The Sleep Course: a randomised controlled trial of an online transdiagnostic sleep intervention for adults with sleep difficulties

The intervention, the Sleep Course, is an internet-delivered self-management program. It runs for 6 weeks and consists of: (a) 4 online lessons with exercises for learning the information and skills. The duration of each lesson is approximately 20 to 30 minutes. Lessons are completed in weeks 1, 2, 4, and 5. Lessons can be viewed in the online platform or downloaded as PDF files. Lessons are accompanied by lesson worksheets which can be downloaded and/or printed as PDF files. Participants are encouraged to engage with the home-based exercises at a frequency and duration that is helpful for them, though a suggested time commitment of at least 30 minutes each week is encouraged. The first lesson (in week 1) is an introduction to the course and overview of the key processes that govern sleep-wake cycles. This includes the circadian rhythm (or body clock) and the sleep pressure system. Participants are encouraged to consider the relevance of these two systems for their unique situation as a home-based exercise. Lesson 2 (week 2) introduces two key behavioural methods to improve sleep – stimulus control and sleep restriction therapy. Participants are also provided with a decision-making tool to determine which strategy they may use. As home-based exercise, participants are encourage to start practicing one of these skills for the next two weeks. Lesson 3 (week 4) introduces the cognitive behavioural model, and explores how thinking processes and appraisals can influence sleep. For their home-based exercises, participants are encouraged to practice cognitive challenging skills. Finally, Lesson 4 (week 5) introduces strategies to manage sleep difficulties during the day. It covers the importance of helpful daytime habits to promote sleep at night, including overcoming sleep inertia, remaining active during the day, and implementing a wind-down routine. Participants are encouraged to experiment with symptoms of fatigue as home-based work, as well as to introduce wake-up and wind-down routines. (b) Automatic emails that help guide people through the course. Examples of these e-mails include; reminders when new lessons are available, congratulatory messages once a lesson has been completed, brief messages that reinforce the core concepts of the lessons, and e-mails inviting contact and encouraging engagement if a participant has not logged in for a while. E-mails are sent approximately once per week. (c) Additional Resources developed specifically for this study. These resources provide information about different problems relevant to people with sleep difficulties. These include managing shift-work, information about nightmares, and managing worry and rumination. The additional resources are made available on the course homepage for download. Participants will also have the option of support from a psychologist as they work through the course, either via telephone or secure personal messaging. Course psychologists will contact participants via secure message in the first week of the course, to obtain participant preferences regarding the frequency and nature of contact. After this point, psychologists will tailor their communication to the participants' preferences. All psychologists will be nationally registered and employed by Macquarie University or one of its entities (e.g., MQ Health). All psychologists will be provided with training and supervision from a senior psychologist to ensure competence and safety in their practice. Adherence with the intervention is monitored via the study's secure web platform, which records information such as; the number of participant log-ins, lesson completions; time spent completing each lesson; and number of downloads of additional resources. A second group will be randomised to a minimal intervention waitlist control (MIWLC) group. Participants in the MIWLC condition will receive brief psychoeducational materials in the first week of the course only. These are purpose-built psychoeducational materials that cover information similar to that in Lesson 1 of the course (information about the circadian rhythm and the sleep pressure system, and brief sleep hygiene tips.) The materials are delivered within the course webpage, as lessons that can be viewed online and downloaded. Participants in the MIWLC will be offered access to the full intervention after 8 weeks.