Effect of CBT Intervention to Improve Sleep on Wellbeing, Dietary Intake and Food Preference

Effect of a Cognitive Behavioural Therapy Intervention to Improve Sleep on Wellbeing, Dietary Intake and Food Preference: a Feasibility Study.

The study aims to investigate the effects of Cognitive Behavioural therapy intervention on sleep and it's effects on well-being, dietary intake and food preferences during COVID-19. The study will investigate whether delivery of a CBT intervention will lead to an improvement in sleep quality and sleep duration and will consequently improve metabolic health. The participants will be randomized into two groups with one half in the intervention arm and the other in the control arm of the study.

Study Overview

• Status: Completed
• Conditions: Sleep; Diet; Well Being
• Intervention / Treatment: Behavioral: Cognitive Behavioural Therapy for Insomnia

Detailed Description

Reduced sleep duration and sleep quality have become increasingly important areas in the study and epidemiology of sleep and are linked with numerous health risks. The Centers for Disease Control and Prevention have found that in the last few years there has been a significant reduction in sleep duration in adults, with an average duration of <7 hours, with some suggestion that this can contribute to increased risk of obesity and type 2 diabetes.

Studies on sleep restriction have observed that even a single night of sleep deprivation leads to a reduction in insulin sensitivity and increases the prevalence of diabetes. Similarly shortened and/or poor-quality sleep has been found to cause dysregulation in ghrelin and leptin levels, which can increase energy intake and motivation to seek out foods with higher fat and sugar content. Although a wide range of research focuses on the effects of short sleep and its impact on health, few studies have focused on whether improving sleep can improve cardiometabolic outcomes.

Research has estimated that almost 30% of individuals suffer from insomnia or insomnia like symptoms. The most common method to combat this has been over-the-counter medication and hypnotics; however, there is very little evidence available on the efficacy of such treatments. Over the years, Cognitive Behavioural Therapy has been found to produce long term and significant results in individuals with insomnia. It has shown to significantly improve the various parameters of sleep such as sleep latency, wake after sleep onset, sleep efficiency and sleep quality. Studies on patients with primary insomnia have shown that those undergoing CBT treatment improve their sleep by an average of 6 hours and improve their sleep efficiency. Furthermore, those undergoing CBT have shown long term improvements with healthy circadian rhythms, regulated hormonal secretory patterns and blood glucose levels.

A research study on short sleep duration with an intervention consisting of behavioural consultations focusing on extending sleep found that extending sleep, through this intervention, reduced the intake of free sugars, fat, and carbohydrates. Since CBT requires minimal intervention, it could be considered as the ideal mode of therapy to improve sleep.

In the current scenario, with the significant effects of COVID-19 observed on morbidity, daily lifestyle behaviours, and mental health, an effective psychological intervention may help to improve both mental and physiological health. This study aims to investigate the effects of an intervention which improves sleep on metabolic health outcomes. Through this study, the investigators aim to test the feasibility of a CBT intervention in improving sleep in our target population consisting of overweight/obese adults reporting poor sleep and to further understand participants' experiences with the CBT to improve health and sleep outcomes during a pandemic.

The study is a randomized control trial where all participants will undergo the screening and baseline measurements. On completion of these procedures, the participants in the intervention group will undergo an 8-week session plan for 1 hour every week conducted online by a certified CBT-i trained psychologist. On completion of the study, all participants will be asked to undertake post-intervention measures.

• Study Type: Interventional
• Enrollment (Actual): 27
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United Kingdom
  • Glasgow, United Kingdom, G12 8QQ
    • University of Glasgow
  • Glasgow, United Kingdom, G12 8TA
    • University of Glasgow

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 25 years to 65 years (ADULT, OLDER_ADULT)
• Accepts Healthy Volunteers: Yes
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• BMI above 25kg/m2.
• Self-reported sleep of <7hrs (confirmed through actigraphy).
• A global score of >5 on the Pittsburgh Sleep Quality Index (PSQI)
• Participants on any kind of self-prescribed or over the counter medication for sleep, will be included in the study after a two-week interval for elimination drug from the system.

Exclusion Criteria:

• Presence of sleep-related disorders measured through the Sleep Disorder Symptoms Checklist (SDSCL-25)
• Any serious medical conditions which might influence sleep i.e. cardiovascular diseases, diabetes, cancer, respiratory disease, other than mild asthma.
• History of bariatric surgery.
• Taking any kind of prescribed hypnotics or sleep medication
• Taking any kind of medication which might affect appetite
• Participating in any kind of dietary and/or weight loss programs
• Taking Antidepressants
• Substance or alcohol abuse
• Shift work
• Currently having to wake up at night to care for another person
• Suffering from and/or receiving treatment for a mental health conditions or sleep apnea.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: TREATMENT
• Allocation: RANDOMIZED
• Interventional Model: PARALLEL
• Masking: SINGLE

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
EXPERIMENTAL: CBT-I Group; Participants in the CBT-I group will undertake weekly sessions for a duration of 8 weeks with a trained psychologist through Zoom or Skype Calls.	Behavioral: Cognitive Behavioural Therapy for Insomnia; Weekly CBTI training
NO_INTERVENTION: Control group; The control group will be asked to maintain the usual lifestyle for the duration of the study

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Sleep Duration	Change in accelerometer measured total sleep time	0-12 weeks

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Sleep Efficiency	Changes in Accelerometer measured sleep efficiency	0-12 weeks
Sleep Latency	Changes in Accelerometer measured sleep latency	0-12 weeks
Total Sleep Time	Changes in Accelerometer measured Total sleep Time	0-12 weeks
Total Time in Bed	Changes in Accelerometer measured Total time in bed	0-12 weeks
Wake After Sleep Onset	Changes in Accelerometer measured Wake after sleep onset	0-12 weeks
Subjective Sleep Quality	Changes in subjective sleep quality measured by The Pittsburgh Sleep Quality Index	0-12 weeks
Sleep Disturbances	Changes in sleep disturbances measured by The Pittsburgh Sleep Quality Index	0-12 weeks
Use of Sleeping Medication	Changes in use of sleeping medication measured by The Pittsburgh Sleep Quality Index	0-12 weeks
Daytime Dysfunction	Changes in daytime dysfunction measured by The Pittsburgh Sleep Quality Index	0-12 weeks
Habitual Sleep Efficiency	Changes in habitual sleep efficiency measured by The Pittsburgh Sleep Quality Index	0-12 weeks
Sleep Duration (self-reported)	Changes in sleep duration measured by The Pittsburgh Sleep Quality Index	0-12 weeks
Excessive Daytime Sleepiness	Changes in excessive daytime sleepiness measured by the Epworth Sleepiness Scale Scale range: Would never nod off 0 Slight chance of nodding off 1 Moderate chance of nodding off 2 High chance of nodding off 3 Scoring Interpretation: Minumum score is 0 and maximum score is 24. 0-5 - Lower Normal Daytime Sleepiness 6-10 - Higher Normal Daytime Sleepiness 11-12 - Mild Excessive Daytime Sleepiness 13-15 - Moderate Excessive Daytime Sleepiness 16-24 - Severe Excessive Daytime Sleepiness	0-12 weeks
Mental Well-being	Changes in cognitive, affective and social dimensions of mental health measured by the Warwick-Edinburgh Mental Well-being Scale Scale range: None of the time 1 Rarely 2 Some of the time 3 Often 4 All of the time 5 Scoring Interpretation: The minimum score is 14 and maximum score is 70. The higher the scores indicate a greater positive mental wellbeing.	0-12 weeks
Depression	Changes in depressive symptoms measured by the Patient Health Questionnaire-9 Scale range: Not at all 0 Several days 1 More than half the days 2 Nearly every day 3 Scoring Interpretation: The minimum score is 0 and maximum score is 20. 0-5 - mild 6-10 - moderate 11-15 - moderately severe 16-20 - severe depression	0-12 weeks
Anxiety	Changes in anxiety measured by the Generalized Anxiety Disorder-7 Scale range: Not at all 0 Several days 1 More than half the days 2 Nearly every day 3 Scoring Interpretation: The minimum score is 0 and maximum score is 21. 0-5 mild 6-10 moderate 11-15 moderately severe anxiety 15-21 severe anxiety.	0-12 weeks
Food preference	Changes in explicit liking and explicit wanting measured by the Leeds Food Preference Questionnaire Scale range: The computerized asessment includes a 100mm visual analogue scale and at the end of the response item participants will be asked: "How much do you want some of this food now? Scoring: The minimum score for VAS scale is 0 and maximum is 100. Scores are recorded and converted in to mean scores for high fat, low fat, sweet or savoury food types and different fat-taste combinations.	0-12 weeks
Food reward	Changes in implicit wanting and food choice measured by the Leeds Food Preference Questionnaire Scale range: The computerized asessment where participants are presented with two images and they choose which they like. Scoring: Reaction time for each answer is recorded and converted in to mean scores for high fat, low fat, sweet or savoury food types and different fat-taste combinations.	0-12 weeks
Food cravings	Changes in craving control, craving for sweet, craving for savoury and positive mood measured by the Control of Eating Questionnaire Scale range: The asessment includes a 20 items with a 10 point scale ranging from "not at all" to "extremely" and 1 item with free text answer. Scoring: The minimum score for VAS scale is 0 and maximum is 100. The sum of items were calculated and divide by number of items in the subscale. Higher the score indicates higher cravings. Positive mood subscales and Craving Control subscales the scores were reversed, so great score indicated greater level of positve mood and craving control.	0-12 weeks
Dietary Intake	Changes in 24 hour food recall measured by the Myfood24 food diary	0-12 weeks

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Anthropometric Measures	Changes in self reported weight	0-12 weeks
Anthropometric measures	Changes in self reported BMI	0-12 weeks
Participant Interviews	Participant feedback and information provided through interviews	0-12 weeks

Collaborators and Investigators

• Sponsor: University of Glasgow

Study record dates

Study Major Dates

• Study Start (ACTUAL): October 16, 2020
• Primary Completion (ACTUAL): December 1, 2021
• Study Completion (ACTUAL): May 9, 2022

Study Registration Dates

• First Submitted: September 29, 2020
• First Submitted That Met QC Criteria: September 29, 2020
• First Posted (ACTUAL): October 6, 2020

Study Record Updates

• Last Update Posted (ACTUAL): August 29, 2022
• Last Update Submitted That Met QC Criteria: August 26, 2022
• Last Verified: August 1, 2022

More Information

Terms related to this study

• Keywords: Well being; Sleep Quality; Cognitive Behavioural Therapy; Sleep deprivation; Dietary intake; Cognitive Behavioural Therapy for Insomnia; CBTi; Sleep Extension
• Other Study ID Numbers: 200190177

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No