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

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

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.

Keywords: Cognitive behavioural therapy for insomnia; Insomnia; Occupational health services; Self-help; Shift work; Shift work disorder; Sleep hygiene education.

Conflict of interest statement

Author Heli Järnefelt has received a grant from The Association of Finnish Non-fiction Writers. Author Kari-Pekka Martimo has received speaker honorariums from pharmaceutical companies Lundbeck and Pfizer. The other authors have nothing to disclose.

Figures

Fig. 1
Fig. 1
Participant flowchart

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