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Wake up psychology! Postgraduate psychology students need more sleep and insomnia education
Australian Psychologist
Abstract
Objective
Poor sleep can significantly impact mental health. Despite this, sleep education is absent from the curriculum of many psychology training programs. The current study examined the amount of sleep education delivered within postgraduate psychology programs in Australia. It also developed a new survey tool to capture postgraduate psychology students’ experience of sleep education.
Method
Two cross-sectional sleep education surveys were emailed to postgraduate psychology programs across Australia via the Heads of Department and Schools of Psychology Association. The first survey explored sleep education from postgraduate psychology program coordinators’ perspectives (n = 35; survey response rate = 73%), while the second custom-designed survey examined postgraduate psychology students’ perspectives (n = 152).
Results
Program coordinators reported a median of 2.00 hours (range 0-9) of didactic sleep education delivered within postgraduate psychology programs. Postgraduate students, however, reported receiving a median of only 1.00 hour (range 0-40) of sleep education, with 47% of students reporting no sleep education. Most students acknowledged already working with clients experiencing sleep disturbances (68%), yet they disclosed low confidence and self-efficacy to manage sleep disturbances in psychology practice. Despite delivering minimal sleep education, thematic analysis indicated that program coordinators viewed sleep education as an important topic for trainee psychologists. Program coordinators preferred sleep education to supplement the postgraduate curriculum, preferably online (63%), whereas students chose clinical supervision (61%).
Conclusions
Postgraduate psychology training programs deliver minimal sleep education to trainee psychologists in Australia. Enhanced integration of sleep education within the postgraduate psychology curriculum is required to improve mental health outcomes.
Key Points
What is already known about this topic:
• (1) Sleep disturbances commonly co-occur with mental health conditions, often with a bidirectional relationship.
• (2) Trainee clinical psychologists in the US receive limited sleep education, which may impact their ability to manage the sleep disturbances in clinical practice.
• (3) There are currently no Australian Psychology Accreditation Council training requirements in sleep and sleep disorders for postgraduate psychology programs, despite the bidirectional relationship between sleep and mental health.
What this topic adds:
• (1) This is the first study to examine sleep education within postgraduate psychology programs in Australia.
• (2) We show that (1) a median of only two hours of didactic sleep education is delivered within postgraduate psychology programs, (2) almost half (47%) of postgraduate students received no sleep education during their training, (3) sleep issues were a common presenting complaint for postgraduate students to address on placement, and (4) overall, graduate students reported low levels of confidence and self-efficacy to manage sleep disturbances in clinical practice.
• (3) Postgraduate psychology students in Australia need more sleep and insomnia education disturbances that commonly co-occur with mental health conditions.
... In an Australian study, 68% of psychologist students reported that they had already worked with a patient who had experienced a sleep disturbance (Meaklim et al. 2021). They also estimated that almost 50% of all patients reported difficulties with sleep (Meaklim et al. 2021). ...
... In an Australian study, 68% of psychologist students reported that they had already worked with a patient who had experienced a sleep disturbance (Meaklim et al. 2021). They also estimated that almost 50% of all patients reported difficulties with sleep (Meaklim et al. 2021). In 2020 (during the pandemic period) in the United States, it was estimated that 14.5% of adults (>18 y old) had trouble falling asleep, and 17.8% had trouble staying asleep (Adjaye-Gbewonyo et al. 2022). ...
... Importantly, part of the sample accessed the biological rhythm studies by their own research (22.89%). In Australia, approximately half of postgraduate students reported a lack of sleep education during their postgraduate psychology degree (Meaklim et al. 2021). In this sense, Meltzer et al. (2009) evaluated 212 university programs and investigated if the teaching of sleep and sleep disorders was included in undergraduate, internship, and graduate programs in clinical psychology approved by the American Psychological Association (APA) or Canadian Psychological Association (CPA). ...
Desynchronization of circadian rhythms and sleep-wake patterns impacts biochemical, physiological, and behavioral functions, including mental processes. The complex relationship between circadian rhythms and mental health makes it challenging to determine causality between circadian desynchronization and mental disorders. Regarding the fact that psychologists act as the front line for initial mental health care, we aimed to assess the knowledge and use of sleep science and basic chronobiology by professional psychologists in Brazil. Data were collected via an online questionnaire completed by 1384 professional psychologists between October 2018 and May 2019. Our findings revealed that ±80% of psychologists reported that at least half of their patients presented some sleep-related complaints; however, only ±27% routinely inquired about sleep quality even in the absence of patient complaints. Additionally, only ±66% initiated treatments to understand these complaints, potentially influenced by the lack of prior academic exposure to biological rhythms as reported by ±76% of Brazilian psychologists interviewed. Importantly, ±15% did not believe in an association between mental health and biological rhythms, and even a significant ±67% were unfamiliar with the term chronobiology and ±63% were not able to describe any other biological rhythm except for the sleep-wake cycle. These results demonstrate that fundamental concepts in chronobiology and sleep science are unknown to a substantial proportion of Brazilian psychologists. In conclusion, we propose that this subject could be more effectively integrated into psychologists' academic training, potentially promoting benefits through the incorporation of a chronobiological approach in mental health practice.
... As basic as this may sound, research indicates that adequate assessment and diagnosing is often lacking before treatment in the form of sleep medication is prescribed (Wickwire et al., 2021), showing that training for healthcare professionals at this foundation level of CBT-I proficiency is also much needed. This is perhaps not surprising, as sleep and sleep medicine are rarely included in basic training for healthcare professionals or only to a very small degree (Meaklim et al., 2021;Romiszewski et al., 2020). In addition, the content of training and how training is delivered vary radically between education providers (Meaklim et al., 2021;Romiszewski et al., 2020). ...
... This is perhaps not surprising, as sleep and sleep medicine are rarely included in basic training for healthcare professionals or only to a very small degree (Meaklim et al., 2021;Romiszewski et al., 2020). In addition, the content of training and how training is delivered vary radically between education providers (Meaklim et al., 2021;Romiszewski et al., 2020). Note that this is true for both healthcare professionals such as General Practitioners (GPs; Romiszewski et al., 2020), who could be expected to work on the first step(s) of a stepped-care model, and clinical psychologists (Meaklim et al., 2021), who could be expected to work on later steps in the model, and may be an important reason why sleep problems are handled quite differently between individual healthcare professionals but rarely according to guidelines (Koffel et al., 2018). ...
... In addition, the content of training and how training is delivered vary radically between education providers (Meaklim et al., 2021;Romiszewski et al., 2020). Note that this is true for both healthcare professionals such as General Practitioners (GPs; Romiszewski et al., 2020), who could be expected to work on the first step(s) of a stepped-care model, and clinical psychologists (Meaklim et al., 2021), who could be expected to work on later steps in the model, and may be an important reason why sleep problems are handled quite differently between individual healthcare professionals but rarely according to guidelines (Koffel et al., 2018). ...
Insomnia is common, and causes substantial individual suffering and costs for society. The recommended first-line treatment is cognitive behavioural therapy for insomnia (CBT-I), which is under-used partly due to a lack of trained providers. To train providers is thus important, but what is the current situation regarding CBT-I training? A systematic search of databases was conducted to identify scientific peer-reviewed papers describing CBT-I training with regards to: existing amounts of training, proposed curricula, trainees, delivery context, content of training, modes of delivery, evaluation of the training from a trainee perspective, and effects on patients. This systematic review shows that research on training in CBT-I is an emerging field, with the literature presenting a limited number of papers, with varying objectives. One group of papers investigate the amount of training that exists in a region or educational context and/or propose training curricula; and another group evaluate training initiatives and describe CBT-I training trainees, context, content, modes of delivery, and outcomes on trainees and on treated patients. The studies show that little training is currently provided and proposed curricula vary, and evaluations present promising results: training is feasible in different contexts and modes, digital training may be used to disseminate training efforts at a large scale, trainees' skills increase and positive effects on patients can be seen. To move the field forward, more high-quality studies on CBT-I training are needed, and we propose that training in CBT-I should be targeted towards varying levels of expertise, matching a stepped-care model.
... A second barrier to CBT-I dissemination is that our mental healthcare providers lack general sleep and insomnia knowledge due to the limited sleep education taught within university-based healthcare training programs [52-54, 81, 93]. Sleep education is scarce in both medical and psychology programs due to limited time, space, and expertise in the curriculum [69,78,[94][95][96][97][98][99][100][101][102][103][104][105][106]. On average, medical students worldwide receive only 2.5 hours of sleep education across their medical degree [107], much less than, for example, the 19.6 hours for nutrition education [108,109]. ...
... Sleep education provided to psychology students is even lower. Graduate psychology students in Australia receive a median of only 1 hour of sleep education, with 47% reporting no sleep education at all [104]. The data are similar in the United States, with only 6% of clinical psychology programs offering a formal course in sleep [100]. ...
... The data are similar in the United States, with only 6% of clinical psychology programs offering a formal course in sleep [100]. Without foundational sleep education, most graduate psychology students enter the workforce lacking critical CBT-I knowledge and thus incorrectly believing that sleep hygiene is an evidence-based treatment for insomnia [78,104]. ...
Study objectives:
Despite the negative impact of poor sleep on mental health, evidence-based insomnia management guidelines have not been translated into routine mental healthcare. Here, we evaluate a state-wide knowledge translation effort to disseminate sleep and insomnia education to graduate psychology programs online using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) evaluation framework.
Methods:
Using a non-randomized waitlist control design, graduate psychology students attended a validated six-hour online sleep education workshop delivered live as part of their graduate psychology program in Victoria, Australia. Sleep knowledge, attitudes, and practice assessments were conducted pre- and post-program, with long-term feedback collected at 12 months.
Results:
Seven out of ten graduate psychology programs adopted the workshop (adoption rate = 70%). The workshop reached 313 graduate students, with a research participation rate of 81%. The workshop was effective at improving students' sleep knowledge and self-efficacy to manage sleep disturbances using Cognitive Behavioral Therapy for Insomnia (CBT-I), compared to the waitlist control with medium-to-large effect sizes (all p <.001). Implementation feedback was positive, with 96% of students rating the workshop as very good-to-excellent. Twelve-month maintenance data demonstrated that 83% of students had used the sleep knowledge/skills learned in the workshop in their clinical practice. However, more practical training is required to achieve CBT-I competency.
Conclusion:
Online sleep education workshops can be scaled to deliver cost-effective foundational sleep training to graduate psychology students. This workshop will accelerate the translation of insomnia management guidelines into psychology practice to improve sleep and mental health outcomes nationwide.
... Despite the strong links between sleep and mental health, behavioral sleep medicine (BSM) education has largely been neglected in mental healthcare provider training programs (Meaklim et al., 2020). In Australia, almost half of trainee psychologists receive no education regarding assessment, diagnosis, or treatment for sleep disorders during graduate school (Meaklim et al., 2021). The story is similar in the U.S., with 69% of clinical psychology graduate programs offering no training in the treatment of sleep disorders (Meltzer et al., 2009) and 95% of practicing psychologists reporting no sleep education during graduate school (Zhou et al., 2021). ...
... Limited sleep education is likely a result of poor knowledge translation, with it taking approximately 17 years to translate research evidence into standard healthcare education and clinical practice (Morris et al., 2011). Additionally, healthcare educators often cite insufficient time, space, and expertise within the curriculum for sleep education (Meaklim et al., 2020(Meaklim et al., , 2021Meltzer et al., 2009;Mindell et al., 2011;Romiszewski et al., 2020). However, this lack of sleep education during graduate training means that many mental healthcare providers do not feel equipped to take a sleep history nor to routinely screen or provide evidencebased treatment for sleep disorders, such as insomnia (Drapeau, 2022;Richardson et al., 2021;Zhou et al., 2021). ...
... The principles of a modified Delphi Method (Boerner et al., 2015) were used to achieve curriculum consensus. The first author developed an initial list of key BSM knowledge and skills to include, based on a narrative review into sleep education for healthcare providers (Meaklim et al., 2020), a survey study into sleep education in graduate psychology programs in Australia (Meaklim et al., 2021), and other published sleep education for healthcare providers literature (Balasubramaniam et al., 2014;Boerner et al., 2015;DelGuercio, 2018;R. E. Salas et al., 2013;Lee et al., 2004;Lichstein et al., 1998;Salas et al., 2018;Manber et al., 2012;Manber & Simpson, 2016;Romiszewski et al., 2020;Mindell et al., 1994;Moline & Zendell, 1993;Orr et al., 1980;Papp et al., 2002;Peachey & Zelman, 2012;Rosen et al., 1998;Sateia et al., 2005;Sciberras et al., 2017;Tze-Min Ang et al., 2008;Zozula et al., 2001). ...
Objectives:
Despite the clear influence of poor sleep on mental health, sleep education has been neglected in psychology training programs. Here, we develop a novel behavioral sleep medicine (BSM) education workshop, the Sleep Psychology Workshop, designed for integration within graduate psychology programs. We also examined the potential efficacy and acceptability of the workshop to upskill trainee psychologists in sleep and insomnia management.
Methods:
The Sleep Psychology Workshop was developed using a modified Delphi Method. Eleven trainee psychologists completing their Master of Psychology degrees (90% female, 24.4 ± 1.6 years old) attended the workshop, delivered as three, two-hour lectures (total of six hours). Sleep knowledge, attitudes, and practice assessments were completed pre-and post-intervention using the GradPsyKAPS Questionnaire. A focus group and 6-month follow-up survey captured feedback and qualitative data.
Results:
Trainees' sleep knowledge quiz scores (% correct) increased from 60% to 79% pre- to post-workshop (p = .002). Trainees' self-efficacy to use common sleep-related assessment instruments and empirically supported interventions to manage sleep disturbances increased, along with their confidence to manage insomnia (all p < .02). Participant feedback was positive, with 91% of trainees rating the workshop as "excellent" and qualitative data highlighting trainees developing practical skills in BSM. Six months post-intervention, 100% of trainees endorsed routinely asking their clients about sleep, with 82% reporting improvements in their own sleep.
Conclusions:
The Sleep Psychology Workshop is a potentially effective and acceptable introductory BSM education program for trainee psychologists, ready for integration within the graduate psychology curriculum.
... Despite the strong links among sleep, circadian rhythms, and mental health, sleep education has largely been neglected in mental healthcare training programs around the world [20]. In Australia, almost half of trainee psychologists receive no sleep education regarding assessment, diagnosis, or treatment for sleep and circadian rhythm disturbances during graduate school [21]. The story is similar in the U.S., with only 31% of clinical psychology graduate programs offering training in the treatment of sleep disorders [22]. ...
... To address this curriculum oversight, the current study created and piloted a sleep education workshop, called the Sleep Psychology Workshop, targeting trainee psychologists in graduate school. In brief, the workshop was informed by a narrative review of the sleep education for healthcare provider literature [20], sleep education survey research with psychology trainees and educators [21], as well as published literature on other sleep education studies for a range of healthcare students and providers (e.g., psychologists, medical doctors, neurologists, nurses, pharmacists) [26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42]. The learning objectives for the Sleep Psychology Workshop were to provide trainee psychologists with the introductory skills they need to assess, diagnose, and manage the sleep and circadian rhythm disturbances that are highly prevalent in mental health populations, such as insomnia (see Section 4.1 and Figures 2, 3 for workshop details). ...
... A strong indicator of the workshop's potential efficacy was the observed increase in trainees' sleep psychology knowledge from pre-to post-workshop, with sleep knowledge quiz scores increasing from 60% to 79%, demonstrating significant learning and retention of sleep psychology knowledge. Sleep education studies across psychology [21,27] and medical students [31,43] show low levels of sleep knowledge without specific sleep education training. Whilst knowledge does not equal competency, these results demonstrate that the Sleep Psychology Workshop greatly increased trainees' awareness of the relationship between sleep and mental health and that students retained important information about evidence-based sleep assessment and management skills post-workshop. ...
Despite the strong links between sleep, circadian rhythms, and mental health, sleep education has been neglected in mental healthcare provider training programs. The current pilot study examined the potential efficacy and acceptability of a sleep education workshop for trainee psychologists, called the Sleep Psychology Workshop. Eleven students completing their Master of Psychology degrees (90% female, 24.4 ± 1.6 years old) attended the Sleep Psychology Workshop as part of their Health Psychology course, delivered as three, two-hour lectures (total six hours). Trainees’ sleep psychology knowledge quiz scores (% correct) demonstrated significant improvement from pre- (M = 60%, SD = .09) to post-workshop (M = 79%, SD = .08), t (6) = -5.18, p = .002. Trainees also reported increased self-efficacy to use common sleep-related assessment instruments and empirically supported interventions to manage sleep and circadian rhythm disturbances, along with increased confidence to manage insomnia disorder in clinical practice (all p<.02). Trainees also endorsed the workshop as an acceptable sleep education program for trainee psychologists via a post-workshop feedback survey, focus group, and six-month follow-up survey. This pilot study provides preliminary evidence for the Sleep Psychology Workshop as an effective and acceptable sleep education program for trainee psychologists.
... Besides the importance of psychotherapy in the monitoring and treatment of sleep problems, previous work also revealed that only 23.88% of psychologists reported receiving education on biological rhythms (including sleep health) during their academic training (Soalheiro et al., 2023). This finding is consistent with studies from other countries, which highlight the limited availability of courses on sleep studies in psychology programs (Meaklim et al., 2021;Meltzer et al., 2009;Zhou et al., 2021). ...
... In this context, it is important to note that only 23.64% of clinical psychologists reported having any exposure to chronobiology during their academic training. Similarly, a lack of academic exposure to biological rhythms has also been reported in other countries, such as Australia (Meaklim et al., 2021) and the USA (Zhou et al., 2021). In the same way, studies on biological rhythms and sleep medicine are not typically included in the education of biology or medical students in the majority of European countries (Montagnese et al., 2021;Romiszewski et al., 2020). ...
Given psychologists’ role and the use of psychotherapies for sleep issues, our study explored: (1) whether psychologists inquire about patients’ sleep quality and their beliefs regarding the relationship between mental health and biological rhythms, and (2) global trends in psychological approaches through a bibliometric analysis. We analyzed responses from 1011 Brazilian clinical psychologists (October 2018–May 2019) and found that most routinely inquire about sleep quality and address sleep problems, while a small portion did not perceive a direct link between mental disorders and biological rhythms. Behavioral psychotherapy practitioners showed greater interest in sleep quality. The bibliometric analysis revealed that cognitive behavioral therapy had the strongest associations with sleep-related terms compared to other approaches. In conclusion, clinical psychology plays a key role in addressing human health. Given rising concerns about biological rhythms, further exploration across psychological approaches is essential, especially to enhance education in this field.
... Survey items were developed following a review of research in climate change and mental health (Doherty et al., 2022;Hoppe et al., 2023) (Meaklim et al., 2021;Scott et al., 2011). ...
ABSTRACT
Objective: There is growing evidence that climate change can negatively impact people’s mental health. Therefore, it is important for psychologists to receive adequate training in this area. However, little is known about current levels of training, including the amount of climate change mental health education within postgraduate psychology programs in Australia and Aotearoa-New Zealand.
Method: Two cross-sectional surveys regarding climate change and mental health were emailed to postgraduate psychology programs in Australia and Aotearoa-New Zealand. The first invited participation from program coordinators (n = 17), the second students (n = 159). We conducted quantitative content analysis and thematic analysis of qualitative responses.
Results: Most participants believe this is an important topic of training for psychologists as climate change will impact the mental health of their clients. Further, results indicate minimal climate change mental health content in postgraduate psychology training programs in Australia and Aotearoa-New Zealand.
Conclusions: Integration of climate change mental health education into postgraduate psychology curriculum will work towards equipping the emerging mental health workforce to address this growing demand, which in turn can improve mental health outcomes in a changing climate.
KEY POINTS
What is already known about this topic:
(1) Climate change negatively impacts mental health in several ways.
(2) These impacts will increase as climate change increases.
(3) Climate change mental health education is not currently an Australian Psychology Accreditation Council or New Zealand Psychologists Board Accreditation Committee requirement for postgraduate psychology programs.
What this study adds:
(1) This is the first study to investigate the perceptions of students and program coordinators regarding climate change mental health, and education on this topic within postgraduate psychology programs in Australia and Aotearoa-New Zealand.
(2) We found that: Almost all participants believe that climate change will negatively impact the mental health of their clients and most participants believe climate change and mental health education ought to be incorporated into programs, however the majority indicated it is not presently included.
(3) It is important to prepare the emerging psychology workforce in mental health and climate change and integrating education into postgraduate psychology programs represents a step forward.
... Sleep Psychology is a necessary resource within any sleep disorders service, with AASM guidelines recommending a Psychologist with experience in behavioural sleep medicine be embedded in multidisciplinary sleep services(8). However, barriers to patient access to treatment include limited availability of appropriately trained and experienced psychologists (9) and lack of knowledge amongst primary practitioners about evidence-based treatment for insomnia (10). To this end, it is important to explore options for improving e ciencies and access to care for individuals requiring intervention. ...
Background: Sleep disorders are common and costly to society. Guidelines from the American Academy of Sleep Medicine (AASM) and the Australasian Sleep Association (ASA) recommend Cognitive Behaviour Therapy for Insomnia (CBTi) as the best treatment modality for insomnia disorder in the long term, however, access issues due to medical first referral pathways and reduced availability of psychologists in the community results in increased wait times, reduces efficient care for patients, and adds burden to specialist medical services.
Method: This phase of a broader single-site, multiphase, mixed methods project will implement, and evaluate a service model of care re-design incorporating a new Direct to Psychology referral pathway for insomnia presentations and a Stepped Care treatment approach in the multidisciplinary sleep service. The RE-AIM framework and Standards for intervention Reporting Implementation Studies(StaRI) will be used to guide the development, implementation, evaluation and reporting of this service change. Quantitative data measuring outcomes of the new models of care on key indices of patient clinical outcomes, patient/clinician service satisfaction, and service efficiencies will be collected pre- and post-service change.
Discussion: The overarching aim of this project is implement and evaluate a model of care change to the service model in a public tertiary hospital multidisciplinary sleep service. The new Direct to Psychology Stepped Care Model incorporates a Direct to Psychology Insomnia referral pathway along with a Stepped Care approach to treatment, flexibly delivered across the continuum of care. The project will measure the impact of the service change in our target population. The new model of care will be compared to the old service model for key outcomes. We anticipate that the new Model of Care will be acceptable to stakeholders, will produce non-inferior patient outcomes, and will improve patient flow and service efficiency.
Trial Registration: The Protocol was registered on 5/08/2022 with the Australian and New Zealand Clinical Trials Registry (ACTRN12622001086752).
... However, there is a risk that this expansion of provision may inadvertently result in a lower standard of care being offered, especially if those clinicians providing the treatment are not trained to appropriately high standards. As mentioned above, previous literature points to the fact that most clinical psychologists, psychiatrists and psychotherapists, who may have expertise in CBT, are generally not properly trained with respect to clinical sleep psychophysiology, insomnia aetiology, and treatment for behavioural sleep problems (e.g., Meaklim et al., 2021;Meltzer et al., 2009;Romiszewski et al., 2020;Stores & Crawford, 1998). Likewise, even certain sleep specialists, e.g., neurologists or respiratory physicians, may not have appropriate training in CBT, and may also lack knowledge regarding insomnia specifically. ...
Despite cognitive behaviour therapy for insomnia (CBT-I) being the first-line intervention for the disorder, it is often not readily available to patients in need. The stepped care model (SCM) represents an approach to facilitating efficient and wide-ranging provision of evidence-based care to those with insomnia. The SCM reflects a pyramid of therapeutics based on CBT-I gradually increasing in clinical intensity and addressing clinical complexity. By applying CBT-I through the SCM it is hoped that the treatment gap can be bridged such that not only more patients can be reached, but that clinical resource can be more effectively distributed, with patients receiving more tailored care as needed. Nevertheless, this should not be done at the risk of a lower quality of care being offered, and high-standard training for clinicians and scrutiny of non-clinician led interventions remains important. As national health laws within European countries have substantial differences, the application of the SCM as it relates to the treatment of insomnia may be challenged by contrasting interpretations. In order that the SCM is appropriately implemented: (a) only evidence-based CBT-I treatments should be promoted within the model; (b) clinicians involved in SCM should be suitably qualified to offer CBT in general, and have appropriate further training in CBT-I; (c) professionals involved in interventions not included in the SCM, but related to it, such as preventive and educational programmes, diagnostic procedures, and pharmacological treatments, should also have good knowledge of the SCM in order to promote correct allocation to the appropriate interventional step.
... 22 For example, a study conducted in 2021 among postgraduate psychology students in Australia (n = 138) reported that students received a median of only one hour of sleep education training, with almost half (47%) receiving no training at all. 23 In summary, our study indicates that discussions about sleep are frequently initiated with health professionals, but this does not necessarily translate to the utilisation of first line treatment (CBTi). The lack of translation to treatment may be attributed to multiple factors, including constraints in time and funding for individual general practitioners, insufficient referral pathways, 22 and the complexities associated with co-occurring mental health issues. ...
Background
Insomnia is a common issue among individuals with mental health conditions, yet the frequency of insomnia treatment remains unclear. The purpose of this study was to investigate the prevalence of probable insomnia, discussions regarding sleep with health professionals, and the utilisation of commonly delivered insomnia treatments in Australian adults diagnosed with mental health conditions.
Methods
This study represents a secondary analysis of data collected through a cross-sectional, national online survey conducted in 2019. A subset included participants (n = 624, age 18–85y) who self-reported a diagnosis of depression, bipolar disorder, anxiety, panic disorder, or post-traumatic stress disorder. Participants were classed as having probable insomnia based on self-reported symptoms and a minimum availability of 7.5 hours in bed.
Results
Among individuals with probable insomnia (n = 296, 47.4%), 64.5% (n = 191) reported discussing sleep with one or more health professionals, predominantly with general practitioners (n = 160, 83.8%). However, 35.4% (n = 105) of people with probable insomnia had not discussed their sleep with a health professional. Additionally, 35.1% (n = 104) used prescribed medication for sleep, while only 15.9% (n = 47) had used the first line recommended treatment of cognitive-behavioral therapy for insomnia in the last 12 months.
Conclusion
Although most participants who met the criteria for probable insomnia had engaged in discussions about sleep with health professionals, utilisation of first line recommended treatment was low. Interventions that promote routine assessment of sleep and first line treatment for insomnia by health professionals would likely benefit people with mental health conditions.
Zusammenfassung
Für die Insomnie im Kindes- und Jugendalter ist wie für die Erwachsenen auch die kognitive Verhaltenstherapie für Insomnie (CBT‑I; deutsch KVT-I) die erste Wahl, jedoch ist sie für die Familien, Kinder und Jugendliche oft nicht ohne Weiteres verfügbar. Das hier präsentierte Stepped-Care-Modell für das Kindes- und Jugendalter (SCM-KJ; englisch SCM-CA) stellt ein Stufenmodell zur vernetzten und evidenzbasierten Versorgung von Kindern und Jugendlichen mit Insomnie dar. Das SCM-KJ berücksichtigt die unterschiedlichen Altersgruppen und stellt eine Präventions- und Interventionspyramide dar, die auf dem Konzept des gesunden Schlafs und der CBT‑I für Kinder und Jugendliche basiert und allmählich an klinischer Intensität und Komplexität zunimmt. Hierdurch sollen diagnostische und therapeutische Behandlungslücken verringert werden, sodass nicht nur mehr Familien erreicht werden können, sondern auch die klinischen Ressourcen effektiver verteilt werden können. Damit das SCM-KJ angemessen umgesetzt wird, sollten altersspezifische Diagnostikinstrumente und Wissen verbreitet werden. Es sollten nur evidenzbasierte CBT-I-Behandlungen für das Kindes- und Jugendalter im Rahmen des Modells gefördert werden. Die im Rahmen des SCM-KJ beteiligten Kliniker*innen sollten qualifiziert sein, um CBT im Kindes- und Jungendalter (CBT-KJ) durchführen zu können, und über eine entsprechende Fortbildung verfügen. Fachkräfte, die im Rahmen von Präventionsprogrammen oder frühen Interventionen beteiligt sind, die nicht im engeren Sinne zum Behandlungsspektrum des SCM-KJ gehören, aber damit in Verbindung stehen, sollten ebenfalls über gute Diagnostikkenntnisse und differenzialdiagnostisches Wissen verfügen, um eine korrekte Zuweisung oder Weiterleitung zu den entsprechenden Interventionsmöglichkeiten zu gewährleisten.
Study Objectives
Insomnia is a highly prevalent and debilitating disorder. Cognitive behavioral therapy for insomnia (CBTi) is the recommended ‘fist line’ treatment, but is accessed by a minority of people with insomnia. This paper describes a system-level implementation program to improve access to CBTi in Australia to inform CBTi implementation in other locations.
Methods
From 2019 to 2023, we conducted a program of work to promote sustained change in access to CBTi in Australia. Three distinct phases included 1) Scoping and mapping barriers to CBTi access, 2) Analysis and synthesis of barriers and facilitators to devise change goals, and 3) Structured promotion and coordination of change. We used a system-level approach, knowledge brokerage, and co-design, and drew on qualitative, quantitative, and implementation science methods.
Results
We identified barriers to CBTi access from the perspectives of people with insomnia, primary care clinicians, and the health system. A stakeholder advisory committee was convened to co-design change goals, identify modifiable barriers, devise program logic and drive change strategies. We commenced a program to promote system-level change in CBTi access via; improved awareness and education of insomnia among primary care clinicians, self-guided interventions, and advocating to Government for additional CBTi funding mechanisms.
Conclusions
This implementation program made significant progress toward improving access to CBTi in Australia. Ongoing work is required to continue this program, as long-term system-level change requires significant and sustained time, effort and resources from multiple stakeholders. This program may be used to inform CBTi implementation activities in other locations.
A 'Direct to Psychology Insomnia' pathway was developed for implementation within a multidisciplinary sleep disorders service in a tertiary hospital in Brisbane, Australia. The project was informed by implementation science principles and methodology to re-design the model of care (MoC). A consensus group workshop using the Nominal Group Technique (NGT) with 12 multidisciplinary staff was undertaken to develop the new MoC. The workshop explored inclusion and exclusion criteria for a Direct to Psychology pathway including patient flow and enablers. The team endorsed a MoC that was acceptable to stakeholders and addressed service-level imperatives. The findings highlighted that patient inclusion or exclusion should be overseen by the Sleep Physician team and an Advanced Psychologist with behavioural sleep medicine expertise. Continuum of care for patients referred via primary care providers was considered. Barriers and risks to the MoC changes were identified which informed the refinement of the MoC.
Chronic insomnia is the most common sleep disorder, occurring in ~32 million people in the United States per annum. Acute insomnia is even more prevalent, affecting nearly half of adults at some point each year. The prevalence of insomnia among primary care patients is even higher. The problem, however, is that most primary care providers do not feel adequately knowledgeable or equipped to treat sleep-related concerns. Many providers have never heard of or have not been trained in cognitive behavioral therapy for insomnia or CBT-I (the first line treatment for insomnia). The focus of the current review is to summarize the factors contributing to why sleep health and insomnia treatment have been mostly neglected, identify how this has contributed to disparities in sleep health among certain groups, particularly racial and ethnic minorities and discuss considerations or potential areas of exploration that may improve access to behavioral sleep health interventions, particularly in primary care.
Objectives:
Mental health care clinicians' training in treating sleep problems was investigated. We examined clinicians' (1) prior training in providing treatment for sleep problems, (2) interest in receiving training in treatment for sleep problems, and (3) perceptions of the importance of treating sleep problems and interest in incorporating sleep treatments into their practices.
Methods:
An online survey was completed by 137 clinicians.
Results:
The majority of clinicians (61.31%) reported receiving prior training in treating sleep problems, most commonly in the form of a workshop and after receiving a graduate degree. Most clinicians reported interest in receiving further training in treating sleep problems. Clinicians reported that the majority (66.67%) of their clients experience sleep problems, yet reported that they address sleep with fewer than half of clients. Addressing sleep in treatment was rated as "somewhat" to "very" important and most clinicians indicated further interest in receiving training in treating sleep.
Conclusions:
Mental health care clinicians receive limited training in treating sleep problems. As clinicians are interested in gaining further training to address sleep concerns within their clinical practice, training programs and continuing education programs should consider increasing the amount of programming in sleep treatment and assessment.
This book explores the different ways sleep medicine is practiced in the world by presenting information from multiple countries from all continents. The editors, all sleep medicine experts, dive into both clinical practice, and research keeping an eye on healthcare needs and disparities, before proposing solutions. The contributions also take into account the social, geographical and political situation of each country, along with demographic considerations such as income levels, adding a dimension of context to the contents. The book is meant to be a reference for sleep medicine practitioners who encounter diverse patients in their daily practice. It also serves as a good resource for anyone interested in the state of global health studies.
Insomnia is a highly prevalent sleep disorder, which has negative consequences on almost all aspects of physical and psychological health. The gold-standard treatment for insomnia disorder is cognitive behavioral therapy for insomnia (CBT-I). While CBT-I is efficacious, access to this therapy is limited. Digital forms of therapy for insomnia, including CBT-I and mindfulness-based therapy for insomnia are emerging, with growing evidence of their efficacy for reducing insomnia severity and other symptoms of the disorder (e.g., pre-sleep arousal) and improving mental health. This chapter describes the evidence for the effectiveness of these therapies, as well as factors that may influence response to treatment. The role of digital therapies for insomnia in stepped-care models is also discussed. Ultimately, digital therapeutics for insomnia will help address the poor sleep endemic faced by modern society, with potential positive flow-on effects for other aspects of health and well-being.
Healthy sleep is crucial to individuals’ health and wellbeing, whereas healthfully waking up from the sleep cycle can significantly improve the sleep quality. Among technologies used as sleep alarms, haptic feedback has been widely adopted to serve as an effective wake-up alarm, yet how it can comfortably wake users up is underexplored. This paper presents a design study of SleepHill, an inflatable sleep pillow that can incrementally bounce its body and softly tilt its surface to create a gentle yet efficient haptic alarm for comfortable wake-up. We prototyped SleepHill and conducted a pilot user study to preliminarily understand the resulted user experiences. Our findings revealed that the wake-up process facilitated by SleepHill allowed participants to be gently awakened without being frightened. Also, we learned that the usage of SleepHill could produce improved sleep and wake-up experiences due to its incremental haptic feedback mechanism. Based on this project, we discuss implications for the future development of embedded tangible interaction design for improving the sleep circle with enriched wake-up experiences.KeywordsInteractive sleep pillowWake-up experienceInflation-based haptic feedback
The daily alternation between sleep and wakefulness is one of the most dominant features of our lives and is a manifestation of the intrinsic 24 h rhythmicity underlying almost every aspect of our physiology. Circadian rhythms are generated by networks of molecular oscillators in the brain and peripheral tissues that interact with environmental and behavioural cycles to promote the occurrence of sleep during the environmental night. This alignment is often disturbed, however, by contemporary changes to our living environments, work or social schedules, patterns of light exposure, and biological factors, with consequences not only for sleep timing but also for our physical and mental health. Characterised by undesirable or irregular timing of sleep and wakefulness, in this Series paper we critically examine the existing categories of circadian rhythm sleep–wake disorders and the role of the circadian system in their development. We emphasise how not all disruption to daily rhythms is driven solely by an underlying circadian disturbance, and take a broader, dimensional approach to explore how circadian rhythms and sleep homoeostasis interact with behavioural and environmental factors. Very few high-quality epidemiological and intervention studies exist, and wider recognition and treatment of sleep timing disorders are currently hindered by a scarcity of accessible and objective tools for quantifying sleep and circadian physiology and environmental variables. We therefore assess emerging wearable technology, transcriptomics, and mathematical modelling approaches that promise to accelerate the integration of our knowledge in sleep and circadian science into improved human health.
Objective
Although clinical guidelines recommend Cognitive Behavioural Therapy for insomnia (CBTi) as the first-line treatment for insomnia, many people with insomnia do not have access to CBTi and are prescribed sedative-hypnotic medicines by medical health professionals. Psychologists have training in CBT and may be well placed to deliver behavioural therapy for insomnia. However, the current treatment of insomnia, amount of sleep-specific training and knowledge of CBTi among Australian psychologists remains unknown.
Method
This qualitative study conducted semi-structured interviews with Australian psychologists. Interviews included case study scenarios to provide an in-depth exploration of psychologists’ knowledge and skills in the management of insomnia. Interview transcripts were analysed using thematic analysis to identify themes.
Results
Twenty-six psychologists participated in this study. Four themes were identified in the data: 1) Sleep is important but rarely a treatment priority; 2) Confusion about funding pathways discourages treatment of insomnia; 3) A variety of approaches are used in the management of insomnia; 4) Psychologists with experience in CBTi are rare.
Conclusions
Most Australian psychologists are not well equipped to manage insomnia effectively with CBTi. Along with other primary health care professionals, psychologists need training in the delivery of evidence-based insomnia treatment.
Background:
Sleep difficulties might be a contributory causal factor in the occurrence of mental health problems. If this is true, improving sleep should benefit psychological health. We aimed to determine whether treating insomnia leads to a reduction in paranoia and hallucinations.
Methods:
We did this single-blind, randomised controlled trial (OASIS) at 26 UK universities. University students with insomnia were randomly assigned (1:1) with simple randomisation to receive digital cognitive behavioural therapy (CBT) for insomnia or usual care, and the research team were masked to the treatment. Online assessments took place at weeks 0, 3, 10 (end of therapy), and 22. The primary outcome measures were for insomnia, paranoia, and hallucinatory experiences. We did intention-to-treat analyses. The trial is registered with the ISRCTN registry, number ISRCTN61272251.
Findings:
Between March 5, 2015, and Feb 17, 2016, we randomly assigned 3755 participants to receive digital CBT for insomnia (n=1891) or usual practice (n=1864). Compared with usual practice, the sleep intervention at 10 weeks reduced insomnia (adjusted difference 4·78, 95% CI 4·29 to 5·26, Cohen's d=1·11; p<0·0001), paranoia (-2·22, -2·98 to -1·45, Cohen's d=0·19; p<0·0001), and hallucinations (-1·58, -1·98 to -1·18, Cohen's d=0·24; p<0·0001). Insomnia was a mediator of change in paranoia and hallucinations. No adverse events were reported.
Interpretation:
To our knowledge, this is the largest randomised controlled trial of a psychological intervention for a mental health problem. It provides strong evidence that insomnia is a causal factor in the occurrence of psychotic experiences and other mental health problems. Whether the results generalise beyond a student population requires testing. The treatment of disrupted sleep might require a higher priority in mental health provision.
Funding:
Wellcome Trust.
Cognitive behavioral therapy for insomnia (CBT-I) is the most prominent nonpharmacologic treatment for insomnia disorders. Although meta-analyses have examined primary insomnia, less is known about the comparative efficacy of CBT-I on comorbid insomnia.
To examine the efficacy of CBT-I for insomnia comorbid with psychiatric and/or medical conditions for (1) remission from insomnia; (2) self-reported sleep efficiency, sleep onset latency, wake after sleep onset, total sleep time, and subjective sleep quality; and (3) comorbid symptoms.
A systematic search was conducted on June 2, 2014, through PubMed, PsycINFO, the Cochrane Library, and manual searches. Search terms included (1) CBT-I or CBT or cognitive behavioral [and its variations] or behavioral therapy [and its variations] or behavioral sleep medicine or stimulus control or sleep restriction or relaxation therapy or relaxation training or progressive muscle relaxation or paradoxical intention; and (2) insomnia or sleep disturbance.
Studies were included if they were randomized clinical trials with at least one CBT-I arm and had an adult population meeting diagnostic criteria for insomnia as well as a concomitant condition. Inclusion in final analyses (37 studies) was based on consensus between 3 authors' independent screenings.
Data were independently extracted by 2 authors and pooled using a random-effects model. Study quality was independently evaluated by 2 authors using the Cochrane risk of bias assessment tool.
A priori main outcomes (ie, clinical sleep and comorbid outcomes) were derived from sleep diary and other self-report measures.
At posttreatment evaluation, 36.0% of patients who received CBT-I were in remission from insomnia compared with 16.9% of those in control or comparison conditions (pooled odds ratio, 3.28; 95% CI, 2.30-4.68; P < .001). Pretreatment and posttreatment controlled effect sizes were medium to large for most sleep parameters (sleep efficiency: Hedges g = 0.91 [95% CI, 0.74 to 1.08]; sleep onset latency: Hedges g = 0.80 [95% CI, 0.60 to 1.00]; wake after sleep onset: Hedges g = 0.68; sleep quality: Hedges g = 0.84; all P < .001), except total sleep time. Comorbid outcomes yielded a small effect size (Hedges g = 0.39 [95% CI, 0.60-0.98]; P < .001); improvements were greater in psychiatric than in medical populations (Hedges g = 0.20 [95% CI, 0.09-0.30]; χ2 test for interaction = 12.30; P < .001).
Cognitive behavioral therapy for insomnia is efficacious for improving insomnia symptoms and sleep parameters for patients with comorbid insomnia. A small to medium positive effect was found across comorbid outcomes, with larger effects on psychiatric conditions compared with medical conditions. Large-scale studies with more rigorous designs to reduce detection and performance bias are needed to improve the quality of the evidence.
Limited information is available regarding sleep medicine education worldwide. Nevertheless, medical education has been blamed for the under-recognition of sleep disorders among physicians. This study was designed to assess the knowledge of Saudi undergraduate medical students about sleep and sleep disorders and the prevalence of education on sleep medicine in medical schools as well as to identify the obstacles to providing such education.
We surveyed medical schools that were established more than 10 years ago, asking fourth- and fifth-year medical students (men and women) to participate. Seven medical schools were selected. To assess knowledge on sleep and sleep disorders, we used the Assessment of Sleep Knowledge in Medical Education (ASKME) Survey, which is a validated 30-item questionnaire. The participants were separated into two groups: those who scored >=60% and those who scored <60%. To assess the number of teaching hours dedicated to sleep medicine in the undergraduate curricula, the organizers of the major courses on sleep disorders were contacted to obtain the curricula for those courses and to determine the obstacles to education.
A total of 348 students completed the survey (54.9% male). Among the participants, 27.7% had a specific interest in sleep medicine. More than 80% of the study sample had rated their knowledge in sleep medicine as below average. Only 4.6% of the respondents correctly answered >=60% of the questions. There was no difference in the scores of the respondents with regard to university, gender, grade-point average (GPA) or student academic levels. Only five universities provided data on sleep medicine education. The time spent teaching sleep medicine in the surveyed medical schools ranged from 0-8 hours with a mean of 2.6 +/-2.6 hours. Identified obstacles included the following: (1) sleep medicine has a lower priority in the curriculum (53%) and (2) time constraints do not allow the incorporation of sleep medicine topics in the curriculum (47%).
Medical students in the surveyed institutions possess poor knowledge regarding sleep medicine, which reflects the weak level of education in this field of medicine. To improve the recognition of sleep disorders among practicing physicians, medical schools must provide adequate sleep medicine education.
Although sleep disturbances are comorbid with most psychiatric disorders and both intensify and exacerbate psychiatric distress, graduate clinical psychology programs provide little training in the assessment of sleep and the treatment of sleep disorders in general practice. To address this, a curriculum for a 10-week, 15-module online course on sleep is presented, including rationale for the chosen content and representative learning experiences. Enrolled students were graduate students in doctoral programs in a professional school of psychology. Students' attitudes toward the topic, their self-efficacy to provide assessment and treatment for sleep complaints, and their knowledge about sleep were evaluated prior to and following the course. A matched comparison group of graduate students completed the same measures. All students completed a skills measure demonstrating their assessment and intervention strategy in response to a complex clinical vignette. Enrolled students' knowledge and self-efficacy significantly increased, and after course completion, enrolled students scored significantly higher than comparison participants in appreciation for the role of sleep in mental and physical health, and in confidence in their ability to assess sleep and apply the techniques taught in the course. They also demonstrated greater knowledge and scores on several domains of the skills assessment. We hope that this course provides a template for generalist training in sleep for students and working professionals.
Background
In the absence of a cure, there has been considerable interest in attempts to prevent or reduce the progression of age-related macular degeneration (AMD) by targeting particular modifiable risk factors. The aim of this study was to conduct a cross-sectional survey of the current practice of UK eye care professionals in relation to advice given on diet and other lifestyle modifications for patients with or at risk of AMD.
Methods
Optometrists and ophthalmologists on the membership databases of professional organisations for the two professions were invited to participate in an online survey. The survey was open for 12 weeks between July and September 2012.
Results
A total of 1,468 responses were received (96.3% from optometrists and 3.7% from ophthalmologists). The response rate of those receiving the invitation was 16.2% (1,414/8735) for optometrists and 6% (54/1460) for ophthalmologists. A majority of respondents reported that they frequently provide dietary advice to patients with established AMD (67.9%) and those at risk of AMD (53.6%). Typical advice consisted of a recommendation to eat plenty of leafy green vegetables and eat more oily fish. The decision to recommend nutritional supplements was based on the risk of progression to advanced AMD, with approximately 93% of respondents recommending supplementation in a patient with advanced AMD in one eye. However for the majority, the type of supplement recommended did not comply with current best research evidence, based on the findings of the Age-related Eye Disease Study (AREDS). Only one in three optometrists regularly assessed smoking status and advised on smoking cessation.
Conclusions
Within a large sample of eye care professionals, consisting predominantly of optometrists, who responded to a cross-sectional survey, there was active engagement in providing nutritional advice to patients with or at risk of AMD. However, the results demonstrate a need to raise awareness of the evidence underpinning the use of nutritional supplements together with an increased involvement in targeted smoking cessation.
Background
The objective of this study was to assess the prevalence of education about sleep and sleep disorders in pediatric residency programs and to identify barriers to providing such education.
Methods
Surveys were completed by directors of 152 pediatric residency programs across 10 countries (Hong Kong, India, Indonesia, Japan, Singapore, South Korea, Thailand, United States-Canada, and Vietnam).
Results
Overall, the average amount of time spent on sleep education is 4.4 hours (median = 2.0 hours), with 23% responding that their pediatric residency program provides no sleep education. Almost all programs (94.8%) offer less than 10 hours of instruction. The predominant topics covered include sleep-related development, as well as normal sleep, sleep-related breathing disorders, parasomnias, and behavioral insomnia of childhood.
Conclusions
These results indicate that there is still a need for more efforts to include sleep-related education in all pediatric residency programs, as well as coverage of the breadth of sleep-related topics. Such education would be consistent with the increased recognition of the importance of sleep and under-diagnosis of sleep disorders in children and adolescents.
Qualitative content analysis and thematic analysis are two commonly used approaches in data analysis of nursing research, but boundaries between the two have not been clearly specified. In other words, they are being used interchangeably and it seems difficult for the researcher to choose between them. In this respect, this paper describes and discusses the boundaries between qualitative content analysis and thematic analysis and presents implications to improve the consistency between the purpose of related studies and the method of data analyses. This is a discussion paper, comprising an analytical overview and discussion of the definitions, aims, philosophical background, data gathering, and analysis of content analysis and thematic analysis, and addressing their methodological subtleties. It is concluded that in spite of many similarities between the approaches, including cutting across data and searching for patterns and themes, their main difference lies in the opportunity for quantification of data. It means that measuring the frequency of different categories and themes is possible in content analysis with caution as a proxy for significance.
Thematic analysis is a poorly demarcated, rarely acknowledged, yet widely used qualitative analytic method within psychology. In this paper, we argue that it offers an accessible and theoretically flexible approach to analysing qualitative data. We outline what thematic analysis is, locating it in relation to other qualitative analytic methods that search for themes or patterns, and in relation to different epistemological and ontological positions. We then provide clear guidelines to those wanting to start thematic analysis, or conduct it in a more deliberate and rigorous way, and consider potential pitfalls in conducting thematic analysis. Finally, we outline the disadvantages and advantages of thematic analysis. We conclude by advocating thematic analysis as a useful and flexible method for qualitative research in and beyond psychology.
The aim of the study described was to capture student experiences in postgraduate clinical programmes across Australian universities. The data collected from the Directors of clinical programmes was used to further illustrate the training practices and constraints within the current Australian context. The data were collected through two survey instruments and were analysed by deriving themes via Leximancer as well as quantitative content analysis of percentage response to direct questions. The results indicate that while many students are happy with the training received, there are also many areas open to significant improvement both in the teaching and assessment of clinical skills and course content more generally. Students overwhelmingly prefer practical, interactive, and competency-based teaching and assessment to didactic, written and exam-based alternatives that are still used in most programmes. The responses from programme Directors further illustrate the concerns currently faced by clinical staff engaged in training programmes, with insufficient training places available in the community, fewer clients accessing training clinics, and concerns related to adequate supervision and the competency of students exited from programmes. The findings are discussed in light of limitations to the study and suggestions for future research directions.
Background and Aims: A 1993 survey reported that US medical schools delivered an average of only 2 hours of undergraduate sleep teaching, with 7% undertaking no teaching whatsoever. Abnormal sleep patterns have become increasingly recognised to contribute adversely to human disease and child development. Our aim was to assess whether clinical knowledge breakthroughs have led to an increase in sleep teaching.
To investigate the pattern of medical student teaching about sleep and its disorders in the UK.
A questionnaire was sent to organisers of preclinical and clinical courses in which aspects of sleep and its disorders might appropriately be included.
All UK medical schools.
There was an overall 71% response rate, with all medical schools represented. A wide variation (80-6%) was seen between departments in the provision of such teaching. The median total time given to sleep and its disorders in undergraduate teaching as a whole was five minutes, for preclinical teaching 15 minutes, and zero in clinical teaching. Teaching was particularly limited on the various types of sleep disorder common in clinical practice, and also on non-medication treatments. Little consistency was evident in teaching format, recommended reading, use of other instructional material and student assessment. Awareness of local sleep research or clinics was reported by very few.
As in other countries, undergraduate medical teaching is inadequate as a basis for the development of competence in diagnosing and treating sleep disorders, which are common and cause difficulties in all sections of the population. There is a need to correct this deficiency in ways compatible with recent recommended changes in medical education.
Introduction: Clinical psychologists often treat patients with a sleep disorder. Cognitive-behavioral treatments can independently, or in combination with medical interventions, effectively improve sleep health outcomes. No studies have examined sleep education and training among practicing clinical psychologists.
Method: Actively practicing clinical psychologists were recruited through psychological associations’ e-mail listservs across the United States and Canada. Respondents (N = 200) provided information about: 1) duration and format of formal sleep education and training; 2) perceived self-efficacy to evaluate and treat sleep disorders; and 3) interest in further sleep training.
Results: Clinical psychologists reported a median of 10.0 hours of didactic sleep training (range 0–130 hours) across their training or career. Ninety-five percent reported no clinical sleep training during graduate school, internship, or post-doctoral fellowship. In terms of evaluation and treatment, 63.2% reported feeling at least “Moderately Prepared” to evaluate a patient’s sleep and 59.5% felt at least “Moderately Prepared” to treat a common sleep disorder (insomnia disorder). However, most endorsed using insomnia disorder treatment approaches inconsistent with empirically supported guidelines. The vast majority (99.3%) desired additional sleep training across a variety of delivery formats.
Discussion: Many clinical psychologists engaged in active patient care have received minimal formal sleep training. Despite this, they felt prepared to evaluate and treat sleep disorders. Their treatment recommendations were not aligned with evidence-based standards. This may result in a delay to, or absence of, effective treatment for patients, underscoring the critical need for sleep training among clinical psychologists. It is essential to improve sleep competencies for the field.
Deficient sleep has been recognized as a current health crisis in Australia and New Zealand, contributing to the increased prevalence and severity of chronic diseases and mental health issues. However, all healthcare disciplines currently receive limited training in addressing deficient sleep, which is contributing to the current health crisis. This narrative review considers the following: (1) the prevalence and burden of deficient sleep in Australia and New Zealand; (2) the limited sleep education in healthcare training programs; (3) healthcare providers' lack of knowledge and evidence-based clinical practice in sleep disorders; (4) sleep-focused education initiatives for healthcare providers; (5) an action agenda for improved sleep education for healthcare providers. Both domestic and international sleep initiatives are considered, as is the role of general practitioners (primary care physicians), pediatricians, psychologists, pharmacists, and nurses. Three key themes emerge and guide action: (1) relevant training for students from all healthcare disciplines; (2) continuing professional development for practicing healthcare providers; and (3) translation of evidence-driven best practice into clinical practice. To achieve this sleep education agenda, the sleep community must form and strengthen partnerships across professional associations, public health agencies, and education providers. By improving education and clinical practice in sleep, we will equip healthcare providers with the knowledge and skills needed to address deficient sleep in Australia and New Zealand.
Sleep is a pillar of health, alongside adequate nutrition and exercise. Problems with sleep are common and often treatable. Twenty years ago, UK medical school education on sleep disorders had a median teaching time of 15 min; we investigate whether education on sleep disorders has improved. This is a cross‐sectional survey, including time spent on teaching sleep medicine, subtopics covered and forms of assessment. Thirty‐four medical degree courses in the UK were investigated via a questionnaire. We excluded responses not concerned with general undergraduate education (i.e. optional modules). Twenty‐five (74%) medical schools responded. Time spent teaching undergraduates sleep medicine was: median, 1.5 hr; mode, <1 hr; mean, 3.2 hr (SD = 2.6). Only two schools had a syllabus or core module (8%) and five (22%) were involved in sleep disorders research. Despite the above, half of the respondents thought provision was sufficient. Free‐text comments had recurring themes: sleep medicine is subsumed into other specialties, obstructive sleep apnea dominates teaching, knowledge of sleep disorders is optional, and there is inertia regarding change. A substantial minority of respondents were enthusiastic about improving provision. In conclusion, little has changed over 20 years: sleep medicine is neglected despite agreement on its importance for general health. Sleep research is the exception rather than the rule. Obstacles to change include views that “sleep is not a core topic” or “the curriculum is too crowded”. However, there is enthusiasm for improvement. We recommend establishment of a sleep medicine curriculum. Without better teaching, doctors will remain ill‐equipped to recognize and treat these common conditions.
Chronic insomnia is highly comorbid with multiple psychological and physical disorders, but most notably depression. While insomnia is now viewed as a risk factor for depression, and not just a 'symptom' of the disorder, the reasons for this change in classification (from symptom to risk factor) have yet to be clearly articulated. This is one goal of the present review. Furthermore, efforts to identify the mechanisms, by which insomnia is related to increases in depression is a burgeoning area of research. Here, our second goal is to highlight several potential mechanisms that can be targets for future research.
Since initially writing on thematic analysis in 2006, the popularity of the method we outlined has exploded, the variety of TA approaches have expanded, and, not least, our thinking has developed and shifted. In this reflexive commentary, we look back at some of the unspoken assumptions that informed how we wrote our 2006 paper. We connect some of these un-identified assumptions, and developments in the method over the years, with some conceptual mismatches and confusions we see in published TA studies. In order to facilitate better TA practice, we reflect on how our thinking has evolved – and in some cases sedimented – since the publication of our 2006 paper, and clarify and revise some of the ways we phrased or conceptualised TA, and the elements of, and processes around, a method we now prefer to call reflexive TA.
Introduction:
Major depressive disorder is one of the most commonly diagnosed psychiatric illnesses, and it has a profound negative impact on an individual's ability to function. Up to 90% of individuals suffering from depression also report sleep and circadian disruptions. If these disruptions are not effectively resolved over the course of treatment, the likelihood of relapse into depression is greatly increased. Cognitive Behavioural Therapy for Insomnia (CBT-I) has shown promise in treating these sleep and circadian disturbances associated with depression, and may be effective as a stand-alone treatment for depression. This may be particularly relevant in cases where antidepressant medications are not ideal (e.g. due to contraindications, cost, or treatment resistance).
Methods:
A systematic literature review was conducted of trials investigating the use of CBT-I to treat depression in adults. Therapy included in-person CBT-I, as well as telehealth and group CBT-I.
Results and conclusions:
CBT-I presents a promising treatment for depression comorbid with insomnia. In-person therapy has the most supporting evidence for its efficacy, though treatment effects may not be additive with those of antidepressant medications. Insomnia improvement due to CBT-I may mediate the improvement in depressive symptoms. There is less evidence for the use of telehealth, though a stepped-care approach is indicated based on baseline depressive severity. More research on group therapy and telehealth modalities of delivering CBT-I are required before making recommendations.
Background:
Sleep hygiene education (SHE) is commonly used as a treatment of insomnia in general practice. Whether SHE or cognitive-behavioural therapy for insomnia (CBT-I), a treatment with stronger evidence base, should be provided first remains unclear.
Objective:
To review the efficacy of SHE for poor sleep or insomnia.
Methods:
We systematically searched six key electronic databases up until May 2017. Two researchers independently selected relevant publications, extracted data and evaluated methodological quality according to the Cochrane criteria.
Results:
Twelve of 15 studies compared SHE with CBT-I, three with mindfulness-based therapy, but none with sham or no treatment. General knowledge about sleep, substance use, regular exercise and bedroom arrangement were commonly covered; sleep-wake regularity and avoidance of daytime naps in seven programs, but stress management in only five programs. Major findings include (i) there were significant pre- to post-treatment improvements following SHE, with small to medium effect size; (ii) SHE was significantly less efficacious than CBT-I, with difference in effect size ranging from medium to large; (iii) pre- to post-treatment improvement and SHE-CBT-I difference averaged at 5% and 8% in sleep-diary-derived sleep efficiency, respectively, and two points in Pittsburgh Sleep Quality Index; (iv) only subjective measures were significant and (v) no data on acceptability, adherence, understanding and cost-effectiveness.
Conclusions:
Although SHE is less effective than CBT-I, unanswered methodological and implementation issues prevent a firm conclusion to be made on whether SHE has a role in a stepped-care model for insomnia in primary care.
Objective:
To assess the current state of sleep medicine educational resources and training offered by North American psychiatry residency programs.
Methods:
In June 2013, a 9-item peer-reviewed Sleep Medicine Training Survey was administered to 39 chief residents of psychiatry residency training programs during a meeting in New York.
Results:
Thirty-four percent of the participating programs offered an elective rotation in sleep medicine. A variety of innovative approaches for teaching sleep medicine were noted. The majority of the chief residents felt comfortable screening patients for obstructive sleep apnea (72%), half felt comfortable screening for restless legs syndrome (53%), and fewer than half were comfortable screening for other sleep disorders (47%).
Conclusions:
This is the first report in the last decade to provide any analysis of current sleep medicine training in North American psychiatry residency training programs. These data indicate that sleep medicine education in psychiatry residency programs is possibly in decline.
As sleep and psychiatric disorders are not only comorbid but also co-dependent, patients require individual and integrated attention. The benefits of treating sleep disorders in the context of psychopathology are likely to extend beyond improved sleep, with demonstrated improvements in mental health.
The need to train non-sleep-specialist health professionals in evidence-based pediatric behavioral sleep care is well established. The objective of the present study was to develop a list of core competencies for training health professionals in assisting families of 1- to 10-year old children with behavioral insomnia of childhood. A modified Delphi methodology was employed, involving iterative rounds of surveys that were administered to 46 experts to obtain consensus on a core competency list. The final list captured areas relevant to the identification and treatment of pediatric behavioral sleep problems. This work has the potential to contribute to the development of training materials to prepare non-sleep-specialist health professionals to identify and treat pediatric behavioral sleep problems, ideally within stepped-care frameworks.
Rapidly emerging evidence continues to describe an intimate and causal relationship between sleep and emotional brain function. These findings are mirrored by long-standing clinical observations demonstrating that nearly all mood and anxiety disorders co-occur with one or more sleep abnormalities. This review aims to (a) provide a synthesis of recent findings describing the emotional brain and behavioral benefits triggered by sleep, and conversely, the detrimental impairments following a lack of sleep; (b) outline a proposed framework in which sleep, and specifically rapid-eye movement (REM) sleep, supports a process of affective brain homeostasis, optimally preparing the organism for next-day social and emotional functioning; and (c) describe how this hypothesized framework can explain the prevalent relationships between sleep and psychiatric disorders, with a particular focus on posttraumatic stress disorder and major depression. Expected final online publication date for the Annual Review of Clinical Psychology Volume 10 is March 20, 2014. Please see http://www.annualreviews.org/catalog/pubdates.aspx for revised estimates.
A third way of conceptualizing mixed methods research is proposed, one based on critical interpretive methodologies.
To evaluate the current state of sleep medicine educational resources and training offered by US neurology residency programs.
In 2010, a 20-item peer reviewed Sleep Education Survey (SES) was sent to neurology residency program directors surveying them about sleep medicine educational resources used in teaching residents. Pearson product momentum correlation was used to determine correlation of program attributes with resident interest in pursuing a career in sleep medicine.
Of the programs completing the survey, 81% listed a formal sleep rotation and 24% included a forum for sleep research. A variety of innovative approaches for teaching sleep medicine were noted. Program directors noted that 5.7% residents entered sleep medicine fellowship training programs in the preceding 5 years. Programs that had a more substantial investment in sleep medicine teaching resources were more likely to report residents entering a sleep medicine training program.
This is the first report providing an analysis of the current state of sleep medicine training in US Neurology Residency Programs. Our data provide evidence that investment by the residency program in sleep education may enhance the ultimate decision by the neurology trainee to pursue a career in sleep medicine.
Avidan AY; Vaughn BV; Silber MH. The current state of sleep medicine education in us neurology residency training programs: where do we go from here? J Clin Sleep Med 2013;9(3):281-286.
Objective:
Over 40-million Americans are undiagnosed, misdiagnosed, or untreated for sleep disorders. Despite the growing need to integrate sleep medicine knowledge into the medical education curriculum, educational leaders have struggled to incorporate contemporary medical topics such as sleep medicine into the already packed curricula. We set out to examine the efficacy of an online, self-paced, sleep medicine learning module as an educational tool for medical students.
Methods:
We studied 87 Johns Hopkins medical students. Participants were randomly assigned to the sham module (SM, n=40) or learning module (LM, n=47). The efficacy of the tool was assessed based on changes in performance (pre- and post-module completion) on a validated sleep knowledge questionnaire (the Dartmouth Sleep Knowledge and Attitude Survey).
Results:
Improvement in overall sleep knowledge, as measured by the Dartmouth Sleep Knowledge and Attitude Survey, was significantly higher in the LM group compared to the SM group (F(1,84)=9.71, p<.01, η(2)=0.10). Although the SM group's improvement was significantly lower than the LM group, within-subject comparisons did show improvement from their pre- to post-assessment scores as well.
Conclusion:
A self-paced learning module is an effective educational tool for delivering sleep medicine knowledge to medical students.
Background and objectives:
Pharmacists are in an optimal position to provide health care to patients with sleep disorders, however, at present their involvement in sleep services is limited. This study aimed to (i) establish an understanding of baseline levels of sleep health awareness, and attitudes towards sleep health in pharmacists and pharmacy undergraduate students in comparison with sleep physicians and (ii) collate the expressed preferences for sleep health training by final year pharmacy undergraduate students and practising community pharmacists.
Methods:
Two previously validated instruments, the Dartmouth sleep knowledge survey and the ASKME (attitudes section) were used to construct a self-report style questionnaire. Data from respondents were collated and analysed to evaluate differences in responses and test scores between the groups, using the statistical software package-spss 14.0.
Results and discussion:
Responses from 14 specialized sleep pharmacists, 14 general community pharmacists, 134 final-year undergraduate pharmacy students and 26 sleep physicians were obtained. The mean knowledge score per cent (35.5 +/- 14.0% for students, 48.2 +/- 19.5% for general and 50.6 +/- 16.6% for specialized sleep pharmacists, 86.7 +/- 9.3% for sleep physicians) and attitudes scores (37.3 +/- 4.0 for students, 37.2 +/- 5.4 for general and 40.3 +/- 5.3 for sleep specialist pharmacists, 42.6 +/- 4.7 for sleep physicians, expressed as a score out of 50) were significantly different between groups (Kruskal-Wallis test, P < 0.001). All groups reported slightly different preferences for future training formats and topics. There is a need to improve practising pharmacists' as well as undergraduate students' knowledge of sleep health. The positive attitude reported by the respondents indicates a high level of interest in acquiring knowledge and suggests that a tailored educational programme would be well received and timely.
Conclusion:
These results provide a valid indication of the pharmacy profession's expressed and actual training needs, and should be used to inform the design, implementation and evaluation of a sleep health educational strategy, which targets practising community pharmacists and students.
This article examines the relationship between sleep disturbance and psychopathology. Epidemiological, cross-sectional, and longitudinal data suggest a high rate of comorbidity between sleep disturbance and psychopathology, particularly between insomnia, anxiety, and depression. Between 50% and 80% of psychiatric patients complain of sleep disturbances during the acute phase of their illness. Conversely, among treatment-seeking individuals with a primary complaint of insomnia and randomly selected community samples, approximately one third display a concurrent psychopathology, one third exhibit psychological symptoms that do not necessarily exceed the threshold for a psychiatric disorder, and another third present insomnia as a functionally autonomous disorder. There is a positive relationship between severity of sleep disturbances and concurrent psychopathology, but unequivocal evidence of a cause-and-effect relationship is still lacking. However, longitudinal data suggest that anxiety and stressful life events often precede acute sleep difficulties, whereas persistent insomnia may be a risk factor for subsequent development of depression. Implications for the prevention and treatment of coexisting sleep disturbance and psychopathology are discussed.
The objective of this study was to assess the prevalence of education about sleep and sleep disorders in medical school education and to identify barriers to providing such education.
Surveys were sent to 409 medical schools across 12 countries (Australia, India, Indonesia, Japan, Malaysia, New Zealand, Singapore, South Korea, Thailand, United States, Canada and Viet Nam).
Overall, the response rate was 25.9%, ranging from 0% in some countries (India) to 100% in other countries (New Zealand and Singapore). Overall, the average amount of time spent on sleep education is just under 2.5h, with 27% responding that their medical school provides no sleep education. Three countries (Indonesia, Malaysia, and Viet Nam) provide no education, and only Australia and the United States/Canada provide more than 3h of education. Paediatric topics were covered for a mere 17 min compared to over 2h on adult-related topics.
These results suggest that there continues to be very limited coverage of sleep in medical school education despite an incredible increase in acknowledgement of the importance of sleep and need for recognition of sleep disorders by physicians.
Bjorvatn, B., Fiske, E. & Pallesen, S. (2011). A self-help book is better than sleep hygiene advice for insomnia: A randomized controlled comparative study. Scandinavian Journal of Psychology 52, 580–585.
The objective was to compare the effects of two types of written material for insomnia in a randomized trial with follow-up after three months. Insomniacs were recruited through newspaper advertisements to a web-based survey with validated questionnaires about sleep, anxiety, depression, and use of sleep medications. A self-help book focusing on cognitive behavioral therapy for insomnia was compared to standard sleep hygiene advice; 77 and 78 participants were randomized to self-help book or sleep hygiene advice, respectively. The response rate was 81.9%. The self-help book gave significantly better scores on the sleep questionnaires compared to sleep hygiene advice. The proportion using sleep medications was reduced in the self-help book group, whereas it was increased in the sleep hygiene group. Compared to pre-treatment, the self-help book improved scores on the sleep (effect sizes 0.61–0.62) and depression (effect size 0.18) scales, whereas the sleep hygiene advice improved scores on some sleep scales (effect sizes 0.24–0.28), but worsened another (effect size –0.36). In addition, sleep hygiene advice increased the number of days per week where they took sleep medications (effect size –0.50). To conclude, in this randomized controlled trial, the self-help book improved sleep and reduced the proportion using sleep medications compared to sleep hygiene advice. The self-help book is an efficient low-threshold intervention, which is cheap and easily available for patients suffering from insomnia. Sleep hygiene advice also improved sleep at follow-up, but increased sleep medication use. Thus, caution is warranted when sleep hygiene advice are given as a single treatment.
Sleep disturbance is increasingly recognized as an important, but understudied, mechanism in the complex and multi-factorial causation of the symptoms and functional disability associated with psychiatric disorders. This review proposes that it is biologically plausible for sleep disturbance to be mechanistically transdiagnostic. More specifically, we propose that sleep disturbance is aetiologically linked to various forms of psychopathology through: its reciprocal relationship with emotion regulation and its shared/interacting neurobiological substrates in (a) genetics--genes known to be important in the generation and regulation of circadian rhythms have been linked to a range of disorders and (b) dopaminergic and serotonergic function--we review evidence for the interplay between these systems and sleep/circadian biology. The clinical implications include potentially powerful and inexpensive interventions including interventions targeting light exposure, dark exposure, the regulation of social rhythms and the reduction of anxiety. We also consider the possibility of developing a 'transdiagnostic' treatment; one treatment that would reduce sleep disturbance across psychiatric disorders.
Sleep disturbance commonly co-occurs with a range of psychiatric disorders. This is of concern given the accruing evidence that sleep is critically important for mood regulation, physical health, cognitive functioning, and quality of life. There is strong evidence that insomnia, even if it is comorbid with another psychiatric disorder, is treatable with cognitive behavioral therapy. There is a need to develop cognitive behavioral approaches to the other types of sleep disturbance often experienced by patients with psychiatric disorders, such as hypersomnia, reduced sleep need, delayed phase, nocturnal panic attacks, and nightmares. The possibility of developing a transdiagnostic treatment that comprehensively treats sleep disturbance for use across psychiatric disorders is discussed because (a) there are many disorders in which multiple types of sleep disturbance can be characteristic at one time or over the life-course of the disorder and (b) there are considerable challenges inherent to disseminating any new treatments but particularly many "disorder-specific" treatments.
There is growing evidence to suggest that clinical psychologists would benefit from more training in sleep and sleep disorders. Sleep disturbances are commonly comorbid with mental health disorders and this relationship is often bidirectional. In addition, psychologists have become integral members of multidisciplinary sleep medicine teams and there are not enough qualified psychologists to meet the clinical demand. The purpose of this study was to evaluate the current education on sleep and sleep disorders provided to clinical psychology predoctoral students and interns. Directors of graduate programs and internships (N=212) completed a brief online survey on sleep education in their program. Only 6% of programs offers formal didactic courses in sleep, with 31% of programs offering training in the treatment of sleep disorders. There are few programs with sleep faculty (16%), and most reported that their institutions were ineffective in providing sleep education. Thirty-nine percent of training directors reported they would implement a standard curriculum on sleep, if available. The findings from this study suggest that more opportunities are needed for trainees in clinical psychology to gain didactic and clinical experience with sleep and sleep disorders.
A national survey was conducted of 126 accredited medical schools in the United States to evaluate physician education in sleep and sleep disorders and to identify potential obstacles to effective teaching in the area. Parallel survey instruments were designed to evaluate preclinical and clinical training in sleep. Instructors indicated the specific courses in which this material is taught, the format of teaching, methods of student evaluation, assigned readings and clinical experience and educational resources provided. A total of 545 responses were received, which represents an 82.6% overall response rate. Responses were obtained from all accredited medical schools, and the sample was about equally divided between preclinical and clinical course directors. Less than 2 hours of total teaching time is allocated to sleep and sleep disorders, on average, with 37 schools reporting no structured teaching time whatever in this area. Only 8% of medical students are trained in the use of sleep laboratory procedures, and 11% have participated in the clinical evaluation of sleep-disordered patients. Less than 5% of medical schools offer 4 or more hours of didactic teaching on sleep, most of which consists of 4th year elective experiences. More than two-thirds of the survey respondents stated that current education is inadequate and that additional time should be devoted to this area. The major obstacles reported are the unavailability of qualified faculty, lack of curriculum time and the need for additional clinical and educational resources. Overall, it appears that physician education in sleep and sleep disorders is largely inadequate, despite increasing evidence of the role of sleep in patient health and well-being.
Previous research has shown evidence of a widening gap between scientific research and clinical teaching in sleep and sleep disorders. To address the deficiencies in current medical education in sleep, the Taskforce 2000 was established by the American Sleep Disorders Association. The present study was undertaken to assess the teaching activities, needs and interests of the membership of the two largest professional sleep societies (American Sleep Disorders Association and Sleep Research Society). Survey instruments included a brief, 5-item postcard survey, which was mailed to all members, followed by an in-depth, 34-item questionnaire, which was completed by 158 respondents from the intitial postcard survey (N = 808). Results indicated that the majority of respondents (65.2%) are currently involved in teaching sleep to medical students or postgraduate trainees, although the average amount of teaching time was only 2.1 hours for undergraduate and 4.8 hours for graduate education in sleep. Teaching of sleep laboratory procedures and clinical evaluation of sleep-disordered patients is limited at either an undergraduate or postgraduate level. The major deficiencies noted were the lack of time in the medical curriculum and the need for better resources and teaching facilities. A large majority of respondents indicated their willingness to be involved in sleep education for physicians, and rated this a high priority for the professional organization.
This report describes the construction and validation of a brief self-administered scale to assess sleep knowledge in medical education ("ASKME Survey"). Few measures of this type have been developed previously; none have been validated or widely adopted. The current instrument was designed as a standardized assessment measure for use in medical education in sleep.
Instrument was developed in four phases: initial item selection, expert panel review, reliability and construct validity assessment, and final item selection. Content validity was assessed in six general domains: basic sleep principles; circadian sleep/wake regulation; normal sleep architecture; sleep disorders; effects of drugs and alcohol on sleep; and sleep in medical disorders.
N/A.
Medical students at Robert Wood Johnson Medical School (RWJMS) and University of Kentucky College of Medicine; students in clinical psychology, nursing and other health-related professions at Rutgers University; school nurses at Texas Christian University; practicing physicians; accredited sleep specialists.
N/A.
Individual item analysis of 30-item survey demonstrated a high degree of discriminant validity. Internal consistency for test items was relatively high (KR-20=0.89). Overall mean percentage correct was highest for accredited sleep specialists (85.3%+/-10.8%) and lowest for school nurses (53.1%+/-13.7%). Significant group differences were observed across all question categories (p < 0.0001). Medical students scored significantly higher than the nurses on questions related to sleep architecture (59.5% vs. 42.5%) and narcolepsy (36.4% vs. 21.3%).
"ASKME" demonstrates a high degree of internal consistency and reliability among survey items. It discriminates between samples with varied levels of education, experience, and specialty training. The survey is currently available via the American Academy of Sleep Medicine website (http://www.aasmnet.org).
To construct and validate an instrument for the purpose of assessing effectiveness of curriculum development and educational interventions in sleep medicine.
Medical school and graduate medical curricula have historically contained quite limited instruction in sleep physiology and sleep medicine. Recent initiatives, particularly the Sleep Academic Award program, have attempted to address this issue through support of programs designed to develop educational resources and implement curriculum change. Effective measures for assessment of educational outcome are an essential component of these interventions.
A panel of sleep experts, other medical professionals, and education consultants developed a knowledge and attitude survey, designed to address a broad range of topics in sleep physiology and medicine. The instrument was modified in response to pilot testing, and a final 24-item survey has been administered to two cohorts of college undergraduates before and immediately following a ten-week course of instruction and to a single cohort of first-year medical students. A group of sleep medicine experts served as the comparison population. Results were analyzed for item difficulty, item discrimination, and instructional sensitivity.
Analyses of item difficulty, item discrimination, and instructional sensitivity were in line with acceptable norms for criterion-referenced tests. There was evidence of discriminative validity, as shown by scores on the measure and acknowledged expertise.
This instrument demonstrates both logical and empirical evidence of validity and may serve as a useful tool in assessing outcome of educational interventions in sleep medicine.
What type of training predicts adherence to CBT-I among professionals specializing in the treatment of insomnia?
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Report on sleep training in clinical psychology programs
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Perceptions, skills, and knowledge of sleep-related difficulties and their treatment in a cancer psychosocial workshop
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A historical perspective and commentary on practice issues
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Bedtime reading: Inquiry into sleep health awareness in Australia
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