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Leonie F Maurer, Colin A Espie, Ximena Omlin, Simon D Kyle, 0385 Daytime Impairment during Sleep Restriction Therapy for Insomnia: Results from a Randomised-Controlled Trial, Sleep, Volume 42, Issue Supplement_1, April 2019, Page A156, https://doi.org/10.1093/sleep/zsz067.384
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Abstract
Preliminary work suggests that Sleep Restriction Therapy (SRT) for insomnia may be associated with daytime symptom exacerbation (Kyle, 2011; Miller, 2013), however no study has assessed this possibility within the context of a rigorously-controlled trial. Here we profiled sleepiness and affect on a daily basis pre and post randomisation to either SRT or a specific factors component control arm called Bedtime Consistency Therapy (BCT).
Fifty-three participants (16 male, mean age = 41.13 ± 8.95) with insomnia disorder were randomised to SRT (n = 25) or BCT (n = 28). Treatment arms were matched for therapist time and number of sessions. During baseline (2 weeks) and treatment (4 weeks), participants completed daily assessments of sleepiness and positive and negative affect. Linear mixed-model analyses were conducted with fixed effects of time (baseline = week 1-2; early treatment = week 3-4; late treatment = week 5-6) and group (SRT vs. BCT). Random effects were run to account for between-subject variation.
Significant time x group interaction effects were observed for all measurements (p < .005). In the SRT group, pairwise comparison between time points revealed a significant increase in both evening and morning sleepiness (from baseline to early and late treatment, p < .0001). Moreover, negative affect increased significantly from baseline to late treatment (p < .01), while positive affect decreased from baseline to early and late treatment (p < .0001). In contrast, the BCT group showed no change in evening sleepiness or positive affect, an increase in morning sleepiness (baseline vs early treatment, p < .05) and a decrease in negative affect (baseline vs early treatment, p < .05).
Conclusion: Our results show that the introduction of SRT is associated with increased sleepiness and negative affect, and reduced positive affect relative to a robust control arm. This work may have important implications for the clinical implementation of SRT.
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