed that after controlling for baseline values, compared to the Control group (n = 51), the Intervention group (n = 52) had lower ISI (p = .011, d = 0.51) and SDis (p = .036, d = 0.42) post-intervention, but differences in SRI, depression, anxiety, and sleep-wake state discrepancy parameters (total sleep time, sleep onset latency, and wake after sleep onset) were not meaningful (P-values >.40). CONCLUSIONS Providing feedback and guidance about sensor-based sleep parameters reduced insomnia severity and sleep disturbance but did not alter sleep-wake state discrepancy in individuals with insomnia more than sleep hygiene and education. The role of sleep wearable devices among individuals with insomnia requires further research. CLINICAL TRIAL REGISTRATION The Novel Insomnia Treatment Experiment (NITE): the effectiveness of incorporating appropriate guidance for sleep wearables in users with insomnia. https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=378452, Australia New Zealand Clinical Trials Registry: ACTRN12619001636145.
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Affiliation(s)
- Marie-Antoinette Spina
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Thomas Andrillon
- School of Philosophical, Historical, and International Studies, Centre for Consciousness and Contemplative Studies, Monash University, Melbourne, VIC, Australia
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, Paris, France
| | - Nina Quin
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Joshua F Wiley
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
- Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Shantha M W Rajaratnam
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Bei Bei
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
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Morin CM, Bei B, Bjorvatn B, Poyares D, Spiegelhalder K, Wing YK. World sleep society international sleep medicine guidelines position statement endorsement of "behavioral and psychological treatments for chronic insomnia disorder in adults: An American Academy of sleep medicine clinical practice guidelines". Sleep Med 2023; 109:164-169. [PMID: 37454606 DOI: 10.1016/j.sleep.2023.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 07/01/2023] [Indexed: 07/18/2023]
Abstract
This paper summarizes the position statement of the World Sleep Society (WSS) International Guidelines Committee regarding the Clinical Practice Guidelines on the Behavioral and Psychological Treatments for Chronic Insomnia Disorder in Adults prepared by a task force of the American Academy of Sleep Medicine (AASM). The practice guidelines were reviewed for their relevance and applicability to the practice of sleep medicine around the world. The WSS Work Group endorsed the AASM strong recommendation for Multicomponent Cognitive Behavioral Therapy as the treatment of choice for Insomnia Disorder and conditional endorsement for its single-therapy components (sleep restriction, stimulus control, relaxation); use of sleep hygiene education as single therapy was not endorsed due to lack of evidence for its efficacy. The strong recommendation for multicomponent CBT-I applied to patients with chronic insomnia disorder with or without comorbid psychiatric and medical conditions. Main caveats with regard to CBT-I remains the lack of adequately trained therapists and variability in terms of training available in different parts of the world. Unanswered questions about the applicability, availability, accessibility and potential sociodemographic (age, sex, ethnicity, regions) moderators of treatment outcomes were discussed. Despite growing evidence documenting the benefits of digital CBT-I, individual, in-person CBT-I delivered by a trained professional (mental health) provider is regarded as the optimal method to deliver CBT-I.
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Affiliation(s)
- Charles M Morin
- School of Psychology, CERVO/BRAIN Research Center, Université Laval, Quebec City, Quebec, Canada.
| | - Bei Bei
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, Australia
| | - Bjørn Bjorvatn
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway and Norwegian Competence Center for Sleep Disorders, Haukeland University Hospital, Bergen, Norway
| | - Dalva Poyares
- Neurology and Sleep Medicine, Psychobiology Department, Sleep Division, Universidade Federal de Sao Paulo, Brazil
| | - Kai Spiegelhalder
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Yun Kwok Wing
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
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Verma S, Quin N, Astbury L, Wellecke C, Wiley JF, Davey M, Rajaratnam SMW, Bei B. Treating postpartum insomnia: a three arm randomised controlled trial of cognitive behavioural therapy and light dark therapy. Psychol Med 2023; 53:5459-5469. [PMID: 36082412 PMCID: PMC10482724 DOI: 10.1017/s0033291722002616] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 07/05/2022] [Accepted: 07/26/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Insomnia symptoms are common during the postpartum period, yet interventions remain scarce. This trial aimed to simultaneously examine the efficacy of cognitive behavioural therapy (CBT) and light dark therapy (LDT), targeting different mechanisms, against treatment-as-usual (TAU), in reducing maternal postpartum insomnia symptoms. METHODS This three-arm randomised controlled trial recruited from the general community in Australia. Nulliparous females 4-12 months postpartum with self-reported insomnia symptoms [Insomnia Severity Index (ISI) scores >7] were included; severe medical/psychiatric conditions were excluded. Participants were randomised 1:1:1 to CBT, LDT, or TAU stratified by ISI (< or ⩾14) and infant age (< or ⩾8 months). Participants and principal investigators were unblinded. Six-week interventions were delivered via digital materials and telephone. The primary outcome was insomnia symptoms (ISI), assessed pre-, midpoint-, post- (primary endpoint), and one-month post-intervention. Analyses were intention-to-treat using latent growth models. RESULTS 114 participants (CBT = 39, LDT = 36, TAU = 39; Mage = 32.20 ± 4.62 years) were randomised. There were significantly greater reductions in ISI scores in CBT and LDT (effect sizes -2.01 and -1.52 respectively, p < 0.001) from baseline to post-intervention compared to TAU; improvements were maintained at follow-up. Similar effects were observed for self-reported sleep disturbance. There were greater reductions in fatigue in CBT (effect size = 0.85, p < 0.001) but not LDT (p = 0.11) compared to TAU. Changes in sleepiness, depression, and anxiety were non-significant compared to TAU (all p > 0.08). Four participants (11%) in the LDT group reported headaches, dizziness, or nausea; no others reported adverse events. CONCLUSIONS Therapist-assisted CBT and LDT were feasible during the first postpartum year; data at post-intervention and 1-month follow-up support their safety and efficacy in reducing postpartum insomnia symptoms.
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Affiliation(s)
- Sumedha Verma
- Faculty of Medicine, Nursing and Health Sciences, The Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, VIC, Australia
| | - Nina Quin
- Faculty of Medicine, Nursing and Health Sciences, The Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, VIC, Australia
- Department of Psychiatry, Women's Mental Health Service, University of Melbourne, Royal Women's Hospital, Parkville, VIC, Australia
| | - Laura Astbury
- Faculty of Medicine, Nursing and Health Sciences, The Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, VIC, Australia
| | - Cornelia Wellecke
- Faculty of Medicine, Nursing and Health Sciences, The Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, VIC, Australia
| | - Joshua F. Wiley
- Faculty of Medicine, Nursing and Health Sciences, The Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, VIC, Australia
- Clinical Psychology Department, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Margot Davey
- Melbourne Children's Sleep Unit, Monash Medical Centre, Clayton South, VIC, Australia
| | - Shantha M. W. Rajaratnam
- Faculty of Medicine, Nursing and Health Sciences, The Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, VIC, Australia
| | - Bei Bei
- Faculty of Medicine, Nursing and Health Sciences, The Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, VIC, Australia
- Department of Psychiatry, Women's Mental Health Service, University of Melbourne, Royal Women's Hospital, Parkville, VIC, Australia
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Verma S, Pinnington DM, Manber R, Bei B. Sleep-wake timing and chronotype in perinatal periods: longitudinal changes and associations with insomnia symptoms, sleep-related impairment, and mood from pregnancy to 2 years postpartum. J Sleep Res 2023:e14021. [PMID: 37608515 DOI: 10.1111/jsr.14021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 06/27/2023] [Accepted: 08/02/2023] [Indexed: 08/24/2023]
Abstract
Across the perinatal transition, existing research focuses mainly on significant changes in sleep duration and quality, neglecting sleep timing. This study investigated change trajectories of sleep timing and chronotype from late pregnancy to 2 years postpartum and examined longitudinal associations of chronotype with symptoms of insomnia, daytime sleep-related impairment, and mood. Data were from a two-arm randomised controlled trial testing parent-focused wellbeing interventions. Participants were a community sample of nullipara without severe sleep/mental health conditions. Participants self-reported bedtime, rise-time, chronotype, insomnia symptoms, sleep-related impairment, depression, and anxiety at seven time points: gestation Weeks 30 and 35, and postpartum Months 1.5, 3, 6, 12 and 24. Trajectories were estimated using mixed-effects models with continuous time, quadratic splines, and a knot at childbirth, controlling for age and group allocation. A total of 163 participants (mean [SD] age 33.35 [3.42] years) took part. Bedtime and rise-times delayed during late pregnancy (~8 and ~20 min, respectively) but became progressively earlier (~20 and ~60 min, respectively) over the 2 postpartum years. Chronotype became more eveningness in late pregnancy, and more morningness after childbirth, however changes were small. Controlling for sleep duration and efficiency, greater morningness was associated with significantly less symptoms of insomnia and sleep-related impairment over time (all p < 0.001); longitudinal associations between chronotype and symptoms of depression and anxiety were non-significant (all p > 0.65). Sleep-wake timing and chronotype became progressively earlier from pregnancy to 2 years postpartum. Morningness chronotype may be sleep-protective during the transition from pregnancy to parenthood. Mechanisms underlying these associations require further research.
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Affiliation(s)
- Sumedha Verma
- The Turner Institute for Brain and Mental Health, School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Donna M Pinnington
- The Turner Institute for Brain and Mental Health, School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
- Women's Mental Health Service, Department of Psychiatry, University of Melbourne, Royal Women's Hospital, Parkville, Victoria, Australia
| | - Rachel Manber
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, California, USA
| | - Bei Bei
- The Turner Institute for Brain and Mental Health, School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
- Women's Mental Health Service, Department of Psychiatry, University of Melbourne, Royal Women's Hospital, Parkville, Victoria, Australia
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Hand AJ, Stone JE, Shen L, Vetter C, Cain SW, Bei B, Phillips AJK. Measuring light regularity: sleep regularity is associated with regularity of light exposure in adolescents. Sleep 2023; 46:zsad001. [PMID: 36625482 PMCID: PMC10424172 DOI: 10.1093/sleep/zsad001] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 10/30/2022] [Indexed: 01/11/2023] Open
Abstract
STUDY OBJECTIVES Light is the main time cue for the human circadian system. Sleep and light are intrinsically linked; light exposure patterns can influence sleep patterns and sleep can influence light exposure patterns. However, metrics for quantifying light regularity are lacking, and the relationship between sleep and light regularity is underexplored. We developed new metrics for light regularity and demonstrated their utility in adolescents, across school term and vacation. METHODS Daily sleep/wake and light patterns were measured using wrist actigraphy in 75 adolescents (54% male, 17.17 ± 0.83 years) over 2 weeks of school term and a subsequent 2-week vacation. The Sleep Regularity Index (SRI) and social jetlag were computed for each 2-week block. Light regularity was assessed using (1) variation in mean daily light timing (MLiT); (2) variation in daily photoperiod; and (3) the Light Regularity Index (LRI). Associations between SRI and each light regularity metric were examined, and within-individual changes in metrics were examined between school and vacation. RESULTS Higher SRI was significantly associated with more regular LRI scores during both school and vacation. There were no significant associations of SRI with variation in MLiT or daily photoperiod. Compared to school term, all three light regularity metrics were less variable during the vacation. CONCLUSIONS Light regularity is a multidimensional construct, which until now has not been formally defined. Irregular sleep patterns are associated with lower LRI, indicating that irregular sleepers also have irregular light inputs to the circadian system, which likely contributes to circadian disruption.
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Affiliation(s)
- Anthony J Hand
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, VIC, Australia
| | - Julia E Stone
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, VIC, Australia
| | - Lin Shen
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, VIC, Australia
| | - Céline Vetter
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO, USA
| | - Sean W Cain
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, VIC, Australia
| | - Bei Bei
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, VIC, Australia
| | - Andrew J K Phillips
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, VIC, Australia
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Vuong V, Mellor A, Risbrough VB, Bei B, Drummond SPA. Protocol for a randomized controlled study examining the role of rapid eye movement sleep in fear-related mechanisms: rapid eye movement fragmentation and fear inhibition in adults with insomnia disorders before and after cognitive behavioral therapy for insomnia. Sleep Adv 2023; 4:zpad030. [PMID: 37663035 PMCID: PMC10474912 DOI: 10.1093/sleepadvances/zpad030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 07/05/2023] [Indexed: 09/05/2023]
Abstract
Insomnia confers a 2.5-to-3-fold risk of developing posttraumatic stress disorder (PTSD) after a traumatic event. The mechanism underlying this increased risk, however, remains unknown. We postulate insomnia may contribute to PTSD by disrupting rapid eye movement (REM) sleep, as REM sleep disruption has been shown to impair fear inhibitory processes, which are central to the natural recovery from trauma. To test this hypothesis, the following protocol aims to: (1) examine the relationship between REM sleep and fear inhibition in insomnia, and (2) examine whether reducing REM fragmentation by treating insomnia, in turn, improves fear inhibition. Ninety-two adults with Insomnia Disorder will be block randomized (1:1; stratified by sex) to an active treatment (7 weekly sessions of Cognitive Behavioral Therapy for Insomnia (CBT-I) via telehealth) or waitlist control condition. REM sleep (latent variable derived from REM %, REM efficiency, and REM latency) and fear inhibition (i.e. safety signal and extinction recall) will be assessed pre- and post-treatment in a 4 night/3 day testing protocol via at-home polysomnography and the fear-potentiated startle paradigm, respectively. Fear extinction recall will serve as the primary outcome, while safety signal recall will serve as the secondary outcome. In summary, this study aims to test an underlying mechanism potentially explaining why insomnia greatly increases PTSD risk, while demonstrating an existing clinical intervention (CBT-I) can be used to improve this mechanism. Findings will have potential clinical implications for novel approaches in the prevention, early intervention, and treatment of PTSD.
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Affiliation(s)
- Vivien Vuong
- School of Psychological Sciences, The Turner Institute for Brain and Mental Health, Monash University, Clayton, VIC, Australia
| | - Alix Mellor
- School of Psychological Sciences, The Turner Institute for Brain and Mental Health, Monash University, Clayton, VIC, Australia
| | - Victoria B Risbrough
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
- Centre of Excellence for Stress and Mental Health, VA San Diego Healthcare System, La Jolla, CA, USA
| | - Bei Bei
- School of Psychological Sciences, The Turner Institute for Brain and Mental Health, Monash University, Clayton, VIC, Australia
| | - Sean P A Drummond
- School of Psychological Sciences, The Turner Institute for Brain and Mental Health, Monash University, Clayton, VIC, Australia
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Manber R, Bei B, Suh S, Simpson N, Rangel E, Sit A, Lyell DJ. Randomized controlled trial of cognitive behavioral therapy for perinatal insomnia: postpartum outcomes. J Clin Sleep Med 2023; 19:1411-1419. [PMID: 37078188 PMCID: PMC10394365 DOI: 10.5664/jcsm.10572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 03/16/2023] [Accepted: 03/16/2023] [Indexed: 04/21/2023]
Abstract
STUDY OBJECTIVES This study aimed to assess the effectiveness of cognitive behavioral therapy for insomnia (CBTI) during the postpartum period as part of a larger randomized controlled trial of CBTI on perinatal insomnia. METHODS A total of 179 women of 18-30 gestational weeks with insomnia disorder were randomly assigned to CBTI or an active control (CTRL) therapy. Participants were assessed between 18 and 32 weeks of pregnancy at baseline, after the intervention during pregnancy, and at 8, 18, and 30 weeks postpartum. The primary outcomes were Insomnia Severity Index (ISI) scores and total awake time, defined as minutes awake during the sleep opportunity period, assessed with actigraphy and sleep diaries. Included in the analyses were women who provided data for at least 1 of 3 postpartum assessments (68 in CBTI; 61 in CTRL). RESULTS Piecewise mixed-effects models revealed a main effect reflecting reduction in ISI scores from 8-18 weeks postpartum (P = .036) and a nonsignificant increase from 18-30 weeks; significant effects for group allocation were present only in week 30 (P = .042). CTRL participants reported significantly longer time awake, excluding time spent caring for the infant, at each postpartum assessment; time awake at night caring for the infant did not differ between groups. There was no significant group difference in the postpartum trajectory of actigraphy-measured total awake time, the two diary measures of time awake (P values > .05). CBTI participants with at least 50% reduction in ISI during pregnancy had consistently stable ISI scores (mean < 6) during the postpartum period; those in the CTRL group had variable ISI scores over time with large individual differences. CONCLUSIONS For women with insomnia disorder during pregnancy, CBTI initiated during pregnancy conferred postpartum benefits in terms of wakefulness after sleep onset (excluding time spent caring for the infant) and insomnia severity, though the latter emerged only later in the postpartum period. These findings underscore the importance of treating insomnia during pregnancy, a conclusion that is further supported by our finding that pregnant women who responded to insomnia treatment during pregnancy experienced better sleep in the postpartum period. CLINICAL TRIAL REGISTRATION Registry: Clinicaltrials.gov; Name: Treatment for Insomnia During Pregnancy; URL: https://www.clinicaltrials.gov/ct2/show/NCT01846585; Identifier: NCT01846585. CITATION Manber R, Bei B, Suh S, et al. Randomized controlled trial of cognitive behavioral therapy for perinatal insomnia: postpartum outcomes. J Clin Sleep Med. 2023;19(8):1411-1419.
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Affiliation(s)
- Rachel Manber
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford University, Stanford, California
| | - Bei Bei
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Victoria 3800, Australia
| | - Sooyeon Suh
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford University, Stanford, California
- Department of Psychology, Sungshin Women’s University, Seoul, South Korea
| | - Norah Simpson
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford University, Stanford, California
| | - Elizabeth Rangel
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford University, Stanford, California
| | - Anita Sit
- General Gynecology and Obstetrics Division, Santa Clara Valley Medical Center, San Jose, California
| | - Deirdre J. Lyell
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford University, Stanford, California
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17
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Cooper R, Di Biase MA, Bei B, Quach J, Cropley V. Associations of Changes in Sleep and Emotional and Behavioral Problems From Late Childhood to Early Adolescence. JAMA Psychiatry 2023; 80:585-596. [PMID: 37017952 PMCID: PMC10077137 DOI: 10.1001/jamapsychiatry.2023.0379] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 01/29/2023] [Indexed: 04/06/2023]
Abstract
Importance Sleep problems and psychopathology symptoms are highly comorbid and bidirectionally correlated across childhood and adolescence. Whether these associations are specific to discrete profiles of sleep problems and specific internalizing and externalizing phenomena is currently unclear. Objective To characterize individual changes in profiles of sleep problems and their prospective associations with psychopathology symptoms across the transition from childhood to adolescence. Design, Setting, and Participants This observational cohort study used baseline data (participant age of 9 to 11 years) and 2-year follow-up data (participant age of 11 to 13 years) from the community-setting, multicenter Adolescent Brain Cognitive Development (ABCD) study. Individuals were assessed for a range of sleep problems at both waves and categorized into profiles via latent profile analysis. The stability and change in these profiles over time was assessed via latent transition analysis. Logistic regression models examined whether psychopathology symptoms were cross-sectionally associated with profile membership and whether transitions between profiles were associated with changes psychopathology symptoms over time. Data were collected from September 2016 to January 2020, and data were analyzed from August 2021 to July 2022. Exposures Sleep problems were assessed at both baseline and follow-up via the parent-reported Sleep Disturbance Scale for Children (SDSC). Main Outcomes and Measures Psychopathology symptoms at both baseline and follow-up were assessed using the internalizing and externalizing dimension scores derived from the parent-reported Child Behavior Checklist. Results A total of 10 313 individuals (4913 [47.6%] were female) were categorized into 4 latent profiles of sleep problems at both baseline and follow-up: a low disturbance profile, a sleep onset/maintenance problems profile, a moderate and nonspecific disturbance profile (termed mixed disturbance), and a high disturbance profile. Individuals in the 3 more severe problem profiles displayed greater risk of concurrent internalizing symptoms (sleep onset/maintenance problems: odds ratio [OR], 1.30; 95% CI, 1.25-1.35; P < .001; mixed disturbance: OR, 1.29; 95% CI, 1.25-1.33; P < .001; high disturbance: OR, 1.44; 95% CI, 1.40-1.49; P < .001) and externalizing symptoms (sleep onset/maintenance problems: OR, 1.20; 95% CI, 1.16-1.23; P < .001; mixed disturbance: OR, 1.17; 95% CI, 1.14-1.20; P < .001; high disturbance: OR, 1.24; 95% CI, 1.21-1.28; P < .001). Transitions between sleep profiles over time were associated with prospective internalizing and externalizing symptoms, but not vice versa. Conclusions and Relevance There are substantial changes in sleep problems across the transition to adolescence that are associated with later internalizing and externalizing symptoms. Sleep profiles could be targeted in future intervention and treatment programs to improve sleep-related and mental health-related outcomes across development.
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Affiliation(s)
- Rebecca Cooper
- Melbourne Neuropsychiatry Centre, The University of Melbourne and Melbourne Health, Melbourne, Australia
| | - Maria A. Di Biase
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne, Melbourne, Australia
- Department of Anatomy and Physiology, School of Biomedical Sciences, The University of Melbourne, Melbourne, Australia
| | - Bei Bei
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Australia
| | - Jon Quach
- Centre for Community Child Health, Murdoch Children’s Research Institute, Royal Children’s Hospital, Parkville, Australia
- Learning Intervention, Melbourne Graduate School of Education, The University of Melbourne, Parkville, Australia
| | - Vanessa Cropley
- Melbourne Neuropsychiatry Centre, The University of Melbourne and Melbourne Health, Melbourne, Australia
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18
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Sun T, Yap Y, Tung YC, Bei B, Wiley JF. Coping strategies predict daily emotional reactivity to stress: An ecological momentary assessment study. J Affect Disord 2023; 332:309-317. [PMID: 37019388 DOI: 10.1016/j.jad.2023.03.090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 02/21/2023] [Accepted: 03/29/2023] [Indexed: 04/07/2023]
Abstract
BACKGROUND Emotional reactivity predicts poor health and psychopathology. Despite its theoretical importance, little research has tested whether coping predicts emotional reactivity to stressors. We analyse three studies to test this hypothesis for negative (NA) and positive affect (PA) reactivity to daily stressors. METHODS 422 Participants (72.5 % females, Mage = 22.79 ± 5.36) came from three longitudinal, ecological momentary assessment (EMA) studies across 7-15 days (ACES N = 190; DESTRESS N = 134; SHS N = 98). Coping was measured at baseline. NA, PA, and daily stressors were assessed via EMA. Mixed effects linear models tested whether coping predicted NA and PA reactivity, defined as their slope on within- and between-person daily stressors. RESULTS Behavioural disengagement and mental disengagement coping predicted greater within-person NA reactivity across all studies (all p < .01, all f2 = 0.01). Denial coping predicted greater within-person NA reactivity in ACES and DESTRESS (both p < .01, f2 from 0.02 to 0.03) and between-person in ACES and SHS (both p < .01, f2 from 0.02 to 0.03). For approach-oriented coping, only active planning coping predicted lower within-person NA reactivity and only in DESTRESS (p < .01, f2 = 0.02). Coping did not predict PA reactivity (all p > .05). LIMITATIONS Our findings cannot be generalised to children or older adults. Emotional reactivity to daily stressors may differ from severe or traumatic stressors. Although data were longitudinal, the observational design precludes establishing causality. CONCLUSIONS Avoidance-oriented coping strategies predicted greater NA reactivity to daily stressors with small effect sizes. Few and inconsistent results emerged for approach-oriented coping and PA reactivity. Clinically, our results suggest that reducing reliance on avoidance-oriented coping may reduce NA reactivity to daily stressors.
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Affiliation(s)
- Tingyue Sun
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia
| | - Yang Yap
- School of Health and Biomedical Sciences, RMIT University, Melbourne, Australia
| | - Yan Chi Tung
- Inner Melbourne Clinical Psychology, Melbourne, Australia
| | - Bei Bei
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia
| | - Joshua F Wiley
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia.
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19
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Jang E, Kang S, Bei B, Chung S, Gradisar M, Kahn M, Barnett N, Suh S. Validation of the Parental Understanding and Misperceptions about BAby's Sleep Questionnaire using auto-videosomnography. J Child Psychol Psychiatry 2023. [PMID: 36998197 DOI: 10.1111/jcpp.13797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/24/2023] [Indexed: 04/01/2023]
Abstract
BACKGROUND Previous studies have suggested that parental cognitions about child's sleep may be an important factor underlying pediatric sleep problems. The current study aimed to (a) develop an assessment tool measuring parental understanding and misperceptions about baby's sleep (PUMBA-Q); (b) validate the questionnaire using self-report and objective sleep measures. METHODS There were 1,420 English-speaking caregivers (68.0% mothers, 46.8% of children being females, mean age 12.3 months), who has completed online self-reported questionnaires. The PUMBA-Q, which was developed for this study, Dysfunctional Beliefs and Attitudes about Sleep (DBAS) and Maternal Cognitions about Infant Sleep Questionnaire (MCISQ) were included to evaluate participant's thoughts on their own or child's sleep. Insomnia Severity Index (ISI) was collected to access participant's subjective insomnia severity. Brief Infant Sleep Questionnaire-Revised (BISQ-R) was used to assess parental-reported child sleep. Auto-videosomnography was used to record child's sleep. RESULTS Exploratory factor analysis indicated the best fit with a 4-factor model using 23 items (RMSEA = .039). The four subscales were labeled: (a) Misperceptions about parental intervention; (b) Misperceptions about feeding; (c) Misperceptions about child's sleep; and (d) General anxiety of parents. Internal consistency was adequate (Cronbach's alpha = .86). PUMBA-Q scores were significantly associated with MCISQ (r = .64, p < .01), DBAS (r = .36, p < .01), ISI (r = .29, p < .01), BISQ-R (r = .-49, p < .01), objective child's total sleep time (r = -.24, p < .01) and objective number of parental nighttime visits (r = .26, p < .01). CONCLUSIONS The results demonstrated that PUMBA-Q 23 is a valid assessment tool for parental cognitions of child sleep. The link between parental cognitions and child sleep highlights the importance of managing parental cognitions about child sleep when treating pediatric sleep problems.
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Affiliation(s)
- Eunyeong Jang
- Department of Psychology, Sungshin Women's University, Seoul, Korea
| | - Solbi Kang
- Department of Psychology, Sungshin Women's University, Seoul, Korea
| | - Bei Bei
- Faculty of Medicine, Nursing and Health Sciences, School of Psychological Sciences, The Turner Institute for Brain and Mental Health, Monash University, Clayton, Vic., Australia
| | - Seockhoon Chung
- Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Michael Gradisar
- WINK Sleep Pty Ltd, Adelaide, SA, Australia
- Sleep Cycle AB, Gothenburg, Sweden
| | - Michal Kahn
- College of Education, Psychology and Social Work, Flinders University, Adelaide, SA, Australia
| | | | - Sooyeon Suh
- Department of Psychology, Sungshin Women's University, Seoul, Korea
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20
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Cooper R, Di Biase MA, Bei B, Allen NB, Schwartz O, Whittle S, Cropley V. Development of morning-eveningness in adolescence: implications for brain development and psychopathology. J Child Psychol Psychiatry 2023; 64:449-460. [PMID: 36325967 PMCID: PMC10952670 DOI: 10.1111/jcpp.13718] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/14/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Morning-evening preference is defined as an individual's preference for a morning- or evening-oriented rhythm. Across adolescence, a preference for eveningness becomes more predominant. Although eveningness is cross-sectionally associated with internalizing and externalizing psychopathology, few studies have examined developmental changes in eveningness and its potential biological substrates. Here, we investigated the longitudinal relationships among the trajectory of eveningness preference, internalizing and externalizing psychopathology and white matter development, across adolescence. METHODS Two-hundred and nine adolescents (49% male) were assessed longitudinally at four separate time points between 12 and 19 years of age. Morning-evening preference and internalizing and externalizing symptoms were assessed at each time point. Diffusion-weighted images were acquired on a subset of participants at the final two time points to estimate changes in global mean fractional anisotropy (FA). Linear mixed models were performed to estimate the change in eveningness over time. A series of linear regression models assessed the influence of change in eveningness on psychopathology and white matter development at age 19. RESULTS Across the sample, a preference for eveningness became more predominant by 19 years of age. Greater individual-level change towards eveningness significantly predicted greater severity in externalizing, but not internalizing, symptoms at 19 years of age. In contrast, change in psychopathology from 12 to 19 years of age was not associated with morning-eveningness at age 19. A change towards eveningness predicted an attenuated increase in FA between 17 and 19 years of age. CONCLUSIONS This study suggests that developmental changes in morning-evening preference may predict both neurodevelopmental and psychological outcomes in adolescents.
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Affiliation(s)
- Rebecca Cooper
- Melbourne Neuropsychiatry CentreThe University of Melbourne and Melbourne HealthMelbourneVictoriaAustralia
| | - Maria A. Di Biase
- Melbourne Neuropsychiatry CentreThe University of Melbourne and Melbourne HealthMelbourneVictoriaAustralia
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's HospitalHarvard Medical SchoolBostonMassachusettsUSA
| | - Bei Bei
- Turner Institute for Brain and Mental Health, School of Psychological SciencesMonash UniversityMelbourneVictoriaAustralia
| | | | - Orli Schwartz
- Orygen Centre for Youth Mental HealthMelbourneVictoriaAustralia
| | - Sarah Whittle
- Melbourne Neuropsychiatry CentreThe University of Melbourne and Melbourne HealthMelbourneVictoriaAustralia
| | - Vanessa Cropley
- Melbourne Neuropsychiatry CentreThe University of Melbourne and Melbourne HealthMelbourneVictoriaAustralia
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21
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Spina MA, Andrillon T, Wiley JF, Rajaratnam SMW, Bei B. Does changing perceptions of sleep by incorporating sleep wearables improve insomnia? Protocol for a randomized study (the Novel Insomnia Treatment Experiment). Sleep Adv 2023; 4:zpad012. [PMID: 37193273 PMCID: PMC10108650 DOI: 10.1093/sleepadvances/zpad012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 11/27/2022] [Indexed: 05/18/2023]
Abstract
Study Objectives Insomnia is common in the general population and is diagnosed based on self-reported sleep complaints. There is a frequent discrepancy between objectively recorded and self-reported sleep (sleep-wake state discrepancy), especially in individuals with insomnia. Although sleep-wake state discrepancy is well-documented in the literature, it is not well understood. This protocol describes the methodology of a randomized control study, which will examine whether providing monitoring and feedback about objectively recorded sleep with support for interpretation of sleep-wake state discrepancy improves insomnia symptoms and will explore the potential mechanisms of change. Methods Participants are 90 individuals with insomnia symptoms (Insomnia Severity Index [ISI] ≥10). Participants will be randomized to one of two conditions: (1) Intervention: feedback about objectively recorded sleep (actigraph and optional electroencephalogram headband) with guidance for data interpretation, (2) Control: sleep hygiene session. Both conditions will involve individual sessions and two check-in calls. The primary outcome is ISI score. Secondary outcomes include sleep-related impairment, symptoms of anxiety and depression, and other sleep and quality of life measures. Outcomes will be assessed using validated instruments at baseline and post-intervention. Discussion With increasing number of wearable devices that measure sleep, there is a need to understand how sleep data provided by these devices could be utilized in the treatment of insomnia. Findings from this study have the potential to better understand sleep-wake state discrepancy in insomnia and uncover new approaches to supplement current insomnia treatment.
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Affiliation(s)
- Marie-Antoinette Spina
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC, Australia
| | - Thomas Andrillon
- School of School of Philosophical, Historical, and International Studies, Centre for Consciousness and Contemplative Studies, Monash University, Melbourne, VIC, Australia
- Paris Brain Institute, Sorbonne Université, Inserm-CNRS, Paris, France
| | - Joshua F Wiley
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC, Australia
| | - Shantha M W Rajaratnam
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC, Australia
| | - Bei Bei
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC, Australia
- Women’s Mental Health Service, Royal Women’s Hospital, Parkville, VIC, Australia
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22
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Manber R, Alcántara C, Bei B, Morin CM, van Straten AA. Integrating technology to increase the reach of CBT-I: state of the science and challenges ahead. Sleep 2023; 46:6779875. [PMID: 36308320 DOI: 10.1093/sleep/zsac252] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 09/26/2022] [Indexed: 11/06/2022] Open
Abstract
In this Round Table Discussion, an international panel of experts discuss issues related to the use of technology in the delivery of cognitive behavioral therapy for insomnia (CBT-I), in order to increase its reach. Panelists were, in alphabetical order, Carmela Alcántara, PhD, an Associate Professor at Columbia University School of Social Work in New York, USA, Bei Bei, PhD., an Associate Professor at Monash University in Melbourne, Australia, Charles M. Morin, PhD., a Professor of Psychology at Laval University in Quebec City, Canada, and Annemieke A. van Straten, PhD., a Professor of Clinical Psychology at the Vrije Universiteit in Amsterdam, the Netherlands. The session was chaired by Rachel Manber, PhD., a Professor of Psychiatry and Behavioral Sciences at Stanford University, in Palo Alto, California, USA. In their introductions each panelist discussed the use of technology in their respective country. All indicated that the most common way technology is used in the treatment of insomnia is through the use of video calls (telemedicine) to deliver individual CBT-I, and that this is mostly covered by publicly funded health insurance programs such as Medicare, especially since the COVID-19 pandemic. There are also some fully automated insomnia treatment programs, but they're often not covered by Medicare or other health insurance programs.
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Affiliation(s)
- Rachel Manber
- Department of Psychiatry and Behavioral Sciences, Center for Sleep and Circadian Sciences, Stanford University, Palo Alto, CA, USA
| | | | - Bei Bei
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Clayton, Victoria, Australia
| | - Charles M Morin
- Department of Psychology, Cervo Brain Research Centre, Laval University, Québec, QC, Canada
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23
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Bei B, Pinnington DM, Quin N, Shen L, Blumfield M, Wiley JF, Drummond SPA, Newman LK, Manber R. Improving perinatal sleep via a scalable cognitive behavioural intervention: findings from a randomised controlled trial from pregnancy to 2 years postpartum. Psychol Med 2023; 53:513-523. [PMID: 34231450 PMCID: PMC8738775 DOI: 10.1017/s0033291721001860] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Sleep disturbance is common in gestational parents during pregnancy and postpartum periods. This study evaluated the feasibility and efficacy of a scalable cognitive behavioural therapy (CBT) sleep intervention tailored for these periods. METHODS This is a two-arm, parallel-group, single-blind, superiority randomised controlled trial. Nulliparous females without severe medical/psychiatric conditions were randomised 1:1 to CBT or attention- and time-matched control. All participants received a 1 h telephone session and automated multimedia emails from the third trimester until 6 months postpartum. Outcomes were assessed with validated instruments at gestation weeks 30 (baseline) and 35 (pregnancy endpoint), and postpartum months 1.5, 3, 6 (postpartum endpoint), 12 and 24. RESULTS In total, 163 eligible participants (age M ± s.d. = 33.35 ± 3.42) were randomised. The CBT intervention was well accepted, with no reported adverse effect. Intention-to-treat analyses showed that compared to control, receiving CBT was associated with lower insomnia severity and sleep disturbance (two primary outcomes), and lower sleep-related impairment at the pregnancy endpoint (p values ⩽ 0.001), as well as at 24 months postpartum (p ranges 0.012-0.052). Group differences across the first postpartum year were non-significant. Participants with elevated insomnia symptoms at baseline benefitted substantially more from CBT (v. control), including having significantly lower insomnia symptoms throughout the first postpartum year. Group differences in symptoms of depression or anxiety were non-significant. CONCLUSIONS A scalable CBT sleep intervention is efficacious in buffering against sleep disturbance during pregnancy and benefitted sleep at 2-year postpartum, especially for individuals with insomnia symptoms during pregnancy. The intervention holds promise for implementation into routine perinatal care.
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Affiliation(s)
- Bei Bei
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, Australia
- Centre for Women’s Mental Health, Royal Women’s Hospital, Victoria, Australia
- Department of Psychiatry, University of Melbourne, Victoria, Australia
| | - Donna M. Pinnington
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, Australia
- Centre for Women’s Mental Health, Royal Women’s Hospital, Victoria, Australia
- Department of Psychiatry, University of Melbourne, Victoria, Australia
| | - Nina Quin
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, Australia
- Centre for Women’s Mental Health, Royal Women’s Hospital, Victoria, Australia
- Department of Psychiatry, University of Melbourne, Victoria, Australia
| | - Lin Shen
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, Australia
| | - Michelle Blumfield
- Department of Nutrition, Dietetics and Food, School of Clinical Sciences, Monash University, Victoria, Australia
| | - Joshua F. Wiley
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, Australia
| | - Sean P. A. Drummond
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, Australia
| | - Louise K. Newman
- Department of Psychiatry, University of Melbourne, Victoria, Australia
| | - Rachel Manber
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA, USA
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24
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Jang E, Kang S, Chung S, Barnett N, Gradisar M, Bei B, Suh S. Parental Report versus Auto-Videosomnography Assessment Of Children’s Sleep. Sleep Med 2022. [DOI: 10.1016/j.sleep.2022.05.542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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25
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Astbury L, Bennett C, Pinnington DM, Bei B. Does breastfeeding influence sleep? A longitudinal study across the first two postpartum years. Birth 2022; 49:540-548. [PMID: 35191089 PMCID: PMC9546104 DOI: 10.1111/birt.12625] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 02/05/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND The association between breastfeeding and sleep of the gestational parent is poorly understood. This longitudinal study investigated how breastfeeding is associated with total nighttime sleep duration and sleep efficiency (percentage of total sleep time in bed) in nulliparous participants over the first two postpartum years. METHODS Nulliparous participants (N = 155, Mage = 33.45, SDage = 3.50) self-reported patterns of breastfeeding via telephone interviews and sleep via self-report at 1.5, 3, 6, 12 and 24 months postpartum. Data were analyzed using mixed-effects models, with breastfeeding variables as predictors and sleep variables as outcomes, controlling for relevant covariates. RESULTS Neither the presence of breastfeeding nor the percentage of human milk in infants' total diets was significantly associated with participants' sleep duration or sleep quality (P-values > 0.08). This finding held after controlling for the number of nighttime feeds (P-values > 0.11). However, greater numbers of nighttime feeds, regardless of feeding content, were strongly associated with shorter sleep duration and poor sleep efficiency (P-values < 0.05). On average, with each additional nighttime feed, nocturnal sleep duration decreased by 6.6-8.4 minutes, and sleep efficiency decreased by 2.88%-3.02%. CONCLUSIONS Data from this study showed that breastfeeding per se was not associated with shorter or poor nocturnal sleep, but the number of nighttime feeds was. Sharing nighttime infant care amongst different carers in the household could help reduce postpartum sleep disturbance and ameliorate its negative impact on wellbeing.
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Affiliation(s)
- Laura Astbury
- Turner Institute for Brain and Mental HealthSchool of Psychological SciencesFaculty of Medicine, Nursing and Health SciencesMonash UniversityClaytonVictoriaAustralia
| | - Christie Bennett
- Department of Nutrition and Dietetics and FoodBe Active Eat Sleep (BASE) FacilitySchool of Clinical SciencesMonash UniversityClaytonVictoriaAustralia
| | - Donna M. Pinnington
- Turner Institute for Brain and Mental HealthSchool of Psychological SciencesFaculty of Medicine, Nursing and Health SciencesMonash UniversityClaytonVictoriaAustralia,Centre for Women’s Mental HealthDepartment of PsychiatryUniversity of MelbourneRoyal Women’s HospitalMelbourneVictoriaAustralia
| | - Bei Bei
- Turner Institute for Brain and Mental HealthSchool of Psychological SciencesFaculty of Medicine, Nursing and Health SciencesMonash UniversityClaytonVictoriaAustralia,Centre for Women’s Mental HealthDepartment of PsychiatryUniversity of MelbourneRoyal Women’s HospitalMelbourneVictoriaAustralia
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26
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Ladyman C, Sweeney B, Sharkey K, Bei B, Wright T, Mooney H, Huthwaite M, Cunningham C, Firestone R, Signal TL. A scoping review of non-pharmacological perinatal interventions impacting maternal sleep and maternal mental health. BMC Pregnancy Childbirth 2022; 22:659. [PMID: 35999501 PMCID: PMC9395885 DOI: 10.1186/s12884-022-04844-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 06/15/2022] [Indexed: 01/24/2023] Open
Abstract
Background A woman’s vulnerability to sleep disruption and mood disturbance is heightened during the perinatal period and there is a strong bidirectional relationship between them. Both sleep disruption and mood disturbance can result in significant adverse outcomes for women and their infant. Thus, supporting and improving sleep in the perinatal period is not only an important outcome in and of itself, but also a pathway through which future mental health outcomes may be altered. Methods Using scoping review methodology, we investigated the nature, extent and characteristics of intervention studies conducted during the perinatal period (pregnancy to one-year post-birth) that reported on both maternal sleep and maternal mental health. Numerical and descriptive results are presented on the types of studies, settings, sample characteristics, intervention design (including timeframes, facilitation and delivery), sleep and mood measures and findings. Results Thirty-seven perinatal interventions were identified and further described according to their primary focus (psychological (n = 9), educational (n = 15), lifestyle (n = 10), chronotherapeutic (n = 3)). Most studies were conducted in developed Western countries and published in the last 9 years. The majority of study samples were women with existing sleep or mental health problems, and participants were predominantly well-educated, not socio-economically disadvantaged, in stable relationships, primiparous and of White race/ethnicity. Interventions were generally delivered across a relatively short period of time, in either the second trimester of pregnancy or the early postnatal period and used the Pittsburgh Sleep Quality Index (PSQI) to measure sleep and the Edinburgh Postnatal Depression Scale (EPDS) to measure mood. Retention rates were high (mean 89%) and where reported, interventions were well accepted by women. Cognitive Behavioural Therapies (CBT) and educational interventions were largely delivered by trained personnel in person, whereas other interventions were often self-delivered after initial explanation. Conclusions Future perinatal interventions should consider spanning the perinatal period and using a stepped-care model. Women may be better supported by providing access to a range of information, services and treatment specific to their needs and maternal stage. The development of these interventions must involve and consider the needs of women experiencing disadvantage who are predominantly affected by poor sleep health and poor mental health.
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Affiliation(s)
- Clare Ladyman
- Sleep/Wake Research Centre, School of Health Sciences, College of Health, Massey University, PO Box 756, Wellington, 6140, New Zealand
| | - Bronwyn Sweeney
- Sleep/Wake Research Centre, School of Health Sciences, College of Health, Massey University, PO Box 756, Wellington, 6140, New Zealand
| | - Katherine Sharkey
- The Warren Alpert Medical School, Brown University, 222 Richmond St, Providence, RI, 02903, USA
| | - Bei Bei
- Turner Institute for Brain and Mental Health, Monash University, 18 Innovation Walk Clayton Campus, Clayton, Victoria, 3800, Australia
| | - Tanya Wright
- School of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand
| | - Hannah Mooney
- Ngāti Raukawa, Te Atiawa, Ngā Rauru, Te Āti Haunui-a-Pāpārangi, School of Social Work, College of Health, Massey University, Private Bag 11-222, Palmerston North, 4442, New Zealand
| | - Mark Huthwaite
- Department of Psychological Medicine, University of Otago, 23 Mein St, Newtown, Wellington, 6242, New Zealand
| | - Chris Cunningham
- Ngāti Raukawa; Ngāti Toarangatira; Te Atiawa; Te Ati Haunui-a-Pāpārangi, Research Centre for Hauora & Health, College of Health, Massey University, PO Box 756, Wellington, 6140, New Zealand
| | - Ridvan Firestone
- Research Centre for Hauora & Health, College of Health, Massey University, PO Box 756, Wellington, 6140, New Zealand
| | - T Leigh Signal
- Sleep/Wake Research Centre, School of Health Sciences, College of Health, Massey University, PO Box 756, Wellington, 6140, New Zealand.
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27
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Bensen-Boakes DB, Lovato N, Meaklim H, Bei B, Scott H. “Sleep-wake state discrepancy”: toward a common understanding and standardized nomenclature. Sleep 2022; 45:6668259. [DOI: 10.1093/sleep/zsac187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Darah-Bree Bensen-Boakes
- Flinders Health and Medical Research Institute: Sleep Health, Flinders University , Adelaide , Australia
| | - Nicole Lovato
- Flinders Health and Medical Research Institute: Sleep Health, Flinders University , Adelaide , Australia
| | - Hailey Meaklim
- Turner Institute for Brain and Mental Health, Monash University , Clayton , Australia
| | - Bei Bei
- Turner Institute for Brain and Mental Health, Monash University , Clayton , Australia
| | - Hannah Scott
- Flinders Health and Medical Research Institute: Sleep Health, Flinders University , Adelaide , Australia
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28
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Maccora J, Garland SN, Ftanou M, Day D, White M, Lopez VA, Mortimer D, Diggens J, Phillips AJK, Wallace R, Alexander M, Boyle F, Stafford L, Francis PA, Bei B, Wiley JF. The sleep, cancer and rest (SleepCaRe) trial: Rationale and design of a randomized, controlled trial of cognitive behavioral and bright light therapy for insomnia and fatigue in women with breast cancer receiving chemotherapy. Contemp Clin Trials 2022; 120:106877. [PMID: 35961468 DOI: 10.1016/j.cct.2022.106877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 08/04/2022] [Accepted: 08/05/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Insomnia and fatigue symptoms are common in breast cancer. Active cancer treatment, such as chemotherapy, appears to be particularly disruptive to sleep. Yet, sleep complaints often go unrecognised and under treated within routine cancer care. The abbreviated delivery of cognitive behavioral therapy for Insomnia (CBTI) and bright light therapy (BLT) may offer accessible and cost-effective sleep treatments in women receiving chemotherapy for breast cancer. METHODS The Sleep, Cancer and Rest (SleepCaRe) Trial is a 6-month multicentre, randomized, controlled, 2 × 2 factorial, superiority, parallel group trial. Women receiving cytotoxic chemotherapy for breast cancer at tertiary Australian hospitals will be randomly assigned 1:1:1:1 to one of four, non-pharmacological sleep interventions: (a) Sleep Hygiene and Education (SHE); (b) CBTI; (c) BLT; (d) CBT-I + BLT combined and simultaneously delivered. Each sleep intervention is delivered over 6 weeks, and will comprise an introductory session, a mid-point phone call, and regular emails. The primary (insomnia, fatigue) and secondary (health-related quality of life, rest activity rhythms, sleep-related impairment) outcomes will be assessed via online questionnaires at five time-points: baseline (t0, prior to intervention), mid-point intervention (t2, Week 4), post-intervention (t3, Week 7), 3-months (t4, Week 18), and 6-months follow-up (t5, Week 30). CONCLUSIONS This study will report novel data concerning the comparative and combined efficacy of CBT-I and BLT during chemotherapy. Findings will contribute to the development of evidence-based early sleep and fatigue intervention during chemotherapy for breast cancer. Clinical trial information Registered with the Australian New Zealand Clinical Trials Registry (http://anzctr.org.au/), Registration Number: ACTRN12620001133921.
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Affiliation(s)
- Jordan Maccora
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, 18 Innovation Walk, Melbourne, VIC 3800, Australia.
| | | | - Maria Ftanou
- Peter MacCallum Cancer Centre, Melbourne, Australia; Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia.
| | - Daphne Day
- Department of Oncology Monash Health, Melbourne, Australia; Monash University, Melbourne, Australia.
| | - Michelle White
- Department of Oncology Monash Health, Melbourne, Australia; Monash University, Melbourne, Australia.
| | | | - Duncan Mortimer
- Centre for Health Economics, Monash Business School, Monash University, Melbourne, Australia.
| | | | - Andrew J K Phillips
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, 18 Innovation Walk, Melbourne, VIC 3800, Australia.
| | - Rebecca Wallace
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, 18 Innovation Walk, Melbourne, VIC 3800, Australia.
| | - Marliese Alexander
- Peter MacCallum Cancer Centre, Melbourne, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia.
| | | | - Lesley Stafford
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia.
| | | | - Bei Bei
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, 18 Innovation Walk, Melbourne, VIC 3800, Australia; Centre for Women's Mental Health, Royal Women's Hospital, Melbourne, Australia.
| | - Joshua F Wiley
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, 18 Innovation Walk, Melbourne, VIC 3800, Australia; Peter MacCallum Cancer Centre, Melbourne, Australia.
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29
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Maskevich S, Shen L, Drummond SPA, Bei B. What time do you plan to sleep tonight? An intense longitudinal study of adolescent daily sleep self-regulation via planning and its associations with sleep opportunity. J Child Psychol Psychiatry 2022; 63:900-911. [PMID: 34811748 DOI: 10.1111/jcpp.13540] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/14/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Most adolescents are sleep deprived on school days, yet how they self-regulate their sleep-wake behaviours is poorly understood. Using ecological momentary assessment, this intense longitudinal study explored patterns of adolescents' daily bedtime and risetime planning and execution, and whether these behaviours predicted sleep opportunity. METHODS Every afternoon, for 2 school weeks and the subsequent 2 vacation weeks, 205 (54.1% female, 64.4% non-White) adolescents from year 10 to 12 (M ± SDage = 16.9 ± 0.9) reported their plans for bedtime (BT) that evening, and for risetimes (RT) the following day. Actual daily sleep was measured via actigraphy and sleep diary. RESULTS Some adolescents never planned bedtime (school 19.5%, non-school 53.2%) or risetime (school 1.5%, non-school 24.4%). More adolescents planned consistently (≥75% of days) on school (BT = 29.9%, RT = 61.3%) compared to non-school nights (BT = 3.5%, RT = 2.5%). On average, adolescents went to bed later than planned, with longer delays on non-school (71 min) compared to school nights (46 min). Of those who executed their plans within ≤15 min, more did it consistently (≥75% of days) on school (BT = 40.9%, RT = 67.7%) than on non-school nights/days (BT = 29.7%, RT = 58.6%). Mixed effects models utilizing daily data, controlling for sex, race, and study day, showed that bedtime planning predicted longer time in bed (TIB; p < .01) on school and shorter TIB on non-school nights (p < .01); and greater delay in actual (compared to planned) BT predicted shorter TIB (p < .001). CONCLUSIONS Adolescents may require support during the transition from parent-controlled to autonomous sleep self-regulation. Bedtime planning on school nights and going to bed as planned are two modifiable sleep regulatory behaviours that are protective and potential therapeutic targets for increasing sleep opportunity in adolescents.
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Affiliation(s)
- Svetlana Maskevich
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, VIC, Australia
| | - Lin Shen
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, VIC, Australia
| | - Sean P A Drummond
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, VIC, Australia
| | - Bei Bei
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, VIC, Australia
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30
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Smith IS, Wallace R, Wellecke C, Bind MA, Weihs KL, Bei B, Wiley JF. Assessing an Internet-Delivered, Emotion-Focused Intervention Compared With a Healthy Lifestyle Active Control Intervention in Improving Mental Health in Cancer Survivors: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2022; 11:e36658. [PMID: 35896021 PMCID: PMC9377468 DOI: 10.2196/36658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 06/26/2022] [Accepted: 06/27/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Cancer survivors are vulnerable to experiencing symptoms of anxiety and depression and may benefit from accessible interventions focused on improving emotion regulation. CanCope Mind (CM) was developed as an internet-delivered intervention adapted from the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders to improve emotion regulation and support the mental health of cancer survivors. OBJECTIVE This protocol aims to provide an outline of the CanCope Study, a trial comparing the efficacy of a Unified Protocol-adapted internet-delivered intervention (CM) designed for cancer survivors compared with an active control condition-an internet-delivered healthy lifestyle intervention, CanCope Lifestyle (CL). The primary aim is to assess and compare the efficacy of both interventions in improving emotion regulation, anxiety and depressive symptoms, and quality of life. The secondary aims involve assessing the mechanisms of the CM intervention. METHODS This trial is a 2-arm randomized controlled trial that allocates cancer survivors to either CM or CL. Both interventions comprise 4 web-based modules and are expected to take participants at least 8 weeks to complete. Participants' mental and physical health will be assessed via self-reported surveys at baseline (T0), between each module (T1, T2, and T3), immediately after the intervention (T4), and at 3-month follow-up (T5). The study aims to recruit 110 participants who have completed T4. RESULTS The CanCope study began recruitment in September 2020. A total of 224 participants have been randomized to the CM (n=110, 49.1%) and CL (n=114, 50.9%) groups. CONCLUSIONS This is one of the first trials to develop and investigate the efficacy of a web-based intervention for cancer survivors that specifically targets emotion regulation. TRIAL REGISTRATION Australian Clinical Trials ACTRN12620000943943; https://tinyurl.com/b3z9cjsp. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/36658.
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Affiliation(s)
- Isabelle S Smith
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia
| | - Rebecca Wallace
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia
| | - Cornelia Wellecke
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia
| | - Marie-Abèle Bind
- Biostatistics Center, Massachusetts General Hospital, Boston, MA, United States
| | - Karen L Weihs
- Department of Psychiatry, College of Medicine, University of Arizona, Tucson, AZ, United States
| | - Bei Bei
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia
| | - Joshua F Wiley
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia
- Peter MacCallum Cancer Centre, Melbourne, Australia
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Khor SPH, Fulgoni CM, Lewis D, Melvin GA, Jorm AF, Lawrence K, Bei B, Yap MBH. Short-term outcomes of the Therapist-assisted Online Parenting Strategies intervention for parents of adolescents treated for anxiety and/or depression: A single-arm double-baseline trial. Aust N Z J Psychiatry 2022; 56:695-708. [PMID: 34231423 DOI: 10.1177/00048674211025695] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE This study aimed to evaluate whether the Therapist-assisted Online Parenting Strategies programme increased parenting behaviours known to be supportive of adolescents experiencing anxiety and/or depression. Secondary parenting outcomes of parental self-efficacy, parental accommodation, carer burden, parent-adolescent attachment, family functioning and parent distress were also examined, along with adolescent outcomes of anxiety and depression symptoms, suicidal ideation and sleep. METHOD Seventy-one parents (94.4% females) and their adolescents (73.2% females) aged 12-18 years (Mean = 15.02, SD = 1.56) being treated for depression and/or anxiety in Australia were recruited into a single-arm double-baseline open-label trial. Parents received Therapist-assisted Online Parenting Strategies, which comprised up to nine web-based modules each supplemented with coaching sessions via videoconferencing. Outcomes were analysed using latent growth curve modelling to determine if changes to outcomes at post-intervention (4 month post-second baseline) exceeded changes between two baselines measured 1 month apart. RESULTS Sixty-five parents (91.6%) completed at least one module of the online parenting intervention and on average received nine coaching sessions (SD = 2). Parenting behaviours targeted by Therapist-assisted Online Parenting Strategies improved at post-intervention (Cohen's d = 1.16, 95% confidence interval [0.78, 1.51]). Parent-reported parental self-efficacy and parent-adolescent attachment increased (Cohen's d = 1.44 [1.05, 1.82] and 0.39 [0.05, 0.74], respectively), while impairments to family functioning and parent distress decreased (Cohen's d = -0.51 [-0.86, -0.16] and -0.84 [-1.23, -0.44], respectively). Changes to adolescent anxiety, depression and sleep were not significant. CONCLUSION The Therapist-assisted Online Parenting Strategies intervention improved self-reported parenting behaviours, parental self-efficacy, parent levels of distress, parent-adolescent attachment, and family functioning in parents with adolescents being treated for anxiety and/or depression. However, significant changes in adolescent mental health and sleep outcomes at post-intervention were not observed. The usefulness of a therapist-supported online parenting programme in addressing a service gap for parents seeking professional help is indicated. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry Number (ACTRN) 12618000290291, prospectively registered on 26 February 2018; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=368031.
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Affiliation(s)
- Sarah Pheik Hoon Khor
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, VIC, Australia
| | - Catherine Margaret Fulgoni
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, VIC, Australia
| | - Deborah Lewis
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, VIC, Australia
| | - Glenn A Melvin
- School of Psychology, Deakin University, Melbourne, VIC, Australia.,Centre for Educational Development, Appraisal and Research, University of Warwick, Coventry, UK
| | - Anthony F Jorm
- School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Katherine Lawrence
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, VIC, Australia
| | - Bei Bei
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, VIC, Australia
| | - Marie Bee Hui Yap
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, VIC, Australia.,School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
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Shen L, Sletten T, Wiley J, Bei B. 0183 Daily sleep predicts adolescents’ next-day psychomotor vigilance, sleepiness, and fatigue: Ecological momentary assessment across 28 days of school and vacation. Sleep 2022. [DOI: 10.1093/sleep/zsac079.181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Few studies have examined the associations between daily sleep and daytime functioning in adolescents during naturalistically-occurring constrained (school term) and unconstrained (vacation) sleep opportunities.
Methods
Adolescents (n = 205; 54.1% females, age M ± SD = 16.9 ± 0.87 years) completed daily measures of sleep and daytime functioning over 28 continuous days (2-week school, and the subsequent 2-week vacation). Total sleep time (TST) and sleep efficiency (SE) were measured using actigraphy and sleep diary. Participants self-reported sleepiness and fatigue every morning and afternoon, and completed the brief, 3.2-minute psychomotor vigilance task (PVT; Joggle Research) on an iPad every afternoon. Using cross-lagged multilevel models, daily TST and SE were examined as predictors of next-day sleepiness, fatigue, and PVT performance. The associations did not differ between school and vacation. The non-significant interaction terms were dropped, and school/vacation status was maintained as a covariate. Previous-day outcome, day of the week, study day, school/vacation and sociodemographics were adjusted. Between-person associations (differences between individuals) and within-person associations (daily deviations from individual’s own mean capturing whether nights with longer- or better-than-average TST or SE respectively, relative to the individual’s average TST/SE, predict next-day outcomes) were tested simultaneously.
Results
Adolescents performed better on the PVT (faster reaction time and fewer lapses) following nights with longer-than-average TST (actigraphy and diary, p-values ≤ .044). Longer-than-average TST (actigraphy and diary) and higher diary SE also predicted lower self-reported sleepiness the next day (morning and afternoon, p-values ≤ .002). Similarly, longer-than-average TST and higher-than-average SE predicted lower self-reported fatigue the next day (morning and afternoon, all p-values ≤ .032). Compared to the vacation, school term was associated with higher self-reported fatigue in the morning and afternoon (p-values ≤ .014), but not higher sleepiness or poorer PVT performance.
Conclusion
Fluctuations in daily sleep were associated with adolescents’ next-day functioning. Importantly, longer- and better-than-average sleep consistently predicted better daytime functioning the next day. Findings were consistent across objective sustained attention and self-reported sleepiness and fatigue, highlighting the short-term effects of sleep restriction on adolescents’ daytime functioning. Protecting adolescents’ sleep duration and promoting good quality sleep on a daily basis could support optimal daytime functioning.
Support (If Any)
Dr Shen was supported by the Monash International Postgraduate Research Scholarship and Monash Graduate Scholarship.
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Affiliation(s)
- Lin Shen
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University , Melbourne , Australia
| | - Tracey Sletten
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University , Melbourne , Australia
| | - Joshua Wiley
- Peter MacCallum Cancer Centre , Melbourne , Australia
| | - Bei Bei
- Women’s Mental Health Service, Royal Women’s Hospital, Department of Psychiatry, University of Melbourne , Melbourne , Australia
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Quin N, Tikotzky L, Astbury L, Stafford L, Fisher J, Wiley J, Bei B. 0474 Three-arm randomised controlled trial of Cognitive Behavioural Therapy for Insomnia, a responsive bassinet, and sleep hygiene for preventing postpartum insomnia: Preliminary findings on maternal insomnia and sleep outcomes (Study for Mother-Infant Sleep). Sleep 2022. [DOI: 10.1093/sleep/zsac079.471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Insomnia symptoms are common during the perinatal period and are linked to adverse parent/infant outcomes. This single-blind 3-arm randomised controlled trial examined how two interventions targeting different mechanisms prevent postpartum insomnia compared to sleep hygiene control. Trial registration: ACTRN12619001166167.
Methods
Participants were nulliparous females 26-32 weeks gestation with self-reported insomnia symptoms (Insomnia Severity Index [ISI] scores ≥ 8). Participants were randomized 1:1:1 to: (a) a responsive bassinet designed to support infant sleep until 6 months postpartum (RB), (b) therapist-assisted cognitive behavioural therapy for insomnia (CBT-I) delivered during pregnancy and postpartum, or (c) a sleep hygiene booklet (control condition; CTRL). Outcomes were assessed at baseline (T1), 35-36 weeks gestation (T2), and 2, 6, and 12 months postpartum (T3-T5). The primary outcome is ISI scores averaged T3-T5. Secondary outcomes are PROMIS Sleep Disturbance (SDI), Sleep-Related Impairment (SRI), and self-report total sleep time (TST). We report preliminary results on T1-T4 as T5 is ongoing. Multiple regression analyses controlling for baseline outcomes examined group differences at post-baseline timepoints.
Results
127 participants were randomised (age M±SD=32.62±3.49; RB = 44, CBT-I = 42, CTRL = 41), and 118 (92.9%) completed T4. Compared to CTRL, CBT-I had lower ISI, SDI, and SRI at T2, T3, and T4 (all p<.05 except p=.07 and .06 for ISI at T3 and T4; Cohen’s d ranges 0.39-0.99); differences in TST were non-significant at all timepoints (all p>.25). The RB condition had significantly longer TST at T4 (40.10 min longer, p=.008, d=.63) compared to CTRL, but these two conditions did not differ significantly on any other measures across all timepoints (p>.22).
Conclusion
Preliminary findings suggest CBT-I was efficacious in preventing insomnia symptoms and reducing sleep disturbance and sleep-related impairment, but did not increase maternal sleep duration postpartum. Conversely, a responsive bassinet designed to support infant sleep meaningfully increased maternal sleep duration at 6 months postpartum but did not prevent insomnia symptoms. These initial findings suggest that perinatal sleep complaints are a multifactorial problem that likely require multi-component interventions targeting different causes and mechanisms.
Support (If Any)
National Health and Medical Research Council, Department of Education and Training.
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Affiliation(s)
- Nina Quin
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University
| | - Liat Tikotzky
- Department of Psychology, Ben-Gurion University of the Negev, Israel
| | - Laura Astbury
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University
| | | | - Jane Fisher
- Global and Women’s Health, School of Public Health and Preventive Medicine, Monash University
| | - Joshua Wiley
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University
| | - Bei Bei
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University
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Drummond S, Jenkins M, Mellor A, Norton P, Baucom D, Bei B. 0473 The impact on treatment adherence of adding a bedpartner to CBT-I: preliminary findings from a randomised controlled trial (Project REST). Sleep 2022. [DOI: 10.1093/sleep/zsac079.470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Cognitive Behavioural Therapy for Insomnia (CBT-I) includes often difficult-to-implement behavioural change, and this can result in poor adherence to treatment recommendations. In other CBTs, adding a significant other to “individual” therapy increases adherence. Here, we report preliminary findings from a randomised controlled trial (RCT) of a newly developed partner-assisted CBT-I.
Methods
117 adults with DSM-5 Insomnia Disorder (age M±SD=47.9±15.3yrs; 73F) and their live-in partners participated in a single-blind parallel RCT. They were assigned 1:1:1 to 7wk individual CBT-I (Ind-CBTI), partner-assisted CBT-I (PA-CBTI), or sleep management control (CTRL) conditions. Participants completed daily sleep diary throughout the intervention. Adherence in CBT-I conditions was assessed for Sleep Restriction Therapy (deviation from bed and wake times, naps) and Stimulus Control Therapy (wake time-in-bed during daytime, overnight, and after final morning awakening). Intention-to-treat, mixed effects models examined differences in adherence for “Build” (initial phase to build sleep debt) and “Maintain” (starting the first week when sleep opportunity was titrated upwards) stages of therapy.
Results
All conditions showed significant increase in sleep efficiency (p<.001), with significantly faster increase in Ind-CBTI and PA-CBTI compared to CTRL (ps<.001). Sleep Restriction Therapy: Build stage (vs Maintain) had greater adherence to prescribed wake time (p=.045); Condition by Stage interaction (p=.010) showed PA-CBTI (vs Ind-CBTI) adhered better in avoiding naps during Build (vs Maintain). Stimulus Control Therapy: PA-CBTI (vs Ind-CBTI) adhered better to avoiding daytime wake time-in-bed (p=.017), especially during Build (interaction p=.071); Condition by Stage interaction (p=.017) showed PA-CBTI (vs Ind-CBTI) adhered better to avoiding overnight wake time-in-bed during Maintain (vs Build). Both conditions had better adherence to avoiding daytime and wake time-in-bed after final awakening during Maintain (vs Build) Stage (ps<.001).
Conclusion
Adherence to CBT-I includes multiple indicators showing distinct features as the intervention progresses across different stages. Aspects of adherence appear modifiable, and adding bedpartners to CBT-I improved adherence to specific aspects of the intervention (i.e., avoiding naps, daytime wake time-in-bed, overnight wake time-in-bed). The Build and Maintain stages of treatment appear to be associated with better adherence to different aspects of the intervention (Sleep Restriction Therapy and Stimulus Control Therapy, respectively).
Support (If Any)
NHMRC grant APP1105458 (SPAD,DHB,PJN), APP1140299 (BB)Trial registration: ACTRN12616000586415
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Maccora J, Bean HR, Diggens J, Ftanou M, Alexander M, Lu Q, Stafford L, Francis PA, Bei B, Wiley JF. Mechanisms of Cognitive Behavioral Therapy and Light Therapy for Cancer-Related Insomnia: A Randomized Clinical Trial during Chemotherapy for Breast Cancer. Behav Sleep Med 2022; 21:227-241. [PMID: 35580165 DOI: 10.1080/15402002.2022.2075364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
STUDY OBJECTIVES This study aimed to investigate the mechanisms of a combined brief cognitive behavioral plus bright light therapy (CBT-I+Light) in women receiving chemotherapy. METHODS Women (N = 101) were randomly assigned to CBT-I+Light or treatment as usual plus relaxation audios (TAU+). Participants completed sleep diaries and wore an actigraph during the 6-week intervention period. Patient-reported outcomes were assessed at baseline, mid-point (week 3), and later (week 6). Cognitive (i.e., dysfunctional sleep beliefs, pre-sleep cognitions, and arousal) and behavioral (i.e., time in bed awake and day-to-day out-of-bedtime variability) mechanisms were examined. RESULTS Cognitively, both groups declined significantly in overall dysfunctional sleep beliefs from pre- to post-intervention (both p< .04); however, they did not differ on sleep-related beliefs nor pre-sleep cognitions and arousal at post-intervention (both p> .50). Dysfunctional beliefs sleep expectations subscale was lower in CBT-I+Light versus TAU+ (p= .01). Behaviorally, CBT-I+Light reported less overall time in bed awake after the start of the intervention (p< .05) and significantly less time in bed during the morning until the final week of the intervention period. Out-of-bedtime day-to-day variability was lower in the CBT-+Light vs TAU+ at the final intervention day. CONCLUSION Mechanisms of CBT-I+Light during chemotherapy remain to be shown. Our results suggest that changes in behavioral mechanisms may be associated with sleep improvements within this cohort. Future studies should assess the role of additional mechanisms (e.g., sleep effort) within larger samples. Whilst intervention brevity is important, more potent interventions may be required to achieve robust changes in target mechanisms.
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Affiliation(s)
- Jordan Maccora
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia
| | - Helena R Bean
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia
| | | | - Maria Ftanou
- Peter MacCallum Cancer Centre, Melbourne, Australia.,Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Marliese Alexander
- Peter MacCallum Cancer Centre, Melbourne, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
| | - Qian Lu
- Department of Health Disparities Research, University of Texas MD Anderson Cancer Centre, Houston, United States of America
| | - Lesley Stafford
- Centre for Women's Mental Health, Royal Women's Hospital, Melbourne, Australia.,Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia
| | | | - Bei Bei
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia.,Centre for Women's Mental Health, Royal Women's Hospital, Melbourne, Australia
| | - Joshua F Wiley
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia.,Peter MacCallum Cancer Centre, Melbourne, Australia
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Yap Y, Tung NYC, Collins J, Phillips A, Bei B, Wiley JF. Daily Relations Between Stress and Electroencephalography-Assessed Sleep: A 15-Day Intensive Longitudinal Design With Ecological Momentary Assessments. Ann Behav Med 2022; 56:1144-1156. [PMID: 35568984 DOI: 10.1093/abm/kaac017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Recent studies have found bi-directional relations between stress and sleep. However, few studies have examined the daily associations between stress and electroencephalography (EEG) measured sleep. PURPOSE This study examined the temporal associations between repeated ecological momentary assessments of stress and EEG-estimated sleep. METHODS Ninety-eight international or interstate undergraduate students (Mage = 20.54 ± 1.64, 76.5% female, 84.7% Asian) reported their stress levels four times daily at morning awakening, afternoon, evening, and pre-bedtime across 15 consecutive days (>4,000 total observations). Next-day stress was coded as an average of morning, afternoon, and evening stress. Z-Machine Insight+ recorded over 1,000 nights EEG total sleep time (TST), sleep onset latency, wake after sleep onset, sleep efficiency (SE), slow-wave sleep (SWS), and rapid eye movement (REM) sleep duration. Multilevel models, adjusted for covariates (i.e., sociodemographic, health factors, and daily covariates) and lagged outcomes, tested the daily within- and between-level stress-sleep associations. RESULTS After adjusting for covariates, within-person shorter TST (b = -0.11 [-0.21, -0.01], p = .04), lower SE (b = -0.02 [-0.03, 0.00], p = .04), less SWS (b = -0.38 [-0.66, -0.10], p = .008), and less REM sleep (b = -0.32 [-0.53, -0.10], p = .004) predicted higher next-day stress. Pre-bedtime stress did not predict same-night sleep. No significant results emerged at the between-person level. CONCLUSIONS These findings demonstrate that poor or short sleep, measured by EEG, is predictive of higher next-day stress. Results for sleep architecture support the role of SWS and REM sleep in regulating the perception of stress. Given that only within-person effects were significant, these findings highlight the importance of examining night-to-night fluctuations in sleep affecting next-day stress and its impact on daytime functioning.
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Affiliation(s)
- Yang Yap
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia
| | - Natasha Yan Chi Tung
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia
| | - Jorja Collins
- Department of Nutrition, Dietetics and Food, Monash University, Melbourne, VIC, Australia
| | - Andrew Phillips
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia
| | - Bei Bei
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia
| | - Joshua F Wiley
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia
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Stone JE, Wiley J, Chachos E, Hand AJ, Lu S, Raniti M, Klerman E, Lockley SW, Carskadon MA, Phillips AJK, Bei B, Rajaratnam SMW. The CLASS Study (Circadian Light in Adolescence, Sleep and School): protocol for a prospective, longitudinal cohort to assess sleep, light, circadian timing and academic performance in adolescence. BMJ Open 2022; 12:e055716. [PMID: 35537785 PMCID: PMC9092183 DOI: 10.1136/bmjopen-2021-055716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND During adolescence, sleep and circadian timing shift later, contributing to restricted sleep duration and irregular sleep-wake patterns. The association of these developmental changes in sleep and circadian timing with cognitive functioning, and consequently academic outcomes, has not been examined prospectively. The role of ambient light exposure in these developmental changes is also not well understood. Here, we describe the protocol for the Circadian Light in Adolescence, Sleep and School (CLASS) Study that will use a longitudinal design to examine the associations of sleep-wake timing, circadian timing and light exposure with academic performance and sleepiness during a critical stage of development. We also describe protocol adaptations to enable remote data collection when required during the COVID-19 pandemic. METHODS Approximately 220 healthy adolescents aged 12-13 years (school Year 7) will be recruited from the general community in Melbourne, Australia. Participants will be monitored at five 6 monthly time points over 2 years. Sleep and light exposure will be assessed for 2 weeks during the school term, every 6 months, along with self-report questionnaires of daytime sleepiness. Circadian phase will be measured via dim light melatonin onset once each year. Academic performance will be measured via national standardised testing (National Assessment Program-Literacy and Numeracy) and the Wechsler Individual Achievement Test-Australian and New Zealand Standardised Third Edition in school Years 7 and 9. Secondary outcomes, including symptoms of depression, anxiety and sleep disorders, will be measured via questionnaires. DISCUSSION The CLASS Study will enable a comprehensive longitudinal assessment of changes in sleep-wake timing, circadian phase, light exposure and academic performance across a key developmental stage in adolescence. Findings may inform policies and intervention strategies for secondary school-aged adolescents. ETHICS AND DISSEMINATION Ethical approval was obtained by the Monash University Human Research Ethics Committee and the Victorian Department of Education. Dissemination plans include scientific publications, scientific conferences, via stakeholders including schools and media. STUDY DATES Recruitment occurred between October 2019 and September 2021, data collection from 2019 to 2023.
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Affiliation(s)
- Julia E Stone
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia
| | - Joshua Wiley
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia
| | - Evangelos Chachos
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia
| | - Anthony J Hand
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia
| | - Sinh Lu
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia
| | - Monika Raniti
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia
- Centre for Adolescent Health, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, Melbourne Medical School, University of Melbourne, Parkville, Victoria, Australia
| | - Elizabeth Klerman
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Steven W Lockley
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Mary A Carskadon
- Department of Psychiatry & Human Behavior, Chronobiology & Sleep Research Laboratory, EP Bradley Hospital, Brown University Warren Alpert Medical School, Providence, Rhode Island, USA
| | - Andrew J K Phillips
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia
| | - Bei Bei
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia
| | - Shantha M W Rajaratnam
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts, USA
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Tung NYC, Yap Y, Bei B, Luecken LJ, Wiley JF. A 14-day ecological momentary assessment study on whether resilience and early family risk moderate daily stress and affect on cortisol diurnal slope. Sci Rep 2022; 12:1240. [PMID: 35075226 PMCID: PMC8786880 DOI: 10.1038/s41598-022-05277-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 12/21/2021] [Indexed: 11/09/2022] Open
Abstract
This study examined whether resilience capacity moderates the association of daily perceived stress and affect with cortisol diurnal slope among relocated emerging adults. Relocated undergraduates (N = 98; aged 18-25 years) were recruited from three groups: Resilient, Vulnerable, and Control. The Resilient group required Risky Family Questionnaire (RFQ) scores ≥ 29 and Brief Resilience Scale (BRS) scores ≥ 3.6. The Vulnerable group required RFQ scores ≥ 29 and BRS scores ≤ 3. The comparison Control group required RFQ scores ≤ 21 and T-scores < 60 on PROMIS anxiety and depression symptoms. Mixed-effects models were used to test the unique associations of perceived stress, negative affect, and positive affect x group interactions (predictors) on diurnal cortisol slope (outcome) across 14 consecutive days. The Resilient group did not moderate the associations between daily stress or affect on cortisol diurnal slope. Instead, both the Resilient and Vulnerable groups with early family risk, showed a steeper diurnal slope unique to higher stress and a flatter slope unique to higher negative affect. Results suggest that riskier early family life was significantly associated with altered cortisol diurnal slope outcomes to stress (i.e., demand) and negative affect (i.e., distress). These associations were not attenuated by current resilience capacity.
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Affiliation(s)
- Natasha Yan Chi Tung
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, 18 Innovation Walk, Melbourne, VIC, 3800, Australia
| | - Yang Yap
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, 18 Innovation Walk, Melbourne, VIC, 3800, Australia
| | - Bei Bei
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, 18 Innovation Walk, Melbourne, VIC, 3800, Australia
| | - Linda J Luecken
- Department of Psychology, Arizona State University, Tempe, USA
| | - Joshua F Wiley
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, 18 Innovation Walk, Melbourne, VIC, 3800, Australia.
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Quin N, Lee JJ, Pinnington DM, Newman L, Manber R, Bei B. Differentiating perinatal Insomnia Disorder and sleep disruption: a longitudinal study from pregnancy to 2 years postpartum. Sleep 2022; 45:6497951. [PMID: 34989808 PMCID: PMC9013000 DOI: 10.1093/sleep/zsab293] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 12/07/2021] [Indexed: 01/07/2023] Open
Abstract
STUDY OBJECTIVES Insomnia Disorder diagnoses require persistent sleep complaints despite "adequate sleep opportunity." Significant Perinatal Sleep Disruption makes this diagnosis challenging. This longitudinal study distinguished between Insomnia Disorder and Perinatal Sleep Disruption and their sleep and mental health correlates. METHODS One hundred sixty-three nulliparous females (age M ± SD = 33.35 ± 3.42) participating in a randomized controlled trial repeated the Insomnia Disorder module of the Duke Structured Interview for Sleep Disorders and Patient-Reported Outcome Measurement Information System measures for sleep and mental health at 30- and 35-weeks' gestation, and 1.5, 3, 6, 12, and 24 months postpartum (944 interviews, 1009 questionnaires completed). We compared clinical features when Diagnostic and Statistical Manual of Mental Disorders (DSM-5) Insomnia Disorder criteria (without the Duration criterion) were: (1) met (Insomnia Disorder), (2) not met only because of the sleep opportunity criteria (Perinatal Sleep Disruption), and (3) not met due to other criteria (Low Complaint). RESULTS Proportions of Insomnia Disorder were 16.0% and 19.8% during early and late third trimester, and ranged 5.3%-11.7% postpartum. If the sleep opportunity criteria were not considered, rates of Insomnia would be 2-4 times higher (21.4%-40.4%) across time-points. Mixed-effects models adjusting for covariates showed that compared to Low Complaint, both Insomnia Disorder and Perinatal Sleep Disruption scored significantly higher on insomnia and sleep disturbance scales, sleep effort, and sleep-related impairments (p values < .01), but depression and anxiety were comparable (p values > .12). CONCLUSION Assessing sleep complaints without considering sleep opportunities can result in over-diagnosis of Insomnia Disorder in the perinatal periods. Insomnia Disorder and Perinatal Sleep Disruption were both associated with adverse sleep and mood outcomes, and need to be carefully differentiated and appropriately addressed. Clinical Trial Registration: The SEED Project (Sleep, Eat, Emotions, and Development): A randomized controlled pilot study of a perinatal sleep intervention on sleep and wellbeing in mothers and infants. https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=371634, Australian New Zealand Clinical Trials Registry: ACTRN12616001462471.
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Affiliation(s)
- Nina Quin
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia,Women’s Mental Health Service, Royal Women’s Hospital, Parkville, VIC, Australia
| | - Jin Joo Lee
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia,Women’s Mental Health Service, Royal Women’s Hospital, Parkville, VIC, Australia
| | - Donna M Pinnington
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia,Women’s Mental Health Service, Royal Women’s Hospital, Parkville, VIC, Australia
| | - Louise Newman
- Department of Psychiatry, University of Melbourne, Melbourne, VIC, Australia
| | - Rachel Manber
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA, USA
| | - Bei Bei
- Corresponding author. Bei Bei, Turner Institute for Brain and Mental Health, School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, 18 Innovation Walk, Clayton Campus, VIC 3800, Australia.
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Quin N, Tikotzky L, Stafford L, Fisher J, Bei B. Preventing postpartum insomnia by targeting maternal versus infant sleep: a protocol for a randomized controlled trial (the Study for Mother-Infant Sleep “SMILE”). SLEEP Advances 2022; 3:zpab020. [PMID: 35156040 PMCID: PMC8824577 DOI: 10.1093/sleepadvances/zpab020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 11/23/2021] [Indexed: 11/19/2022]
Abstract
Symptoms of insomnia are common during the perinatal periods and are linked to adverse parent/infant outcomes. Theories on insomnia development (e.g. 3P model) suggest that significant sleep disruption (e.g. nighttime infant care) can precipitate, while unhelpful sleep-related cognitions/behaviors can perpetuate parental insomnia symptoms. This study aims to examine how two interventions, one addressing infant sleep as the precipitator, the other targeting maternal sleep-related cognitions/behaviors as the perpetuator, might prevent postpartum insomnia. Participants are 114 nulliparous females 26 to 32 weeks gestation, with self-reported insomnia symptoms (Insomnia Severity Index scores ≥ 8). Participants are randomized to one of three conditions and receive: (1) a “responsive bassinet” used until 6 months postpartum, designed to boost/consolidate infant sleep and target infant sleep as a precipitator of insomnia, (2) therapist-assisted cognitive behavioral therapy for insomnia, addressing unhelpful sleep-related cognitions/behaviors as perpetuators of insomnia, or (3) a sleep hygiene booklet (control condition). The primary outcome is maternal insomnia symptoms. Secondary outcomes include maternal sleep duration/quality, mental health (e.g. depression, anxiety), and wellbeing-related variables (e.g. sleep-related impairment). Outcomes are assessed using validated instruments at 26–32 and 35–36 weeks’ gestation, and 2, 6, and 12 months postpartum. This study adopts an early-intervention approach and longitudinally compares two distinct approaches to prevent postpartum insomnia in an at-risk population. If interventions are efficacious, findings will demonstrate how interventions targeting different mechanisms mitigate insomnia symptoms in perinatal populations. This will provide empirical evidence for future development of multi-component sleep intervention to improve mother-infant wellbeing. Clinical Trial Registration: The Study for Mother-Infant Sleep (The SMILE Project): reducing postpartum insomnia using an infant sleep intervention and a maternal sleep intervention in first-time mothers. https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=377927, Australian New Zealand Clinical Trials Registry: ACTRN12619001166167.
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Affiliation(s)
- Nina Quin
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
- Women’s Mental Health Service, Royal Women’s Hospital, Melbourne, Victoria, Australia
| | - Liat Tikotzky
- Department of Psychology, Ben-Gurion University of the Negev, Be’er Sheva, Israel
| | - Lesley Stafford
- Women’s Mental Health Service, Royal Women’s Hospital, Melbourne, Victoria, Australia
- School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Jane Fisher
- Global and Women’s Health, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Bei Bei
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
- Women’s Mental Health Service, Royal Women’s Hospital, Melbourne, Victoria, Australia
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Verma S, Rajaratnam SMW, Davey M, Wiley JF, Bei B. Cognitive Behavioural Therapy and Light Dark Therapy for Maternal Postpartum Insomnia Symptoms: Protocol of a Parallel-Group Randomised Controlled Efficacy Trial. Front Glob Womens Health 2021; 1:591677. [PMID: 34816165 PMCID: PMC8593939 DOI: 10.3389/fgwh.2020.591677] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 12/17/2020] [Indexed: 11/13/2022] Open
Abstract
Background: Symptoms of insomnia are common in new mothers and have been associated with a range of negative maternal and child outcomes. Despite this, interventions to improve maternal postpartum sleep remain scarce. Cognitive Behavioural Therapy (CBT) and Light Dark Therapy (LDT) represent two promising interventions for insomnia symptoms and associated daytime consequences such as fatigue. This randomised controlled trial examines whether CBT and LDT improve maternal insomnia symptoms as the primary outcome and maternal sleep disturbance, mood, fatigue, and sleepiness as secondary outcomes. This protocol paper outlines the development, design, and implementation of the trial. Methods: Participants are an Australian community-sample of 90 first-time mothers who are 4-12 months postpartum with self-reported symptoms of insomnia (Insomnia Severity Index scores ≥ 8). Exclusion criteria include current severe sleep/psychiatric disorders, unsettled infant sleep behaviour, sleep-affecting medication use, and photosensitivity. Eligible women are randomised into a CBT (strategies targeting sleep, worries, fatigue, and relaxation), LDT, or a treatment-as-usual control condition. Interventions are therapist-assisted and personalised through two telephone calls and include a series of automated intervention emails delivered over 6 weeks. Primary and secondary outcomes are assessed at four time points: baseline, intervention mid-point, post-intervention, and 1-month post-intervention. Discussion: If found effective, these interventions could represent efficacious, safe, and inexpensive treatments for improving postpartum insomnia and mitigate its negative impact on maternal well-being. Interventions tested are highly scalable and can be integrated into postpartum care and made available to the broader community. ANZCTR trial registration: Accessible at: https://anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12618000842268.
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Affiliation(s)
- Sumedha Verma
- Faculty of Medicine, Nursing and Health Sciences, School of Psychological Sciences, The Turner Institute for Brain and Mental Health, Monash University, Clayton, VIC, Australia
| | - Shantha M W Rajaratnam
- Faculty of Medicine, Nursing and Health Sciences, School of Psychological Sciences, The Turner Institute for Brain and Mental Health, Monash University, Clayton, VIC, Australia
| | - Margot Davey
- Melbourne Children's Sleep Unit, Monash Medical Centre, Clayton South, VIC, Australia
| | - Joshua F Wiley
- Faculty of Medicine, Nursing and Health Sciences, School of Psychological Sciences, The Turner Institute for Brain and Mental Health, Monash University, Clayton, VIC, Australia
| | - Bei Bei
- Faculty of Medicine, Nursing and Health Sciences, School of Psychological Sciences, The Turner Institute for Brain and Mental Health, Monash University, Clayton, VIC, Australia.,Department of Psychiatry, Centre for Women's Mental Health, Royal Women's Hospital, University of Melbourne, Parkville, VIC, Australia
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Bean HR, Diggens J, Ftanou M, Alexander M, Stafford L, Bei B, Francis PA, Wiley JF. Light Enhanced Cognitive Behavioral Therapy (CBT-I+Light) for Insomnia and Fatigue During Chemotherapy for Breast Cancer: A Randomized Controlled Trial. Sleep 2021; 45:6383287. [PMID: 34618907 DOI: 10.1093/sleep/zsab246] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 07/21/2021] [Indexed: 11/13/2022] Open
Abstract
STUDY OBJECTIVES Sleep problems are common during chemotherapy for breast cancer (BC). We evaluated whether combined brief cognitive behavioral and bright light therapy (CBT-I+Light) is superior to treatment as usual with relaxation audio (TAU+) for insomnia symptoms and sleep efficiency (primary outcomes). METHODS We randomized women receiving intravenous chemotherapy, stratified by tumor stage and insomnia severity index (ISI), to 6-weeks CBT-I+Light or TAU+. CBT-I+Light included one in-person session, one telephone call, seven emails, and 20 minutes bright light each morning. TAU+ comprised usual treatment and two emails with relaxation audio tracks. Patient-reported outcomes were assessed at baseline, midpoint (week 3), post (week 6) and 3-month follow-up. RESULTS Women (N = 101) were randomly assigned to CBT-I+Light or TAU+. The CBT-I+Light group showed significantly greater improvement in insomnia symptoms than the TAU+ group (-5.06 vs -1.93, P = .009; between-group effect size [ES] = .69). At 3-month follow-up, both groups were lower than baseline but did not differ from each other (between-group ES = .18, P = .56). CBT-I+Light had higher patient-reported sleep efficiency than TAU+ immediately after the start of intervention (P = .05) and significantly greater improvement in fatigue (between-group ES = .59, P = .013) and daytime sleep-related impairment (between-group ES = .61, P = .009) than the TAU+ group. CONCLUSION CBT-I+Light had a clinically significant impact on insomnia and fatigue with moderate effect sizes. Results support offering cognitive behavioral therapy for insomnia and bright light therapy during chemotherapy for breast cancer to help manage sleep and fatigue.
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Affiliation(s)
- Helena R Bean
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Innovation Walk, Melbourne, VIC, Australia
| | | | - Maria Ftanou
- Peter MacCallum Cancer Centre, Melbourne, Australia.,Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Marliese Alexander
- Peter MacCallum Cancer Centre, Melbourne, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
| | - Lesley Stafford
- Centre for Women's Mental Health, Royal Women's Hospital, Melbourne, Australia.,Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia
| | - Bei Bei
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Innovation Walk, Melbourne, VIC, Australia.,Centre for Women's Mental Health, Royal Women's Hospital, Melbourne, Australia.,Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia
| | | | - Joshua F Wiley
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Innovation Walk, Melbourne, VIC, Australia.,Peter MacCallum Cancer Centre, Melbourne, Australia
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Ng Y, Nguyen E, Bei B, Hamilton G, Rajaratnam S, Ou C, Mansfield D. P103 Impact of the COVID-19 pandemic on the sleep of patients of a multidisciplinary sleep clinic. SLEEP Advances 2021. [PMCID: PMC8500137 DOI: 10.1093/sleepadvances/zpab014.147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Introduction
This study aimed to assess the impact of the COVID-19 pandemic on the sleep of adult patients of a multidisciplinary sleep clinic.
Methods
Patients were invited to complete online surveys: Survey 1 in October 2020 (increased COVID-19 restrictions) followed by Survey 2 in February 2021 (after easing of restrictions for a COVIDSafe summer).
Results
Of the 746 patients invited to participate, 73 completed and 8 partially returned Survey 1 (mean age 50.1 years, range 21–83 years, 58% female). Subsequently, 46 completed and 5 partially answered Survey 2. In Survey 1, 22/74 (29.7%) reported reduced sleep quantity and 31/75 (41.3%) indicated worse sleep quality compared with prior to the pandemic. In Survey 2, 33/46 (71.7%) described unchanged sleep quantity whilst 5/46 (10.9%) reported increased sleep quantity since easing COVID-19 restrictions. 36/46 (78.3%) indicated unchanged sleep quality whereas 5/46 (10.9%) described improved sleep quality since easing restrictions. However, 9/46 (19.6%) reported that their sleep remained worse compared with pre-pandemic. For patients who completed both surveys, there was no significant change in Insomnia Severity Index scores (Survey 1 mean 13.6, Survey 2 mean 12.9, mean difference -0.67 [95%CI -2.02, 0.68], p=0.32) or PROMIS Sleep-Related Impairment 8a T-scores (Survey 1 mean 59.0, Survey 2 mean 59.5, mean difference 0.44 [95%CI -1.55, 2.42], p=0.66).
Discussion
The COVID-19 pandemic has negatively affected the sleep of 44% of patients. Following easing of restrictions, symptoms of insomnia and sleep-related impairment did not change significantly, and 19.6% reported that their sleep was not back to their pre-pandemic baseline.
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Affiliation(s)
- Y Ng
- Monash University, Notting Hill, Australia
- Monash Lung, Sleep, Allergy and Immunology, Monash Health, Clayton, Australia
| | - E Nguyen
- Monash University, Notting Hill, Australia
| | - B Bei
- Monash University, Notting Hill, Australia
| | - G Hamilton
- Monash University, Notting Hill, Australia
- Monash Lung, Sleep, Allergy and Immunology, Monash Health, Clayton, Australia
| | | | - C Ou
- Monash University, Notting Hill, Australia
| | - D Mansfield
- Monash University, Notting Hill, Australia
- Monash Lung, Sleep, Allergy and Immunology, Monash Health, Clayton, Australia
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Le F, Yap Y, Tung NYC, Bei B, Wiley JF. The Associations Between Daily Activities and Affect: a Compositional Isotemporal Substitution Analysis. Int J Behav Med 2021; 29:456-468. [PMID: 34608593 DOI: 10.1007/s12529-021-10031-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/23/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Daily activities are associated with affective experiences. A 24-h day can be separated into five mutually exclusive activity types: sleep, awake in bed, moderate-to-vigorous physical activity (MVPA), light-intensity physical activity (LIPA), and sedentary behavior (SB). Most research has examined these activities independently and not collectively, yet increased time in one activity must be offset by decreasing other activities. Using compositional isotemporal substitution analyses, this study examined the associations between time spent in daily activities and affect, including both high and low arousal positive and negative affect. METHOD Across three separate studies, daily activities and affect were measured throughout 7-15 days (Mdays = 10) in 361 healthy community adults (72.5% females, Mage = 22.79 years). Activities were objectively assessed using accelerometry and self-reported affect was assessed using repeated ecological momentary assessments. Minutes spent in each activity and affect values across the three studies were averaged for each participant. RESULTS Longer sleep duration at the expense of time awake in bed was associated with lower high arousal negative affect (e.g., nervousness, b = - 0.24, p = .007). More MVPA at the expense of LIPA or SB was associated with higher high arousal positive affect (e.g., happiness, b = 0.35, p = .027). Activity composition was not associated with low arousal positive or negative affect (all p ≥ .06). CONCLUSION Associations between 24-h activity composition and affect differed based on types of activities, types of affect, and the interrelationships between activities within the composition. Findings can aid interventions to develop integrated guidance on the optimal activity patterns for mental health.
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Affiliation(s)
- Flora Le
- School of Psychological Science, Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia
| | - Yang Yap
- School of Psychological Science, Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia
| | - Natasha Yan Chi Tung
- School of Psychological Science, Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia
| | - Bei Bei
- School of Psychological Science, Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia
| | - Joshua F Wiley
- School of Psychological Science, Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia.
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Shen L, Wiley JF, Bei B. Sleep and affect in adolescents: Bidirectional daily associations over 28-day ecological momentary assessment. J Sleep Res 2021; 31:e13491. [PMID: 34585468 DOI: 10.1111/jsr.13491] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 07/25/2021] [Accepted: 09/05/2021] [Indexed: 12/01/2022]
Abstract
We examined bidirectional, temporal associations between daily sleep and affect under naturally restricted (school) and unrestricted (vacation) sleep opportunities, while incorporating valence (positive/negative) and arousal (high/low) dimensions of affect. Sleep and affect were measured over 2 weeks of school and 2 weeks of vacation in 205 adolescents (54.1% females, Mage = 16.9 years), providing 5,231 days of data. Total sleep time and sleep efficiency were measured using actigraphy and sleep diary. High- and low-arousal positive and negative affect were self-reported each afternoon. Between- and within-person sleep-affect associations were tested using cross-lagged, multilevel models. Lagged outcome, day of the week, study day and socio-demographics were controlled. Bidirectional associations between self-report sleep and affect were found between-persons: longer self-report total sleep time associated with lower high- and low-arousal negative affect. Higher high-arousal positive affect associated with longer actigraphy total sleep time between-persons, but predicted shorter same-night actigraphy total sleep time within-persons. Results did not differ between school and vacation. Significant within-person random effects demonstrate individual differences in daily sleep-affect associations. Associations differed based on sleep measurement and affect dimensions, highlighting the complex sleep-affect relationship. Strong between-person associations between self-report sleep and affect suggest improving either sleep or mood may benefit the other; alternatively, addressing a common cause may lead to changes in both sleep and affect. Although overall high-arousal positive affect was protective of sleep duration, on a day-to-day basis, higher-than-usual high-arousal positive affect may reduce sleep duration on nights it is experienced. Further research needs to identify causes of individual differences in sleep-affect associations.
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Affiliation(s)
- Lin Shen
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Vic., Australia
| | - Joshua F Wiley
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Vic., Australia
| | - Bei Bei
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Vic., Australia.,Department of Psychiatry, Women's Mental Health Service, Royal Women's Hospital, University of Melbourne, Melbourne, Vic., Australia
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Yuksel D, Prouty D, Bei B, Baker FC, de Zambotti M. Re-thinking insomnia disorder in adolescents: the importance of an accurate diagnosis. Sleep 2021; 44:6361534. [PMID: 34469580 DOI: 10.1093/sleep/zsab221] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Dilara Yuksel
- Center for Health Sciences, SRI International, Menlo Park, CA, USA
| | - Devin Prouty
- Center for Health Sciences, SRI International, Menlo Park, CA, USA
| | - Bei Bei
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Fiona C Baker
- Center for Health Sciences, SRI International, Menlo Park, CA, USA.,Brain Function Research Group, School of Physiology, University of the Witwatersrand, Johannesburg, South Africa
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Stone JE, Phillips AJK, Chachos E, Hand AJ, Lu S, Carskadon MA, Klerman EB, Lockley SW, Wiley JF, Bei B, Rajaratnam SMW. In-person vs home schooling during the COVID-19 pandemic: Differences in sleep, circadian timing, and mood in early adolescence. J Pineal Res 2021; 71:e12757. [PMID: 34273194 PMCID: PMC8420593 DOI: 10.1111/jpi.12757] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 07/05/2021] [Accepted: 07/15/2021] [Indexed: 12/17/2022]
Abstract
During the COVID-19 pandemic, schools around the world rapidly transitioned from in-person to remote learning, providing an opportunity to examine the impact of in-person vs remote learning on sleep, circadian timing, and mood. We assessed sleep-wake timing using wrist actigraphy and sleep diaries over 1-2 weeks during in-person learning (n = 28) and remote learning (n = 58, where n = 27 were repeat assessments) in adolescents (age M ± SD = 12.79 ± 0.42 years). Circadian timing was measured under a single condition in each individual using salivary melatonin (Dim Light Melatonin Onset; DLMO). Online surveys assessed mood (PROMIS Pediatric Anxiety and Depressive Symptoms) and sleepiness (Epworth Sleepiness Scale - Child and Adolescent) in each condition. During remote (vs in-person) learning: (i) on school days, students went to sleep 26 minutes later and woke 49 minutes later, resulting in 22 minutes longer sleep duration (all P < .0001); (ii) DLMO time did not differ significantly between conditions, although participants woke at a later circadian phase (43 minutes, P = .03) during remote learning; and (iii) participants reported significantly lower sleepiness (P = .048) and lower anxiety symptoms (P = .006). Depressive symptoms did not differ between conditions. Changes in mood symptoms were not mediated by sleep. Although remote learning continued to have fixed school start times, removing morning commutes likely enabled adolescents to sleep longer, wake later, and to wake at a later circadian phase. These results indicate that remote learning, or later school start times, may extend sleep and improve some subjective symptoms in adolescents.
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Affiliation(s)
- Julia E. Stone
- Turner Institute for Brain and Mental HealthSchool of Psychological SciencesMonash UniversityClaytonVICAustralia
| | - Andrew J. K. Phillips
- Turner Institute for Brain and Mental HealthSchool of Psychological SciencesMonash UniversityClaytonVICAustralia
| | - Evangelos Chachos
- Turner Institute for Brain and Mental HealthSchool of Psychological SciencesMonash UniversityClaytonVICAustralia
| | - Anthony J. Hand
- Turner Institute for Brain and Mental HealthSchool of Psychological SciencesMonash UniversityClaytonVICAustralia
| | - Sinh Lu
- Turner Institute for Brain and Mental HealthSchool of Psychological SciencesMonash UniversityClaytonVICAustralia
| | - Mary A. Carskadon
- Department of Psychiatry & Human BehaviorChronobiology & Sleep Research LaboratoryEP Bradley HospitalThe Alpert Medical School of Brown UniversityProvidenceRIUSA
| | - Elizabeth B. Klerman
- Department of NeurologyMassachusetts General HospitalBostonMAUSA
- Division of Sleep and Circadian DisordersDepartments of Medicine and NeurologyBrigham and Women's HospitalBostonMAUSA
- Division of Sleep MedicineHarvard Medical SchoolBostonMAUSA
| | - Steven W. Lockley
- Division of Sleep and Circadian DisordersDepartments of Medicine and NeurologyBrigham and Women's HospitalBostonMAUSA
- Division of Sleep MedicineHarvard Medical SchoolBostonMAUSA
| | - Joshua F. Wiley
- Turner Institute for Brain and Mental HealthSchool of Psychological SciencesMonash UniversityClaytonVICAustralia
| | - Bei Bei
- Turner Institute for Brain and Mental HealthSchool of Psychological SciencesMonash UniversityClaytonVICAustralia
| | - Shantha M. W. Rajaratnam
- Turner Institute for Brain and Mental HealthSchool of Psychological SciencesMonash UniversityClaytonVICAustralia
- Division of Sleep and Circadian DisordersDepartments of Medicine and NeurologyBrigham and Women's HospitalBostonMAUSA
- Division of Sleep MedicineHarvard Medical SchoolBostonMAUSA
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Smith IS, Wellecke C, Weihs KL, Bei B, Wiley JF. Piloting CanCope: An internet-delivered transdiagnostic intervention to improve mental health in cancer survivors. Psychooncology 2021; 31:107-115. [PMID: 34425036 DOI: 10.1002/pon.5787] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 08/02/2021] [Accepted: 08/02/2021] [Indexed: 12/18/2022]
Abstract
OBJECTIVE CanCope is an internet-delivered, cognitive-behavioural intervention adapted from the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders to improve emotion regulation and support the mental health of cancer survivors. Four separate pilot studies evaluated each of CanCope's modules for (1) feasibility and participant satisfaction, and changes in (2) module-specific outcomes, and (3) global measures of emotion dysregulation and anxiety and depressive symptoms, from pre-to-post module delivery. METHODS Eligible cancer survivors self-selected into one two-week online module designed to improve a specific aspect of emotion regulation ([1] understanding emotions, [2] mindfulness of emotions, [3] cognitive reappraisals, [4] challenging emotion-driven behaviours). RESULTS Across modules, post-intervention surveys were completed by 17-19 participants, (58.1%-90.5% completion rate for participants who received the intervention). Each module was feasible and participants reported high satisfaction. Moderate-to-large pre-to-post effect sizes in mean differences were observed in module-specific target outcomes (p's < 0.05). Emotion dysregulation significantly decreased across modules 1 to 3 (p's < 0.05) with a non-significant decrease for module 4 (p = 0.13). Anxiety symptoms significantly decreased across all modules (p's < 0.05). Depressive symptoms significantly decreased across modules 1 and 3 (p's < 0.05), with non-significant decreases across modules 2 (p = 0.08) and 4 (p = 0.06). CONCLUSIONS Each CanCope module demonstrated promise in targeting emotion regulation skills and supporting the mental health of cancer survivors. Randomised controlled trials are required to test the efficacy of CanCope as an intervention in its entirety.
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Affiliation(s)
- Isabelle S Smith
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia
| | - Cornelia Wellecke
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia
| | - Karen L Weihs
- The Department of Psychiatry, College of Medicine, University of Arizona, Tucson, Arizona, USA
| | - Bei Bei
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia
| | - Joshua F Wiley
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia
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Shen L, Wiley JF, Bei B. Perceived daily sleep need and sleep debt in adolescents: associations with daily affect over school and vacation periods. Sleep 2021; 44:6330595. [PMID: 34323993 DOI: 10.1093/sleep/zsab190] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 07/13/2021] [Indexed: 11/13/2022] Open
Abstract
STUDY OBJECTIVES To describe trajectories of perceived daily sleep need and sleep debt, and examine if cumulative perceived sleep debt predicts next-day affect. METHODS Daily sleep and affect were measured over 2 school weeks and 2 vacation weeks (N=205, 54.1% females, M±SDage = 16.9±0.87 years). Each day, participants wore actigraphs and self-reported the amount of sleep needed to function well the next day (i.e., perceived sleep need), sleep duration, and high- and low-arousal positive and negative affect (PA, NA). Cumulative perceived sleep debt was calculated as the weighted average of the difference between perceived sleep need and sleep duration over the past 3 days. Cross-lagged, multilevel models were used to test cumulative sleep debt as a predictor of next-day affect. Lagged affect, day of the week, study day, and sociodemographics were controlled. RESULTS Perceived sleep need was lower early in the school week, before increasing in the second half of the week. Adolescents accumulated perceived sleep debt across school days and reduced it during weekends. On weekends and vacations, adolescents self-reported meeting their sleep need, sleeping the amount, or more than the amount of sleep they perceived as needing. Higher cumulative actigraphy sleep debt predicted higher next-day high arousal NA; higher cumulative diary sleep debt predicted higher NA (regardless of arousal), and lower low arousal PA the following day. CONCLUSION Adolescents experienced sustained, cumulative perceived sleep debt across school days. Weekends and vacations appeared to be opportunities for reducing sleep debt. Trajectories of sleep debt during vacation suggested recovery from school-related sleep restriction. Cumulative sleep debt was related to affect on a daily basis, highlighting the value of this measure for future research and interventions.
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Affiliation(s)
- Lin Shen
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Australia
| | - Joshua F Wiley
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Australia
| | - Bei Bei
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Australia.,Women's Mental Health Service, Royal Women's Hospital, Department of Psychiatry, University of Melbourne, Melbourne, Australia
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Verma S, Quin N, Astbury L, Wellecke C, Wiley J, Davey M, Rajaratnam S, Bei B. 365 Cognitive Behavioral Therapy and Light Dark Therapy for Postpartum Insomnia Symptoms: Findings from a Randomized Controlled Trial. Sleep 2021. [DOI: 10.1093/sleep/zsab072.364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Symptoms of insomnia are common in the postpartum period and are associated with a range of negative outcomes. Despite this, interventions to improve maternal postpartum sleep remain scarce. Cognitive Behavioral Therapy (CBT) and Light Dark Therapy (LDT) target two different mechanisms to reduce sleep disturbance. This randomized controlled trial examined the efficacy of CBT and LDT against a treatment-as-usual (TAU) condition in reducing maternal postpartum insomnia symptoms.
Methods
Nulliparous women 4–12 months postpartum with self-reported symptoms of insomnia (Insomnia Severity Index scores [ISI] >7) were included; excluded were those with: current severe health/psychiatric conditions, unsettled infant behaviors, sleep-affecting medication use and photosensitivity. Eligible women were randomized 1:1:1 to 6 weeks of CBT (CBT for insomnia and fatigue), LDT (morning bright light therapy, evening light hygiene), or TAU. Interventions were therapist-assisted and personalized through two telephone calls and included automated self-help intervention materials (i.e., emails) delivered over six weeks. Symptoms of insomnia (ISI; primary outcome), fatigue, sleepiness, depression, and anxiety were assessed at baseline, mid-intervention, post-intervention, and 1-month post-intervention. Analyses were intention-to-treat latent growth models.
Results
114 women were randomized (mean age = 32.20 ± 4.62 years) and 108 women completed the intervention. Compared to TAU, symptoms of insomnia significantly reduced from baseline to post-intervention in both CBT and LDT groups (p-values <.001), with very large effect sizes (d > 1.5) at post-intervention; gains were maintained at follow-up. Fatigue symptoms significantly reduced in the CBT group (p<.0001; d = 0.85) but not LDT (p = 0.11) compared to TAU at post-intervention; gains were maintained for CBT at follow-up. Group differences in sleepiness, depression, and anxiety were nonsignificant (all p > 0.08).
Conclusion
Therapist-assisted self-help CBT and LDT with different therapeutic mechanisms are both efficacious for reducing maternal insomnia symptoms during the postpartum period. Findings were mixed for fatigue, sleepiness and mood. Future research on predictors of treatment responses is needed.
Support (if any)
Australian National Health and Medical Research Council, Department of Education RTP Scholarship. Lucimed SA supplied light therapy glasses. Funders had no role in design/implementation of the trial. ANZCTR: ACTRN12618000842268.
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