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A138
SLEEP, Volume 40, Abstract Supplement, 2017
aimed to determine whether the effectiveness of CBTi is reduced in the
presence of mild, or moderate-severe co-morbid obstructive sleep apnea.
Methods: A retrospective chart review was conducted to examine 455
insomnia patients entering a CBTi treatment program in a hospital out-
patient setting. Of these 455, 314 patients were diagnosed with insom-
nia-alone, 103 were found also to have mild sleep apnea, and 38 also
had moderate or severe OSA. Improvements in sleep diary parameters,
the Insomnia Severity Index, and several daytime functioning ques-
tionnaires from baseline, to post-treatment, to 3-month follow-up were
compared between these groups.
Results: Patients with co-morbid insomnia and OSA experienced sig-
nificant improvements in insomnia symptoms during treatment. For
example, among patients with mild sleep apnea, sleep onset latency was
reduced by 46 minutes, wake after sleep onset was decreased by 66 min-
utes, and sleep efficiency was increased by 19%. Among patients with
moderate and severe sleep apnea, sleep onset latency reduced by 18 min-
utes, wake after sleep onset by 70 minutes, and sleep efficiency increased
by 16%. These improvements in average sleep-diary parameters as well
as global insomnia severity, and daytime functioning measures were not
significantly different between patients with insomnia-alone, patients
with mild sleep apnea, or patients with moderate to severe sleep apnea.
Conclusion: Cognitive/behavioral therapy for insomnia is an effec-
tive treatment in the presence of mild, moderate, and severe co-morbid
obstructive sleep apnea. This information offers some support for the
suggestion that patients with co-morbid insomnia and OSA should be
treated with CBTi prior to initiating treatment of the OSA.
Support (If Any): No support.
0371
EFFECT OF SLEEP AID ON SLEEP: COMPARISON OF
SLEEP TIME PARAMETERS USING POLYSOMNOGRAPHY
AND DRUG INFORMATION DATABASE
Kim J, Maurer R, Im K
The University of Iowa, Iowa City, IA
Introduction: Many different sleep aids are used to manage insomnia
symptoms. Nevertheless, there is paucity of literature comparing this
wide range of sleep aids comprehensively by measuring the effect of
sleep aids using the gold standard, polysomnography (PSG). We con-
ducted a study showing the effect of each sleep aid category on the
sleep time parameters using PSG database.
Methods: Twelve months of diagnostic polysomnographic data and
drug information from the University Sleep Disorders Center database
totaling 847 subjects of 18 years of age or older were collected and
analyzed. The sleep aids were categorized into: benzodiazeping (BDZ)
receptor agonists (Z-drugs), BDZs, melatonin agonists (MTN), anti-
histamines (AH), sedating tricyclic antidepressants (TCA), 5HT2A
antagonists (5HTA: trazodone, mirtazapine, quetiapine). We examined
the PSG time parameters of total sleep time (TST), sleep efficiency
(SE), sleep latency (SL), and wake after sleep onset (WASO) based on
the sleep aid category including sleep aid non-users.
Results: Out of 847 subjects, 607 were sleep aid non-users and 240
were sleep aid users. Sleep aid non-users showed TST 333 min, SE
77.5%, SL 24.3 min, WASO 72.3 min. When adjusted for age, sex,
body-mass index and apnea-hypopnea index, sleep aid users showed
significantly better sleep parameters in SE (79.8 %; p < 0.05) and
WASO (64.2 min; p < 0.05). Further analysis based on sleep aid cate-
gories showed the following: TST was significantly increased in MTN
(413 min; p < 0.001) and BDZ (357 min; p < 0.05); SE was significantly
increased in 5HTA (81.4 %; p < 0.05) and elevated in MTN (84.8%;
p = NS); WASO was significantly lower in 5HTA (57.5 min; p < 0.05).
AHs showed worse parameters than sleep aid non-users across all four
sleep time (TST 298 min, SE 72.4%, SL 32.6 min, WASO 83.8 min).
Conclusion: All sleep aids except antihistamine can benefit sleep
quantity in patients with insomnia. The best categories are melatonin
and 5-HT2A antagonists such as trazodone. On the other hand, antihis-
tamines may worsen sleep. Melatonin receptor and 5-HT2A receptor
might be more effective target of interest in future insomnia research.
Support (If Any): none.
0372
NURSE DELIVERED BRIEF BEHAVIORAL THERAPY-
INSOMNIA FOR LUNG CANCER SURVIVORS
Dean GE1, Ferreira da Rosa Silva C1, Jungquist CR1, Klimpt ML2,
Dickerson SS1
1University at Buffalo School of Nursing, Buffalo, NY, 2Roswell Park
Cancer Institute, Buffalo, NY
Introduction: Insomnia occurs in 45 to 57% of lung cancer survivors.
Cognitive behavioral therapy for insomnia (CBT-I) is the standard treat-
ment for insomnia; however access is impaired by treatment length and
shortage of trained psychologists to deliver CBT-I. Nurses are uniquely
positioned to deliver a modified version of CBT-I, i.e., Brief Behavioral
Therapy-Insomnia (BBT-I) involving sleep restriction, stimulus control,
sleep hygiene education and brief telephone therapy. This study deter-
mined efficacy of BBT-I compared to attention control (healthy eating
education) for insomnia in lung cancer survivors.
Methods: Lung cancer survivors were randomized to either the exper-
imental (BBT-I) or attention control (healthy eating education). The
study inclusion criteria were Insomnia Severity Index (ISI) >7, stage
I/II non-small cell lung cancer ≥ 6 weeks from surgery, and ≥21 years
of age. Exclusion criteria included untreated pre-existing sleep disor-
ders or medical or psychiatric instability. Objective measures included
screening for sleep apnea (ApneaLink) and 14-day actigraphy before
and after the interventions. Subjective measures included Pittsburgh
Sleep Quality Index, Dysfunctional Beliefs & Attitudes about Sleep,
Epworth Sleepiness Scale, Profile of Moods Fatigue Scale, Hospital
Anxiety and Depression Scale, Functional Assessment of Cancer
Therapy-Lung and 14-day sleep diaries.
Results: Demographics on randomized sample (n=40): 66 years of
age (± 7.6; range 53–82), 40% (n=16) male, 87.5% (n=35) Caucasian,
50% (n=20) married, BMI 27.7 (± 5.8), and 10% (n=4) never smokers.
Disease-treatment characteristics included 80% (n=32) adenocarci-
noma, 60% (n=24) stage 1A, and 90% (n=36) lobectomy. At baseline
there was no significant difference between the groups (p=.12). Post-
treatment mean ISI for the experimental intervention was 6.40 ± 4.98,
while the attention control mean was 14.10 ± 4.48 (p=.001) with an
effect size of 1.61. One third of patients screened required referral
for treatment: 4/44 (9%) screened positive for sleep apnea and 12/44
(27%) had low nighttime oxygenation.
Conclusion: This study demonstrated efficacy of nurse delivered
BBT-I in lung cancer survivors and will inform a larger study to eval-
uate implementation strategies to promote dissemination and sustain-
ability. Brief, practical interventions can significantly improve sleep in
cancer survivors with insomnia.
Support (If Any): Supported by NIH grant NINR R15 NR01377.
0373
DE-CLUTTERING THE BEDROOM AS A POSSIBLE SLEEP
HYGIENE STEP TO IMPROVE SLEEP QUALITY
Thacher PV, Onyper SV, Tuthill J
St. Lawrence University, Canton, NY
Introduction: Clinicians often suggest sleep hygiene interventions
for sleep disorders, such as developing a bedtime routine, sleeping in
B. Clinical Sleep Science I. Insomnia
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A139 SLEEP, Volume 40, Abstract Supplement, 2017
one’s own bed, and regular bed/waketimes. Contextual cues such as
cluttered bedrooms may also interfere with sleep quality, perhaps by
contributing to rumination or anxiety. Our study examined whether
de-cluttering the bedroom helps improve sleep.
Methods: Participants were 1052 subscribers to a website offering
help with housekeeping routines, particularly de-cluttering and dis-
carding (95% female, mean age 50.5 years). Subscribers were given
access to an on-line study link for five consecutive days in December
2015. Measures included demographics; Pittsburgh Sleep Quality
Index (PSQI); Daytime/Nighttime Sleep Problems (DNSP), and
Housekeeping Habits Survey (HHS). The HHS asked participants
which of four recommended habits they had adopted on an at-least
weekly basis: 1) regular, brief de-cluttering (tidying and discarding
objects in the bedroom); 2) planning for next day’s activities; 3) self-
care (eating regular meals and keeping “reasonable” bedtimes; and
4) keeping thoughts positive and avoiding perfectionism.
Results: Hierarchical regression revealed that De-cluttering and
Self-Care habits predicted increased sleep quality (PSQI; beta = -.13
and -.13, respectively) and fewer sleep-related problems (DNSP:
beta = -.08 and -.17); earlier bedtimes accounted for the largest amount
of variability (beta = -.18 and -.23). Length of website subscription
predicted better sleep quality. Global PSQI was highest (M:13.2) for
new subscribers, positive outcomes were achieved (p=.04) after as lit-
tle as 4 weeks of regular engagement with the recommended habits,
although PSQI scores remained elevated (global score: 11.4) even for
those who spent 3 years on the website.
Conclusion: De-cluttering the bedroom area is not typically recom-
mended to insomnia patients by health care providers; our results indi-
cate that for some patients, recommendations to tidy the bedroom area
may be helpful as a way to improve sleep. Because many insomniacs
attempt to fall asleep too early, practitioners usually emphasize delay-
ing bedtimes, to keep sleep efficiency high. Some patients, however,
may be delaying sleep excessively, and directions to advance bedtimes
may be more appropriate.
Support (If Any): No support to declare.
0374
GROUP COGNITIVE BEHAVIORAL THERAPY FOR
INSOMNIA (GCBT-I) AND PREDISPOSING FACTORS IN
COLLEGE STUDENTS
Moked Z1,2, Tzischinsky O3, Shochat T1
1Cheryl Spencer Department of Nursing, University of Haifa, Haifa,
ISRAEL, 2Pat Matthews Academic School of Nursing, Hillel Yaffe
Medical Center, Hadera, ISRAEL, 3Emek Yezreel Academic College,
Emek Yezreel, ISRAEL
Introduction: Insomnia is prevalent in college students, who may
be vulnerable, due to high academic demands, to predisposing fac-
tors such as perceived stress, pre-sleep arousal, and perfectionism.
Although the effectiveness of group cognitive behavioral therapy for
insomnia (GCBT-I) on insomnia severity in the general population is
well established, its effects on predisposing factors are unclear. Our
objectives were to assess (1) the effects of GCBT-I on symptoms of
insomnia, perceived stress, pre-sleep arousal, and perfectionism; and
(2) how changes in predisposing factors relate to changes in insomnia
among college students.
Methods: This prospective study included 39 undergraduate students
(mean age 25 ± 5; 21% male), with an insomnia severity index (ISI) >
14, indicating mild to severe insomnia, who volunteered to take part
in a GCBT-I intervention lasting four weekly sessions. The multi-com-
ponent intervention included sleep restriction, stimulus control, sleep
education, sleep hygiene and relaxation methods. Students completed
validated questionnaires to assess insomnia symptoms (ISI), stress
(perceived stress scale - PSS), arousal (pre sleep arousal scale - PSA),
and perfectionism (perfectionism cognitions inventory - PCI), before
treatment and at seven weeks post-treatment. Paired t-tests were per-
formed to assess changes pre to post treatment. Linear regression was
performed to assess change scores in predisposing factors as predictors
of change scores in insomnia.
Results: ISI total scores decreased from 16.08 ± 3.93 to 12.69 ± 4.58
(p<0.01), indicating lower symptom severity. Changes in predispos-
ing factors included decreases in PSS (21.58 ± 7.90 to 14.89 ± 6.59;
p<.001), PSA (44.77 ± 9.69 to 40.33 ± 10.95; p<.05), and PCI
(49.82 ± 24.38 to 38.97 ± 21.31; p<.01). Changes in predisposing
factors accounted for 61% of the explained variance for change in
insomnia (PSA: β=0.57, p<0.001; PCI: β=0.24, p=0.04; PSS: β=0.16,
p=0.21).
Conclusion: Results support the effectiveness of GCBT-I in college
students, and suggest that the beneficial effects of GCBT-I extend
beyond symptoms of insomnia, to affect predisposing factors that may
be state-dependent.
Support (If Any): None.
0375
CHANGES IN EPWORTH SLEEPINESS SCALE DURING
BEDTIME RESTRICTION THERAPY IN CO-MORBID
INSOMNIA AND OBSTRUCTIVE SLEEP APNEA
Sweetman AM1, Lack LC1, Smith SS2, Catcheside PG3, Antic NA3,
Chai-Coetzer C3, Douglas JA4, O’Grady A3, Dunn N4, Robinson J4,
McEvoy D3
1School of Psychology, Flinders University of South Australia,
Bedford Park, SA, 5042, Australia, Adelaide, AUSTRALIA, 2Recover
injury Research Centre, The University of Queensland, Herston,
QLD, Brisbane, AUSTRALIA, 3Adelaide Institute for Sleep Health,
Flinders Centre for Research Excellence, Flinders University of
South Australia, Bedford Park, SA, 5042, Australia, Adelaide,
AUSTRALIA, 4Thoracic Program, The Prince Charles Hospital,
QLD, Australia, Brisbane, AUSTRALIA
Introduction: Co-morbid insomnia and sleep apnea (COMISA) is a
highly prevalent and debilitating condition. Recommended treatment
for COMISA includes initial treatment with Cognitive Behavioral
Therapy for Insomnia (CBTi). Bedtime restriction therapy is an effec-
tive component of CBTi that involves temporarily reducing time spent
in bed to consolidate sleep periods and decrease pre-sleep hypera-
rousal. However bedtime restriction also temporarily increases day-
time sleepiness. As sleep apnea is commonly associated with increased
sleepiness at baseline, it is important to monitor the effect of bedtime
restriction therapy in COMISA patients during CBTi to avoid poten-
tially dangerous excessive daytime sleepiness.
Methods: 72 patients with co-morbid insomnia (ICSD-2) and sleep
apnea (AHI ≥ 15) who were participating in a randomized controlled
trial completed 7-day sleep diaries, and Epworth Sleepiness Scales
at baseline, during 4-weekly sessions of CBTi, and at post-treat-
ment. Paired t-tests were used to compare differences in average
sleep parameters and sleepiness between baseline and each week of
treatment.
Results: Epworth Sleepiness Scale scores did not increase signifi-
cantly during any week of CBTi compared to baseline. Instead they
showed a small significant reduction by week-4 (2 point reduction,
p≤0.001) and post-treatment (1.5 point reduction, p≤0.001) compared
to baseline. Subjective total sleep time showed a 30 minute decrease by
the second CBTi session (p≤0.001), but was significantly greater than
baseline by week-4 (15 minute increase, p≤0.01) and post-treatment
B. Clinical Sleep Science I. Insomnia
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