Disseminating cognitive behavioural therapy (CBT) for insomnia at scale: capitalising on the potential of digital CBT to deliver clinical guideline care

Journal of Sleep Research, Journal Year: 2023, Volume and Issue: 32(6)

Published: Aug. 29, 2023

Summary Cognitive behavioural therapy (CBT) is the recommended first‐line treatment for insomnia. However, guideline care very seldom available and most patients receive no treatment, or less effective second‐line pharmacotherapy sleep hygiene, neither of which are evidence‐based chronic The primary challenge CBT has been supply. There not enough therapists to meet enormous demand. We must accelerate clinician training, but this approach can never be sufficient, even with abbreviated, efficient therapies. Fortunately, however, landscape also changed dramatically. Fully‐automated digital (dCBT) emerged as a safe, effective, scalable delivery format. dCBT software only, so it disseminated readily widely medication. Moreover, integrated into services. Just medications delivered through health professionals systems, approved programmes same. an ecosystem psychologically‐based should necessitate medical prescription model. Our proposed stepped framework, comprises both population clinical service initiatives, enabling universal access diverse ways in may (in‐person, face‐to‐face, using telehealth, group therapy, digitally) operate congruently efficiently optimise people at all levels complexity need. With safe clinically products now set become established treatments, clearly differentiated from wellness apps, there potential rapidly transform insomnia services and, first time, deliver international scale.

Language: Английский

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Improving sleep after stroke: A randomised controlled trial of digital cognitive behavioural therapy for insomnia

Journal of Sleep Research, Journal Year: 2023, Volume and Issue: 33(2)

Published: July 5, 2023

Stroke is frequently accompanied by long-term sleep disruption. We therefore aimed to assess the efficacy of digital cognitive behavioural therapy for insomnia improve after stroke. A parallel group randomised controlled trial was conducted remotely in participant's homes/online. Randomisation online with minimisation between-group differences age and baseline Sleep Condition Indicator-8 score. In total, 86 community-dwelling stroke survivors consented, whom 84 completed assessments (39 female, mean 5.5 years post-stroke, 59 old), were or control (sleep hygiene information). Follow-up at post-intervention (mean 75 days baseline) 8 weeks later. The primary outcome self-reported symptoms, as per (range 0-32, lower numbers indicate more severe insomnia, reliable change 7 points) post-intervention. There significant improvements compared (intention-to-treat, n = 48, 36, 5 imputed datasets, effect p ≤ 0.02,

Language: Английский

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Sleep Following a Stroke: Multimodal Evaluation of Sleep Health and Disruptions and Impact on Recovery During Acute Inpatient Rehabilitation

Neurorehabilitation and neural repair, Journal Year: 2025, Volume and Issue: unknown

Published: May 6, 2025

Background Our understanding of sleep during early stroke care and its impact on rehabilitation outcomes remains limited. The objectives this work were to (1) evaluate multidimensional health disruptions acute inpatient for individuals with stroke, (2) explore the relationship between health/disruptions functional recovery. Methods Data from 103 analyzed rehabilitation. Sleep assessed via patient reports, actigraphy, biometric sensors. Functional measured at admission discharge. Generalized Linear Models (GLMs) used describe changes in over time, multivariate regressions sleep-related predictors Results Over stays, improved a 23% reduction wake after onset 15% fewer multiple overnight disruptions. GLMs revealed that quality was associated reduced activity increased heart rate time. Poor initial cognitive status more Lastly, minimal associations found Conclusions is generally poor, though improves affected by neurological recovery hospital environment. Overnight autonomic biomarkers perceived health, both physiological environmental factors triggered association indirect indicators requires further investigation. These findings reveal new insights about which can inform early, targeted interventions optimize post-stroke outcomes. SIESTA, ClinicalTrials.gov (NCT04254484).

Language: Английский

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Analyzing metaverse-based digital therapies, their effectiveness, and potential risks in mental healthcare

Scientific Reports, Journal Year: 2025, Volume and Issue: 15(1)

Published: May 16, 2025

The metaverse, defined as a collective virtual shared space created by the convergence of augmented reality (AR), (VR), and Internet, offers new opportunities for mental healthcare delivering immersive engaging digital therapies. This study examines current landscape metaverse-based applications, analyzing their effectiveness potential risks. Using systematic literature review (SLR) case research, four therapeutic applications-NightWare, Freespira, EndeavorRx, Sleepio-were evaluated ability to address conditions such PTSD, anxiety, ADHD. results indicate that therapies can provide significant benefits, with clinical validation supporting effectiveness. However, concerns around user privacy, accessibility, long-term efficacy remain challenges. Overall, represent promising shift in healthcare, offering innovative, personalized, scalable solutions. Further research is needed ethical issues, improve confirm impact these interventions.

Language: Английский

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Sleep disorders as both risk factors for, and a consequence of, stroke: A narrative review

International Journal of Stroke, Journal Year: 2023, Volume and Issue: 19(5), P. 490 - 498

Published: Oct. 27, 2023

Background and purpose: Sleep disorders are increasingly implicated as risk factors for stroke, well a determinant of stroke outcome. They can also occur secondary to the itself. In this review, we describe variety different sleep associated with analyze their effect on Methods: A search term-based literature review (“sleep,” “insomnia,” “narcolepsy,” “restless legs syndrome,” “periodic limb movements during sleep,” “excessive daytime sleepiness” AND “stroke” OR “cerebrovascular” in PubMed; “sleep” ClinicalTrials.gov) was performed. English articles from 1990 March 2023 were considered. Results: Increasing evidence suggests that stroke. addition, disturbance has been reported half all sufferers; specifically, an increase is not only sleep-related breathing but periodic sleep, narcolepsy, rapid eye movement (REM) behavior disorder, insomnia, duration, circadian rhythm sleep–wake disorders. Poststroke worse Conclusion: common consequence Recent guidelines suggest screening after It possible treatment could both reduce improve outcome, although further data clinical trials required.

Language: Английский

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Is cognitive behavioral therapy for insomnia more cost-effective? New-perspective on economic evaluations: a systematic review and meta-analysis

SLEEP, Journal Year: 2024, Volume and Issue: 47(8)

Published: May 25, 2024

To investigate the cost-effectiveness of cognitive behavioral therapy for insomnia (CBTI), with an additional focus on digital CBTI (dCBTI) in adults insomnia. We searched eight electronic databases economic evaluations CBTI: PubMed, Scopus, Web Science, psycINFO, Cochrane, Library, CINAHL, ProQuest, and National Health Service Economic Evaluation Database. Meta-analyses were performed to effects costs between control groups (no treatment, other treatments included hygiene education treatment as usual). Subgroup analyses dCBTI conducted. Twelve randomized controlled trial studies 2004 2023 our systematic review meta-analyses. The incremental cost-utility ratios showed that more cost-effective than controls, from healthcare perspective societal perspective, respectively. Compared demonstrated significantly better efficacy within 12 months. Healthcare higher compared controls 6 months but there was no difference at Additionally, associated lower presenteeism Our findings suggest is or It may bring benefits long term, especially long-lasting cost reduction. In addition, one options CRD42 022 383 440. www.crd.york.ac.uk/PROSPERO. Cost-effectiveness (CBTI): a meta-analysis.

Language: Английский

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Improving sleep and learning in rehabilitation after stroke, part 2 (INSPIRES2): study protocol for a home-based randomised control trial of digital cognitive behavioural therapy (dCBT) for insomnia

BMJ Open, Journal Year: 2023, Volume and Issue: 13(4), P. e071764 - e071764

Published: April 1, 2023

Consolidation of motor skill learning, a key component rehabilitation post-stroke, is known to be sleep dependent. However, disrupted highly prevalent after stroke and often associated with poor recovery quality life. Previous research has shown that digital cognitive behavioural therapy (dCBT) for insomnia can effective at improving stroke. Therefore, the aim this trial evaluate potential improvement using dCBT programme, improve outcomes We will conduct parallel-arm randomised controlled (Sleepio) versus treatment as usual among individuals following affecting upper limb. Up 100 participants randomly allocated (2:1) into either intervention (6-8 week dCBT) or control (continued usual) group. The primary outcome study change in symptoms pre post compared usual. Secondary include overnight memory consolidation measures between groups, correlations changes behaviour group depression fatigue groups. Analysis covariance models used analyse data from secondary outcomes. received approval National Research Ethics Service (22/EM/0080), Health Authority (HRA) Care Wales (HCRW), IRAS ID: 306 291. results disseminated via presentations scientific conferences, peer-reviewed publication, public engagement events, stakeholder organisations other forms media where appropriate. NCT05511285.

Language: Английский

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Focus on insomnia, nightmares and mental health

Journal of Sleep Research, Journal Year: 2024, Volume and Issue: 33(2)

Published: Feb. 21, 2024

Dear members of the ESRS, readers JSR, In this issue we have a focus on insomnia, nightmares and mental health. Nevertheless, also other areas sleep medicine research are covered: few articles deal with disordered breathing, neurology is covered, one article relates to dreaming animal some others age, in children adolescents. Let me highlight for you: Pahari et al. (2024) investigated whether reaction time psychomotor vigilance related hypoxic load patients apnea. To end 855 (473 males, 382 females) suspected OSA who underwent overnight polysomnography task (PVT) were studied. By means sophisticated analysis it turned out that severity intermittent hypoxaemia was strongly associated longer times males but not females. On hand arousal index had strongest association PVT results Thus, authors conclude impact impaired seems be stronger than Fleming studied randomized controlled trial digital cognitive behavioral therapy insomnia might improved after stroke through therapeutic intervention. The performed parallel group conducted remotely participants' homes online. 86 community-dwelling survivors took part study, 84 completed baseline assessments either or control condition. Follow-ups contacted as well. Primary outcomes self-reported symptoms Sleep Condition Indicator. It there significant improvements Indicator compared Furthermore respect secondary shorter sleep-onset latencies better mood treatment. Cost-effectiveness demonstrated intervention superior control. No serious events occurred. further should test made accessible large samples post-stroke order improve their sleep. Šonka longitudinal study idiopathic hypersomnia. Sixty diagnosed hypersomnia ≥3 years ago center. Mean duration follow-up almost 10 years. 83% reported persistent hypersomnia, only 55% no disease could explain excessive daytime sleepiness prolonged A complete resolution hypersomnolence without stimulant treatment lasting 6 months rated 17%. So initially presented change typical picture. Saner effects restriction (with high-intensity exercise) alertness young healthy males. 24 matched into three, 5-night interventions: normal sleep, down less four hours exercise. average, despite previously findings, exercise did positive detriments mood, wellness, alertness.

Language: Английский

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Chinese herbal medicine and acupuncture for insomnia in stroke patients: A systematic review and meta-analysis of randomised controlled trials

Sleep Medicine, Journal Year: 2024, Volume and Issue: 120, P. 65 - 84

Published: May 12, 2024

Insomnia is highly prevalent in stroke patients; however, there no ideal intervention. This systematic review examined the effect and safety of Chinese herbal medicine (CHM) acupuncture on sleep adults with stroke.

Language: Английский

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Sleep and motor learning in stroke (SMiLES): a longitudinal study investigating sleep-dependent consolidation of motor sequence learning in the context of recovery after stroke

BMJ Open, Journal Year: 2024, Volume and Issue: 14(2), P. e077442 - e077442

Published: Feb. 1, 2024

There is growing evidence that sleep disrupted after stroke, with worse relating to poorer motor outcomes. It also widely acknowledged consolidation of learning, a critical component poststroke recovery, sleep-dependent. However, whether the relationship between and poor outcomes stroke related direct interference sleep-dependent processes, currently unknown. Therefore, aim present study understand measures mediate clinical post stroke. We will conduct longitudinal observational up 150 participants diagnosed affecting upper limb. Participants be recruited assessed within 7 days their followed at approximately 1 6 months. The primary objective determine in subacute phase recovery explains variability limb (over above predicted potential from Predict Recovery Potential algorithm) this dependent on learning. test mediates whole-body outcomes, associated specific electrophysiological signals alterations during recovery. This trial has received both Health Research Authority, Care Wales National Ethics Service approval (IRAS: 304135; REC: 22/LO/0353). results help enhance our understanding role function disseminated via presentations scientific conferences, peer-reviewed publication, public engagement events, stakeholder organisations other forms media where appropriate. ClinicalTrials.gov: NCT05746260, registered 27 February 2023.

Language: Английский

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