The impact of thought processes on sleep outcomes in adults aged 60 - 80 years

This study will examine sleep quality in adults aged 60 - 80 years residing in Western Australia. It will investigate whether cognitive or thought processes influence treatment outcomes of online CBTi in individuals with synchronous and asynchronous sleep pattern and sleep appraisal. Participants will be asked to complete an online questionnaire battery using Qualtrics software examining their sleep related beliefs and self-rated sleep quality, including Dysfunctional Beliefs and Attitudes about Sleep (DBAS-16) (Morin, Vallières, & Ivers, 2007), Pittsburgh Sleep Quality Index (PSQI)(Buysee, Reynolds, Monk, Berman, & Kupfer, 1989), Insomnia Severity Index (ISI) (Morin, 1993; Morin, Belleville, Bélanger, & Ivers, 2011), Depression, Anxiety and Stress Scale – 21 (DASS-21) (Lovibond & Lovibond, 1995), Glasgow Sleep Effort Scale (GSES) (Broomfield & Espie, 2005), Self-Efficacy for Sleep Scale (SE-S) (Lacks, 1987), Sleep Locus of Control Scale (SLOC) (Vincent, Sande, Read, & Giannuzzi, 2004), Pre-Sleep Arousal Scale (PSAS) (Nicassio, Mendlowitz, Fussell, & Petras, 1985, Morningness-Eveningness questionnaire (MEQ) (Horne & Ostberg, 1976), Treatment Acceptability Questionnaire (TAQ) (Hunsley, 1992) and the Sleep-Related Behaviours Questionnaire (SRBQ) (Ree & Harvey, 2004). In addition, participants will wear an actigraph (ActiGraph wGT3x-BT) and complete a sleep diary over 96 hours (72 hours plus an additional 24 hours to account for wear time non-adherence). The actigraphs will be posted by the PI and collected by courier at a time convenient for the participant. Participants will be considered poor sleepers if they have sleep-onset-latency or wake-after-sleep-onset of equal or more than 31 minutes at least once during the recording period, and will be considered complaining sleepers if they report having had a sleep problem (e.g. trouble falling asleep) for a minimum of six months. Based on their actigraphy results and sleep complaint status (complaining vs non-complaining sleepers), participants will be grouped into four sleep groups: non-complaining good sleepers (NG), complaining good sleepers (CG), non-complaining poor sleepers (NP), and complaining poor sleepers (CP). All groups will be asked to complete a four-session online CBTi sleep intervention, with NG providing the control group. Following the baseline assessment including recording of demographic information and sleep complaint, administration of the questionnaires, and actigraphy measurement, all groups (NG, CG, NP and CP) will receive the online CBTi instructions and a link to the online CBTi website. The programme consists of four lessons in a comic-based format. Participants will be asked to complete the four sessions (plus homework) of the online CBTi programme within four weeks (one session each week). Each session will take a minimum of twenty minutes to complete. Lesson one provides some background knowledge about sleep and insomnia and which factors are conducive to good sleep and which to insomnia. Lesson two & three address the management of thought and behaviours that interfere with sleep, and lesson four focusses on relaxation techniques. Since progress cannot be monitored directly, participants will receive weekly email reminders from the PI (via telephone) to confirm completion of each of the four online CBTi modules. Once the completion of the online CBTi programme has been confirmed with the participant, actigraphy, sleep diary and questionnaire measurements will be repeated post-treatment.