Assessment and management of sleep disorders in shift workers: Challenges and considerations for general practice.

BACKGROUND: Shift work is characterised by displaced sleep opportunities and associated sleep disturbance. Shift workers often report sleepiness and other wake time symptoms associated with poor sleep. However, clinical sleep disorders are also prevalent in shift workers. Although prevalence rates are similar or higher in shift workers compared with the general population, help seeking in shift workers with sleep disorders is low. OBJECTIVE: This article aims to provide general practitioners with a contemporary overview of the prevalence rates for sleep disorders in shift workers, to clarify the existing evidence relating to mental and physical health consequences of sleep disorders in shift workers and to highlight the need to consider undiagnosed sleep disorders before attributing sleep-related symptoms solely to work schedules. DISCUSSION: Symptoms of sleep loss associated with shift work overlap with symptoms experienced by individuals living with sleep disorders. Although >40% of middle-aged Australians live with a sleep disorder that requires investigation and management, symptoms in shift workers are often attributed to the work schedule and, as a result, might not be investigated for appropriate diagnosis and treatment. We argue that screening for sleep disorders in shift workers with sleep complaints should be a priority.

The Good Sleeper Scale-15 items: a questionnaire for the standardised assessment of good sleepers.

Research with 'good sleepers' is ubiquitous, yet there are no standardised criteria to identify a 'good sleeper'. The present study aimed to create and validate a questionnaire for identifying good sleepers for use in research studies known as the Good Sleeper Scale-15 items (GSS-15). Data were derived from a population-based survey of Australian adults (n = 2,044). A total of 23 items were chosen for possible inclusion. An exploratory factor analysis (EFA) was conducted on ~10% of the survey dataset (n = 191) for factor identification and item reduction. A confirmatory factor analysis (CFA) was conducted on the remaining data (n = 1,853) to test model fit. Receiver operating characteristic curves and correlations were conducted to derive cut-off scores and test associations with sleep, daytime functioning, health, and quality-of-life. The EFA identified six factors: 'Sleep Difficulties', 'Timing', 'Duration', 'Regularity', 'Adequacy', and 'Perceived Sleep Problem'. The CFA showed that model fit was high and comparable to other sleep instruments, χ2 (63) = 378.22, p < 0.001, root mean square error of approximation = 0.05, with acceptable internal consistency (α = 0.76). Strong correlations were consistently found between GSS-15 global scores and outcomes, including 'a good night's sleep' (r = 0.7), 'feeling un-refreshed' (r = -0.59), and 'experienced sleepiness' (r = -0.51), p < 0.001. Cut-off scores were derived to categorise individuals likely to be a good sleeper (GSS-15 score ≥40) and those very likely to be a good sleeper (GSS-15 score ≥45). The GSS-15 is a freely available, robust questionnaire that will assist in identifying good sleepers for the purpose of sleep research. Future work will test relationships with other sleep measures in community and clinical samples.

Implementation of a digital cognitive behavioral therapy for insomnia pathway in primary care.

Background Insomnia is a prevalent and debilitating disorder commonly managed by family physicians. Insomnia guidelines recommend cognitive behavioral therapy for insomnia (CBTi) as the 'first-line' treatment. However, family physicians report limited time, knowledge, access, support, and referral options to manage patients with CBTi. Consequently, many patients with insomnia are prescribed potentially harmful and addictive sedative-hypnotic medicines (e.g. benzodiazepines). Family physicians require an insomnia management pathway that is specifically tailored to the guideline-recommendations, time demands, and capacity of family practice. Methods This mixed-methods implementation trial will test the feasibility, acceptability and effectiveness of a comprehensive digital insomnia management pathway in family practice. This novel pathway includes digital recruitment of family physicians, automatic identification of patients whose electronic medical records contain recent sedative-hypnotic prescriptions using a software management pathway and real-time notifications prompting physicians to refer patients to a well-established digital CBTi program. At least 10 family physicians and 375 patients with insomnia will be recruited. Physicians will be provided with an eBook to guide gradual sedative-hypnotic withdrawal. Feasibility and acceptability will be assessed from the perspective of patients and physicians. Effectiveness will be determined by co-primary outcomes: cessation of sedative-hypnotic use, and improvement in self-reported insomnia symptoms from baseline to 12-month follow-up. Analysis of trends in costs, cost-effectiveness and cost-utility analyses will be conducted from a societal perspective. Results and discussion This implementation trial will pave the way for future scaling-up of this insomnia management pathway to improve access to CBTi and reduce reliance on sedative-hypnotic medicines in family practice. Trial Registration: This trial was prospectively registered on the Australian and New Zealand Clinical Trials Registry (ANZCTR) (ACTRN12619001539123).

The Sleep Impact on Activity Diary (SIAD): A Novel Assessment of Daytime Functioning in Insomnia.

Daytime impairments feature in the diagnostic criteria for insomnia disorder yet are rarely assessed comprehensively in clinical practice and tend to focus on mood and subjective assessment of cognitive competence. In order to gain more information about the engagement in daily activities we developed the Sleep Impact on Activity Diary (SIAD). This initial investigation included 22 insomnia patients (15 females, aged 49.9 years, SD = 17.6) and 19 normal sleeper controls (13 females, aged 30.9 years, SD = 8.9). For 14 consecutive evenings, participants rated how their prior night-time sleep impacted their participation in 12 common daytime activities (e.g., work, self-care, leisure). They also rated how much effort each activity required (Range: 0-4). Overall, insomnia patients participated in only one fewer activity type per day (M = 7.48, SD = 1.34) than controls (M = 8.39, SD = 1.43) (p = 0.041, d = 0.66). More noteworthy, they reported that sleep negatively affected their participation more than controls (M = 1.56, SD = 0.92 versus M = 0.23, SD = 0.35; p = < 0.001, d = 1.90), and that activities required more effort (M = 1.58, SD = 0.64 versus M = 0.81, SD = 0.76; p = 0.001, d = 1.10). This pilot study with the SIAD suggests that, compared to good sleepers, insomnia patients participate in somewhat fewer activities but that their activities require considerably more effort and are adversely affected by their sleep. The SIAD tool promises to provide a more comprehensive picture of the everyday impact of insomnia. It remains to be validated on a much larger sample in a clinical treatment study.

Economic evaluation of cognitive behavioural therapy for insomnia (CBT-I) for improving health outcomes in adult populations: A systematic review.

Cognitive behavioural therapy for insomnia (CBT-I) is a promising intervention with established efficacy, yet evidence of its cost-effectiveness remains unclear. Systematic searches were conducted in Medline, Psychinfo, ProQuest, Cochrane, Scopus, CINAHL, Web of Science and Emcare. Titles and abstracts were screened against eligibility criteria, and studies reporting full economic evaluations of CBT-I in adult populations were included and examined in detail. Study characteristics were extracted using a standardised template. Quantitative measures and relevant findings were summarised using a qualitative approach following recommended reporting standards. 1,168 non-duplicate articles were identified, of which 44 were selected for full-text review. Seven full economic evaluations of CBT-I in adult populations met the inclusion criteria and were incorporated in the final synthesis. Using the dominance ranking framework to compare cost and outcomes, CBT-I was cost-effective compared to pharmacotherapy or no treatment. The limited number of studies included in this review implies that caution should be exercised when interpreting these results. Future studies are encouraged to employ longer time-horizons and larger sample sizes to enable better determination of sustained cost and outcomes changes. Prospero registration number: CRD42019133554.

A preliminary assessment of the reliability and validity of a computerized working memory task.

The aim of the current study was to evaluate the psychometric properties of a recently developed measure of working memory: the Double Span Task. The Double Span Task is the first experimental task designed to assess all three components of Baddeley's (1992) model of working memory. The reliability of the Double Span Task was assessed in a sample of 105 older adults (M age = 64.3 yr., SD = 6.4). The internal consistency and test-retest reliability of the Double Span Task were good. The validity of the Double Span Task was assessed using a different sample of 49 older adults (M age = 70.0 yr., SD = 9.3). Performance on the Double Span Task was positively correlated with performance on a well-established measure of working memory, the Letter Number Sequencing Task. The Double Span Task also showed good discriminant validity. The Double Span Task is a reliable and valid measure of all three components of the working memory system.