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International Archives of Occupational and Environmental Health

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Open Access 01-07-2020 | Insomnia | Original Article

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

Authors: Heli Järnefelt, Mikko Härmä, Mikael Sallinen, Jussi Virkkala, Teemu Paajanen, Kari-Pekka Martimo, Christer Hublin

Published in: International Archives of Occupational and Environmental Health | Issue 5/2020

Abstract

Introduction

The aim of the study was to compare the effectiveness of cognitive behavioural therapy interventions for insomnia (CBT-I) to that of a sleep hygiene intervention in a randomized controlled design among shift workers. We also studied whether the features of shift work disorder (SWD) affected the results.

Methods

A total of 83 shift workers with insomnia disorder were partially randomized into a group-based CBT-I, self-help CBT-I, or sleep hygiene control intervention. The outcomes were assessed before and after the interventions and at 6-month follow-up using questionnaires, a sleep diary, and actigraphy.

Results

Perceived severity of insomnia, sleep-related dysfunctional beliefs, burnout symptoms, restedness, recovery after a shift, and actigraphy-based total sleep time improved after the interventions, but we found no significant differences between the interventions. Mood symptoms improved only among the group-based CBT-I intervention participants. Non-SWD participants had more mental diseases and symptoms, used more sleep-promoting medication, and had pronounced insomnia severity and more dysfunctional beliefs than those with SWD. After the interventions, non-SWD participants showed more prominent improvements than those with SWD.

Conclusions

Our results showed no significant differences between the sleep improvements of the shift workers in the CBT-I interventions and of those in the sleep hygiene control intervention. Alleviation of mood symptoms seemed to be the main added value of the group-based CBT-I intervention compared to the control intervention. The clinical condition of the non-SWD participants was more severe and these participants benefitted more from the interventions than the SWD participants did.

Trial registration

ClinicalTrials.gov, NCT02523079.

Aalto AM, Aro AR, Teperi J (1999) RAND-36 as a measure of health-related quality of life. Realibility, construct validity and reference values in Finnish general population. Helsinki: Stakes. https://www.julkari.fi/bitstream/handle/10024/76006/Tu101.pdf?s

American Academy of Sleep Medicine (2014) international classification of sleep disorders; diagnostic and coding manual, 3rd edn. American Academy of Sleep Medicine, Darien

Baglioni C, Battagliese G, Feige B, Spiegelhalder K, Nissen C, Voderholzer U, Riemann D (2012) Insomnia as a predictor of depression: a meta-analytic evaluation of longitudinal epidemiological studies. J Affect Disord 135(1–3):10–19

Bastien CH, Vallieres A, Morin CM (2001) Validation of the Insomnia Severity Index as an outcome measure for insomnia research. Sleep Med 2(4):297–307CrossRef

Beck AT, Steer RA, Garbin MG (1988) Psychometric properties of the Beck Depression Inventory: twenty-five years of evaluation. Clin Psychol Rev 8(1):77–100CrossRef

Buysse DJ, Ancoli-Israel S, Edinger JD, Lichstein KL, Morin CM (2006) Recommendations for a standard research assessment of insomnia. Sleep 29(9):1155–1173CrossRef

Carney CE, Buysse DJ, Ancoli-Israel S, Edinger JD, Krystal AD, Lichstein KL, Morin CM (2012) The consensus sleep diary: standardizing prospective sleep self-monitoring. Sleep 35(2):287–302. https://doi.org/10.5665/sleep.1642 CrossRef

Cheng SK, Dizon J (2012) Computerised cognitive behavioural therapy for insomnia: a systematic review and meta-analysis. Psychother Psychosom 81(4):206–216. https://doi.org/10.1159/000335379 CrossRef

Drake CL, Roehrs T, Richardson G, Walsh JK, Roth T (2004) Shift work sleep disorder: prevalence and consequences beyond that of symptomatic day workers. Sleep 27(8):1453–1462CrossRef

Eurofound (2017) Sixth European working conditions survey overview report. Publications Office of the European Union, Luxembourgh

Flo E, Pallesen S, Moen BE, Waage S, Bjorvatn B (2014) Short rest periods between work shifts predict sleep and health problems in nurses at 1-year follow-up. Occup Environ Med 71(8):555–561. https://doi.org/10.1136/oemed-2013-102007 CrossRef

Fortier-Brochu E, Beaulieu-Bonneau S, Ivers H, Morin CM (2012) Insomnia and daytime cognitive performance: a meta-analysis. Sleep Med Rev 16(1):83–94. https://doi.org/10.1016/j.smrv.2011.03.008 CrossRef

Freeman D, Sheaves B, Goodwin GM, Yu LM, Nickless A, Harrison PJ, Espie CA (2017) The effects of improving sleep on mental health (OASIS): a randomised controlled trial with mediation analysis. Lancet Psychiatry 4(10):749–758. https://doi.org/10.1016/S2215-0366(17)30328-0 CrossRef

Harma M, Ropponen A, Hakola T, Koskinen A, Vanttola P, Puttonen S, Kivimaki M (2015) Developing register-based measures for assessment of working time patterns for epidemiologic studies. Scand J Work Environ Health 41(3):268–279. https://doi.org/10.5271/sjweh.3492 CrossRef

Harma M, Karhula K, Ropponen A, Puttonen S, Koskinen A, Ojajarvi A, Kivimaki M (2018) Association of changes in work shifts and shift intensity with change in fatigue and disturbed sleep: a within-subject study. Scand J Work Environ Health 44(4):394–402. https://doi.org/10.5271/sjweh.3730 CrossRef

Harvey AG, Buysse DJ (2018) Treating sleep problems a transdiagnostic approach. The Guilford Press, New York

Hays RD, Sherbourne CD, Mazel RM (1993) The RAND 36-Item Health Survey 1.0. Health Econ 2(3):217–227CrossRef

Irish LA, Kline CE, Gunn HE, Buysse DJ, Hall MH (2015) The role of sleep hygiene in promoting public health: a review of empirical evidence. Sleep Med Rev 22:23–36. https://doi.org/10.1016/j.smrv.2014.10.001 CrossRef

Jacobs GD, Pace-Schott EF, Stickgold R, Otto MW (2004) Cognitive behavior therapy and pharmacotherapy for insomnia: a randomized controlled trial and direct comparison. Arch Intern Med 164(17):1888–1896. https://doi.org/10.1001/archinte.164.17.1888 CrossRef

Jarnefelt H, Lagerstedt R, Kajaste S, Sallinen M, Savolainen A, Hublin C (2012) Cognitive behavioral therapy for shift workers with chronic insomnia. Sleep Med 13(10):1238–1246. https://doi.org/10.1016/j.sleep.2012.10.003 CrossRef

Jarnefelt H, Sallinen M, Luukkonen R, Kajaste S, Savolainen A, Hublin C (2014) Cognitive behavioral therapy for chronic insomnia in occupational health services: analyses of outcomes up to 24 months post-treatment. Behav Res Ther 56:16–21. https://doi.org/10.1016/j.brat.2014.02.007 CrossRef

Jarvinen O, Saarinen T, Julkunen J, Huhtala H, Tarkka MR (2003) Changes in health-related quality of life and functional capacity following coronary artery bypass graft surgery. Eur J Cardiothorac Surg 24(5):750–756CrossRef

Kecklund G, Axelsson J (2016) Health consequences of shift work and insufficient sleep. BMJ 355:i5210. https://doi.org/10.1136/bmj.i5210 CrossRef

Kerkhof GA (2018) Shift work and sleep disorder comorbidity tend to go hand in hand. Chronobiol Int 35(2):219–228. https://doi.org/10.1080/07420528.2017.1392552 CrossRef

Kinnunen U, Feldt T (2013) Job characteristics, recovery experiences and occupational well-being: testing cross-lagged relationships across 1 year. Stress Health 29(5):369–382. https://doi.org/10.1002/smi.2483 CrossRef

Kronholm E, Partonen T, Harma M, Hublin C, Lallukka T, Peltonen M, Laatikainen T (2016) Prevalence of insomnia-related symptoms continues to increase in the Finnish working-age population. J Sleep Res 25(4):454–457. https://doi.org/10.1111/jsr.12398 CrossRef

Kucharczyk ER, Morgan K, Hall AP (2012) The occupational impact of sleep quality and insomnia symptoms. Sleep Med Rev 16(6):547–559. https://doi.org/10.1016/j.smrv.2012.01.005 CrossRef

Lappalainen K, Aminoff M, Hakulinen H, Hirvonen M, Räsänen K, Sauni R, Stengård J (2016) Occupational healthcare in Finland 2015. Finnish Institute of Occupational Health, Helsinki

Meyer TJ, Miller ML, Metzger RL, Borkovec TD (1990) Development and validation of the Penn State Worry Questionnaire. Behav Res Ther 28(6):487–495CrossRef

Morin CM, Hauri PJ, Espie CA, Spielman AJ, Buysse DJ, Bootzin RR (1999) Nonpharmacologic treatment of chronic insomnia. An American academy of sleep medicine review. Sleep 22(8):1134–1156CrossRef

Morin CM, Vallieres A, Ivers H (2007) Dysfunctional beliefs and attitudes about sleep (DBAS): validation of a brief version (DBAS-16). Sleep 30(11):1547–1554CrossRef

Morin CM, Belleville G, Belanger L, Ivers H (2011) The Insomnia Severity Index: psychometric indicators to detect insomnia cases and evaluate treatment response. Sleep 34(5):601–608CrossRef

Morin CM, Drake CL, Harvey AG, Krystal AD, Manber R, Riemann D, Spiegelhalder K (2015) Insomnia disorder. Nat Rev Dis Primers 1:15026. https://doi.org/10.1038/nrdp.2015.26 CrossRef

Okajima I, Komada Y, Inoue Y (2011) A meta-analysis on the treatment effectiveness of cognitive behavioral therapy for primary insomnia. Sleep Biol Rhythms 9(1):24–34. https://doi.org/10.1111/j.1479-8425.2010.00481.x CrossRef

Partinen M, Gislason T (1995) Basic Nordic Sleep Questionnaire (BNSQ): a quantitated measure of subjective sleep complaints. J Sleep Res 4(S1):150–155CrossRef

Partinen M, Hublin C (2011) Epidemiology of sleep disorders. In: Kryger M, Roth T, Dement WC (eds) Principles and practice of sleep medicine. Elsevier Saunders, St Louis, pp 694–715CrossRef

Peter L, Reindl R, Zauter S, Hillemacher T, Richter K (2019) Effectiveness of an online CBT-I intervention and a face-to-face treatment for shift work sleep disorder: a comparison of sleep diary data. Int J Environ Res Public Health. https://doi.org/10.3390/ijerph16173081 CrossRef

Riemann D, Baglioni C, Bassetti C, Bjorvatn B, Dolenc Groselj L, Ellis JG, Spiegelhalder K (2017) European guideline for the diagnosis and treatment of insomnia. J Sleep Res 26(6):675–700. https://doi.org/10.1111/jsr.12594 CrossRef

Saksvik IB, Bjorvatn B, Hetland H, Sandal GM, Pallesen S (2011) Individual differences in tolerance to shift work–a systematic review. Sleep Med Rev 15(4):221–235. https://doi.org/10.1016/j.smrv.2010.07.002 CrossRef

Sallinen M, Kecklund G (2010) Shift work, sleep, and sleepiness differences between shift schedules and systems. Scand J Work Environ Health 36(2):121–133CrossRef

Schiller H, Soderstrom M, Lekander M, Rajaleid K, Kecklund G (2018) A randomized controlled intervention of workplace-based group cognitive behavioral therapy for insomnia. Int Arch Occup Environ Health 91(4):413–424. https://doi.org/10.1007/s00420-018-1291-x CrossRef

Seligman MEP (1995) The effectiveness of psychotherapy: the Consumer Reports Study. Am Psychol 50(12):965–974CrossRef

Shirom A, Melamed S (2006) A comparison of the construct validity of two burnout measures in two groups of professionals. Int J Stress Manag 13(2):176–200CrossRef

Sivertsen B, Lallukka T, Salo P, Pallesen S, Hysing M, Krokstad S, Simon O (2014) Insomnia as a risk factor for ill health: results from the large population-based prospective HUNT Study in Norway. J Sleep Res 23(2):124–132. https://doi.org/10.1111/jsr.12102 CrossRef

Stepanski EJ, Wyatt JK (2003) Use of sleep hygiene in the treatment of insomnia. Sleep Med Rev 7(3):215–225CrossRef

Taylor DJ, Pruiksma KE (2014) Cognitive and behavioural therapy for insomnia (CBT-I) in psychiatric populations: a systematic review. Int Rev Psychiatry 26(2):205–213. https://doi.org/10.3109/09540261.2014.902808 CrossRef

Vanttola P, Harma M, Viitasalo K, Hublin C, Virkkala J, Sallinen M, Puttonen S (2018) Sleep and alertness in shift work disorder: findings of a field study. Int Arch Occup Environ Health. https://doi.org/10.1007/s00420-018-1386-4 CrossRef

Vanttola P, Puttonen S, Karhula K, Oksanen T, Harma M (2019) Prevalence of shift work disorder among hospital personnel: a cross-sectional study using objective working hour data. J Sleep Res. https://doi.org/10.1111/jsr.12906 CrossRef

Vgontzas AN, Fernandez-Mendoza J, Liao D, Bixler EO (2013) Insomnia with objective short sleep duration: the most biologically severe phenotype of the disorder. Sleep Med Rev 17(4):241–254. https://doi.org/10.1016/j.smrv.2012.09.005 CrossRef

World Health Organization (1995) International statistical classification of diseases and related health problems (ICD-10), 10 th revision. 2nd ed., WHO, Geneva

Waage S, Pallesen S, Moen BE, Mageroy N, Flo E, Di Milia L, Bjorvatn B (2014) Predictors of shift work disorder among nurses: a longitudinal study. Sleep Med 15(12):1449–1455. https://doi.org/10.1016/j.sleep.2014.07.014 CrossRef

West AC, Bechtold DA (2015) The cost of circadian desynchrony: evidence, insights and open questions. BioEssays 37(7):777–788. https://doi.org/10.1002/bies.201400173 CrossRef

Wickwire EM, Geiger-Brown J, Scharf SM, Drake CL (2017) Shift work and shift work sleep disorder: clinical and organizational perspectives. Chest 151(5):1156–1172. https://doi.org/10.1016/j.chest.2016.12.007 CrossRef

Wright KP Jr, Bogan RK, Wyatt JK (2013) Shift work and the assessment and management of shift work disorder (SWD). Sleep Med Rev 17(1):41–54. https://doi.org/10.1016/j.smrv.2012.02.002 CrossRef

Title: Cognitive behavioural therapy interventions for insomnia among shift workers: RCT in an occupational health setting
Authors: Heli Järnefelt
Mikko Härmä
Mikael Sallinen
Jussi Virkkala
Teemu Paajanen
Kari-Pekka Martimo
Christer Hublin
Publication date: 01-07-2020
Publisher: Springer Berlin Heidelberg
Keywords: Insomnia
Behavioural Therapy
Published in: International Archives of Occupational and Environmental Health / Issue 5/2020
Print ISSN: 0340-0131
Electronic ISSN: 1432-1246
DOI: https://doi.org/10.1007/s00420-019-01504-6

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

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

Abstract

Introduction

Methods

Results

Conclusions

Trial registration

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusions

Trial registration

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