Developing Sleepful

Sleepful has been developed through research supported by the Clinical Sleep Research Unit at Loughborough University. The following studies and trials have directly influenced the content and approach used in the programme.

Morgan, K., Dixon, S., Mathers, N., Thompson, J., & Tomeny, M. (2004). Psychological treatment for insomnia in the regulation of long-term hypnotic drug use. Health Technology Assessment, 8(8).

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Morgan K, Dixon S, Mathers N, Thompson J, Tomeny M. Psychological treatment for insomnia in the management of long-term hypnotic drug use in general practice: a pragmatic randomised controlled trial. British Journal of General Practice 2003; 53: 923-928.

Kyle S.D., Espie C.A., Morgan K. (2011) No Pain, No Gain: An Exploratory Within-Subjects Mixed-Methods Evaluation of the Patient Experience of Sleep Restriction Therapy (SRT). Sleep Medicine, 12(8), 735-747

Morgan, K., Gregory, P., Tomeny, M., David, B. M., & Gascoigne, C. (2012). Self-Help Treatment for Insomnia Symptoms Associated with Chronic Conditions in Older Adults: A Randomized Controlled Trial. Journal of the American Geriatrics Society, 60(10), 1803-1810.

Middlemass, J., Davy, Z., Cavanagh, K., Linehan, C., Morgan, K., Lawson, S., et al. (2012). Integrating online communities and social networks with computerised treatment for insomnia: a qualitative study. British Journal of General Practice, 62(605).

Lawson, S., Jamison-Powell, S., Garbett, A., Linehan, C., Kucharczyk, E., Verbann, S., Rowland, D. & Morgan, K (2013). Validating a mobile phone application for the everyday, unobtrusive, objective measurement of sleep. CHI2012: Proceedings of the 30th annual CHI conference on human factors in computing systems; 2013: 2497-2506.

Perlis, M. L., Zee, J., Swinkels, C., Kloss, J., Morgan, K., David, B., et al. (2014). The incidence and temporal patterning of insomnia: a second study. Journal of Sleep Research, 23(5), 499-507.

Hartescu, I., Morgan, K., & Stevinson, C. D. (2015). Increased physical activity improves sleep and mood outcomes in inactive people with insomnia: a randomized controlled trial. Journal of Sleep Research, 24(5), 526-534.

Research supporting CBT-I

Cognitive Behavioural Therapy for Insomnia (CBT-I), delivered as face-to-face, manualised self-help, or online therapy is clinically effective in the treatment of insomnia disorder and comorbid insomnias. Evidence supporting these conclusions is summarised in the following academic reviews.

Morin, C. M., Hauri, P. J., Espie, C. A., Spielman, A. J., Buysse, D. J., & Bootzin, R. R. (1999). Nonpharmacologic treatment of chronic insomnia. Sleep, 22(8), 1134-1156.

Morin, C. M., Bootzin, R. R., Buysse, D. J., Edinger, J. D., Espie, C. A., & Lichstein, K. L. (2006). Psychological and behavioral treatment of insomnia: Update of the recent evidence (1998-2004). Sleep, 29(11), 1398-1414.

Miller, C. B., Espie, C. A., Epstein, D. R., Friedman, L., Morin, C. M., Pigeon, W. R., et al. (2014). The evidence base of sleep restriction therapy for treating insomnia disorder. Sleep Medicine Reviews, 18(5), 415-424.

Ho, F. Y. Y., Chung, K. F., Yeung, W. F., Ng, T. H., Kwan, K. S., Yung, K. P., et al. (2015). Self-help cognitive-behavioral therapy for insomnia: A meta-analysis of randomized controlled trials. Sleep Medicine Reviews, 19, 17-28.

Wu, J. Q., Appleman, E. R., Salazar, R. D., & Ong, J. C. (2015). Cognitive Behavioral Therapy for Insomnia Comorbid With Psychiatric and Medical Conditions A Meta-analysis. Jama Internal Medicine, 175(9), 1461-1472.

Kay-Stacey, M., & Attarian, H. (2016). Advances in the management of chronic insomnia. BMJ - British Medical Journal, 354. (Article Number: i2123; DOI: 10.1136/bmj.i2123)

Ye, Y. Y., Chen, N. K., Chen, J., Liu, J., Lin, L., Liu, Y. Z., et al. (2016). Internet-based cognitive-behavioural therapy for insomnia (ICBT-i): a meta-analysis of randomised controlled trials. Bmj Open, 6(11).

Seyffert, M., Lagisetty, P., Landgraf, J., Chopra, V., Pfeiffer, P. N., Conte, M. L., et al. (2016). Internet-Delivered Cognitive Behavioral Therapy to Treat Insomnia: A Systematic Review and Meta-Analysis. Plos One, 11(2).

Clinical Guidance

Clinical guidance internationally supports the use of CBT-I as the first-line treatment for chronic insomnia. Guidance published for the US, the UK and Australia is cited below.

The US National Institutes of Health State-of-the-Science Conference Statement on manifestations and management of chronic insomnia in adults (2008) concluded that "evidence supports the efficacy of cognitive-behavioral therapy and benzodiazepine receptor agonist" in the treatment of chronic insomnia. However, the report also emphasised adverse effects associated with hypnotic medications (including "residual daytime sedation, cognitive impairment, motor incoordination, dependence, and rebound insomnia") adding that "These problems appear to be worse in the elderly."

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A more recent guideline from the American College of Physicians recommends that "all adult patients receive cognitive behavioral therapy for insomnia (CBT-I) as the initial treatment for chronic insomnia disorder". (Qaseem, A., Kansagara, D., Forciea, M. A., Cooke, M., Denberg, T. D., & Clinical Guidelines Comm, A. (2016). Management of Chronic Insomnia Disorder in Adults: A Clinical Practice Guideline From the American College of Physicians. Annals of Internal Medicine, 165(2), 125-).

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UK clinical guidance offered by the National Institute for Health and Care Excellence (NICE) through Clinical Knowledge Summaries (CKS) emphasises that Cognitive Behavioural Therapy for Insomnia is "widely recommended for the treatment of long-term [>4 weeks] insomnia", and recommends cognitive-behavioural approaches as the first-line treatment.

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Guidance on the treatment of insomnia from the Royal Australian College of General Practitioners states "Cognitive behavioural therapy (CBT) based treatment packages for chronic insomnia, including sleep restriction and stimulus control, are effective and therefore should be offered to patients as first-line treatment."

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The Sleep Assessment

The sleep assessment accessed via the Sleepful landing page is based on the two validated questionnaires cited below. The feedback messages generated by Sleepful are linked to the score-ranges reported in these papers.

  • The Insomnia Severity Index

Bastien, C. H., Vallieres, A., & Morin, C. M. (2001). Validation of the Insomnia Severity Index as an outcome measure for insomnia research. Sleep Medicine, 2(4), 297-307.

  • The STOP-Bang Questionnaire

Chung, F., Yegneswaran, B., Liao, P., Chung, S. A., Vairavanathan, S., Islam, S., et al. (2008). STOP questionnaire - A tool to screen patients for obstructive sleep apnea. Anesthesiology, 108(5), 812-821.

Chung, F., Yang, Y. L., & Brown, R. (2014). Alternative Scoring Models of STOP-Bang Questionnaire Improve Specificity To Detect Undiagnosed Obstructive Sleep Apnea. Journal of Clinical Sleep Medicine, 10(9), 951-958.