Investigating the Effectiveness of a Sleep Intervention Among Psychiatric Patients.

This study aims to implement a brief sleep intervention (Cognitive Behavioural Therapy for Insomnia (CBT-I)) adapted for suitability with psychiatric hospital inpatients, evaluating the effectiveness of this intervention in both the reduction of insomnia symptom severity and suicidal ideation. CBT-I components aim to address the perpetuating factors contributing to the development and maintenance of chronic insomnia. The program will cover both cognitive (i.e., cognitive therapy) and behavioural components (i.e., stimulus control therapy), relaxation techniques, sleep hygiene and psychoeducation. Stimulus control therapy aims to re-associate the bed with sleep, rather than wakefulness or anxiety. This process occurs through minimising the use of the bed for activities other than sleep, and only going to bed when an individual feels sleepiness. The standard 'sleep restriction therapy' component of CBT-I will be removed. Additional adaptations made to a standard CBT-I program were guided by the literature on CBT-I considerations for specific comorbidities, such as schizophrenia or bipolar disorder. The therapy session plans are outlined below: Session 1: Introduction to CBT-I, psychoeducation about sleep and chronic insomnia, stimulus control therapy (termed Bed Equals Sleep Therapy (BEST)), sleep diary introduction. Session 2: Addressing barriers to BEST, psychoeducation (three physiological factors that control sleep), sleep hygiene. Session 3: Psychoeducation (the cycle of insomnia), relaxation techniques (progressive muscle relaxation activity), cognitive therapy (cognitive restructuring for unhelpful beliefs around sleep). Session 4: Cognitive re-focusing (strategy), scheduled constructive worry time (strategy), program recap, self-management after discharge. The program will be delivered to patients during admission to a voluntary, 100-bed mental health hospital in Perth, Western Australia. The intervention will be run in face-to-face group therapy sessions across four days (two days per week, for two weeks). Each session will last for approximately 90 minutes. In terms of therapy materials, a handout will be provided to participants during each CBT-I session. These handouts, which were designed specifically for this study, reiterate important information from the session for future reference. Groups will comprise of between 8 to 10 patients. All sessions will be delivered by trained clinical staff, with qualifications as registered psychologists or occupational therapists specialised in mental health. Clinicians will maintain an attendance register. This brief program is designed to require minimal homework beyond a sleep diary and stimulus control therapy (due to patients’ involvement in multiple other therapy groups during admission). Thus, the completion of sleep diaries will be logged by therapists to monitor treatment adherence (e.g. stimulus control therapy, maintaining consistent wake-up times). Intervention fidelity will be monitored using a session checklist, with therapists reporting any CBT-I components that were not delivered (e.g., due to time constraints).