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Cited by 37Sleep and related disordersHealth Policy Implementation SciencePsychotherapy Techniques and Applications

Become your own SLEEPexpert: design, implementation, and preliminary evaluation of a pragmatic behavioral treatment program for insomnia in inpatient psychiatric care

Open access
Schneider, Carlotta Louisa, Hertenstein, Elisabeth, Fehér, Kristoffer, Maier, Jonathan Gabriel, Cantisani, Andrea, Moggi, Franz, Berger, Thomas, Nissen, Christoph·2020·SLEEP Advances
DOI 10.1093/sleepadvances/zpaa005PMC PMC10104352
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Abstract

Study Objectives: The majority of patients with mental disorders suffer from insomnia, associated with adverse health outcomes. Cognitive behavioral therapy for insomnia (CBT-I) represents the first-line treatment, but is too complex for severely ill patients and not systematically implemented in inpatient psychiatric care. This project aimed to develop a pragmatic behavioral treatment program that empowers inpatients with severe mental disorders to take care of their own sleep health. Methods: CBT-I was adapted based on implementation research involving 24 inpatients with psychiatric disorders across diagnostic entities and comorbid insomnia and 30 health care providers at the University Hospital of Psychiatry and Psychotherapy, Bern. The program was implemented and evaluated by 15 patients and 22 health care providers based on interviews and questionnaires before participation and prior to discharge. Results: Implementation research resulted in the SLEEPexpert intervention, centering on bedtime restriction and circadian adaptation in three phases; therapist-guided treatment initiation, self-management with nursing support, and self-management. Evaluative pre-post assessments in 15 patients demonstrated feasibility. Time in bed decreased by 60 minutes (520 ± 105.3 vs. 460 ± 78.1, p = 0.031, d = 0.6) and total sleep time increased by around 45 minutes (331 ± 110.6 vs. 375 ± 74.6, p = 0.09, d = 0.5), resulting in increased sleep efficiency (65.3 ± 21.8 vs. 81.9 ± 11.2%, p = 0.011, d = 0.8). Patients improved on the Insomnia Severity Index (18.3 ± 4.6 vs. 11.4 ± 4.4, p < 0.001, d = 1.2) and Pittsburgh Sleep Quality Index (12.9 ± 3.8 vs. 10.3 ± 3.3, p = 0.031, d = 0.6). Conclusions: We propose a new pragmatic behavioral treatment program (SLEEPexpert) customized to the needs of patients and health care providers in inpatient psychiatric care. Data demonstrate feasibility. An improvement of insomnia severity was observed, but a control comparison is needed to further test for efficacy.

AI snapshot

Written from the paper’s full text.

TL;DR

The paper describes the development, implementation, and preliminary evaluation of SLEEPexpert, a pragmatic inpatient psychiatric behavioral insomnia program adapted from CBT-I and centered on bedtime restriction and circadian adaptation. In 15 evaluated inpatients, insomnia severity and sleep efficiency improved pre-post, but the authors state that a control comparison is needed to test efficacy.

Key findings

  • Implementation research with 24 inpatients with acute psychiatric disorders and comorbid insomnia and 30 health care providers produced SLEEPexpert in three phases: therapist-guided treatment initiation, self-management with nursing support, and self-management.
  • In 15 patients, time in bed decreased by 60 minutes (520 ± 105.3 vs. 460 ± 78.1, p = 0.031, d = 0.6), total sleep time increased by around 45 minutes (331 ± 110.6 vs. 375 ± 74.6, p = 0.09, d = 0.5), and sleep efficiency increased (65.3 ± 21.8 vs. 81.9 ± 11.2%, p = 0.011, d = 0.8).
  • Insomnia Severity Index decreased from 18.3 ± 4.6 to 11.4 ± 4.4 (p < 0.001, d = 1.2), and Pittsburgh Sleep Quality Index decreased from 12.9 ± 3.8 to 10.3 ± 3.3 (p = 0.031, d = 0.6); Brief Symptom Inventory-18 change was non-significant (29.1 ± 13.7 vs. 24.0 ± 14.4, p = 0.055, d = 0.5).
  • Evaluative interviews indicated most patients perceived sleep therapy as important, the therapist-guided initiation with individually prescribed sleep window was judged most helpful, and health care providers reported the additional effort was feasible but greater with severely affected patients.

Methods

  • Program development used implementation research involving 24 inpatients and 30 health care providers; semi-structured interviews were analyzed with qualitative content analysis, alongside design thinking, nursing team training, and iterative adaptations.
  • Evaluation included 15 patients and 22 health care providers using interviews and questionnaires before participation and prior to discharge (days 17.9 ± 6.7), including sleep diary, Insomnia Severity Index, Pittsburgh Sleep Quality Index, and Brief Symptom Inventory-18.
  • Data analysis reported means and standard deviations, paired-samples t-tests, effect size estimates, and SPSS version 26.

Limitations

  • The paper states that a control comparison is needed to further test efficacy, that future randomized controlled and powered trials are required, and that follow-up assessments are needed after discharge; it also notes that the small sample size prevented further differentiation by diagnosis and that the PSQI offers low resolution as an adherence measure.
  • Evident from the text: the evaluation is an uncontrolled pre-post pilot with only 15 patients, no follow-up, and a heterogeneous severely ill inpatient sample; implementation challenges included patients unavailable for evaluation due to discharge and ward routines such as early dinner times and reduced evening activity complicating adherence.
  • The paper states that medication changes suggest effects cannot be fully attributed to pharmacotherapy, while also reporting no systematic increase in sedative medication; this remains a potential confound in the uncontrolled design.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1093/sleepadvances/zpaa005

Cites

24 of 24 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

0 of 18 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    Evaluative pre-post assessments in 15 patients demonstrated feasibility.

    “Evaluative pre-post assessments in 15 patients demonstrated feasibility.”
    Quote in the paperSubstantial claim
  • Findingown data

    Time in bed decreased by 60 minutes from pre- to post-assessment in 15 patients.

    “Time in bed decreased by 60 minutes (520 ± 105.3 vs. 460 ± 78.1, p = 0.031, d = 0.6)”
    • Also stated in: § Feasibility and observation of sleep-related improvement · hedged
      “The reported TIB decreased by about 60 minutes (Panel E, 520 ± 105.3 vs.460 ± 78.1, t(14) = 2.4, p = 0.031, d = 0.6)”
    Quote in the paperSubstantial claim
  • Findingown data

    Most patients believe their mental disorder to be a possible source of their insomnia, followed by dysfunctional thoughts and stress.

    “Most patients believe their mental disorder to be a possible source of their insomnia, followed by dysfunctional thoughts (“I can’t stop ruminating during bedtime”) and stress (“I feel a constant pressure is the biggest burden on me”) (Panel C).”
    Quote in the paperNot a substantial claim
  • Findingown data

    Sleep efficiency increased from pre- to post-assessment in 15 patients.

    “resulting in increased sleep efficiency (65.3 ± 21.8 vs. 81.9 ± 11.2%, p = 0.011, d = 0.8)”
    • Also stated in: § Feasibility and observation of sleep-related improvement · plain
      “Panel C shows an increase of sleep efficiency from pre- to post-assessment (SE, 65.3% ± 21.8 vs. 81.9% ± 11.2, t(14) = −2.9, p = 0.011, d = 0.8).”
    Quote in the paperSubstantial claim
  • Findingown data

    Patients improved on the Insomnia Severity Index from pre- to post-assessment.

    “Patients improved on the Insomnia Severity Index (18.3 ± 4.6 vs. 11.4 ± 4.4, p < 0.001, d = 1.2)”
    • Also stated in: § Feasibility and observation of sleep-related improvement · plain
      “both ISI (Panel A, 18.3 ± 4.6 vs. 11.4 ± 4.4, t(14) = 4.5, p < 0.001, d = 1.2) and PSQI scores (Panel B, 12.9 ± 3.8 vs. 10.3 ± 3.3, t(14) = 2.4, p = 0.031, d = 0.6) significantly decreased from pre- to post-assessments (n = 15).”
    Quote in the paperSubstantial claim
  • May combine two claims. 14
  • Classified as probably not a substantial claim. 26

  • May combine two claims.

    Findingown data

    Implementation research resulted in the SLEEPexpert intervention, centering on bedtime restriction and circadian adaptation in three phases: therapist-guided treatment initiation, self-management with nursing support, and self-management.

    “Implementation research resulted in the SLEEPexpert intervention, centering on bedtime restriction and circadian adaptation in three phases; therapist-guided treatment initiation, self-management with nursing support, and self-management.”
    • Also stated in: § “Become your own SLEEPexpert”: the intervention · plain
      “Implementation research resulted in a pragmatic treatment program (“Become your own SLEEPexpert”) customized to the needs of inpatients and health care providers in inpatient psychiatry.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Our own clinical experience and data, in line with other work, shows that insomnia is often treated with hypnotics, comprising benzodiazepines or benzodiazepine receptor agonists, associated with the risk of tolerance and dependency.

    “Our own clinical experience and data, in line with other work, shows that insomnia is often treated with hypnotics, comprising benzodiazepines or benzodiazepine receptor agonists, associated with the risk of tolerance and dependency.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Patients, some suffering from acute hallucinations or suicidality, as well as health care providers on psychiatric wards show a strong interest in non-pharmacological treatment options.

    “Our work shows that patients, some of them suffering from acute hallucinations or suicidality, as well as health care providers on psychiatric wards show a strong interest in non-pharmacological treatment options.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Findingown data

    A broad consensus amongst health care providers was the wish to reduce overtreatment with sleep medication.

    “A broad consensus amongst health care providers was the wish to reduce overtreatment with sleep medication; however, they felt a lack of alternative due to limited resources (available non-medicinal treatment, knowledge, and training).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The majority reported an increase in their awareness towards their sleep-wake rhythm, followed by a decrease in bedtime rumination.

    “The majority reported an increase in their awareness towards their sleep-wake rhythm, followed by a decrease in bedtime rumination (Panel E).”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Findingown data

    Initial interviews in 30 health care providers emphasize the need for a specialized insomnia treatment due to the high prevalence, negative impact, and additional work-load insomnia poses on daily ward routines.

    “Initial interviews in 30 health care providers emphasize the need for a specialized insomnia treatment due to the high prevalence, negative impact, and additional work-load insomnia poses on daily ward routines.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Findingown data

    Health care providers felt a lack of alternative to sleep medication due to limited resources.

    “A broad consensus amongst health care providers was the wish to reduce overtreatment with sleep medication; however, they felt a lack of alternative due to limited resources (available non-medicinal treatment, knowledge, and training).”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Findingreasoning

    The individual sleep window was determined during the kick-off session based on patient reports and therapist feedback to circumvent substantial delays in the acute care setting.

    “In contrast to standard procedures (sleep window based on sleep diary entries over a 2-week period), the sleep window here was determined during the kick-off session based on patient reports and therapist feedback (TIB, TST, chronotype, etc.) to circumvent substantial delays in the acute care setting.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Determining the individual sleep window during the kick-off session based on patient reports and therapist feedback is adequate to circumvent delays without compromising treatment.

  • May combine two claims.

    Findingown data

    At post-assessment, most patients scored below clinically relevant insomnia, with three scoring below the insomnia subthreshold.

    “At post-assessment, most patients scored below clinically relevant insomnia, with three scoring below the insomnia subthreshold (score ≤ 8).”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    The nursing team pointed to challenges such as patient adherence.

    “The nursing team reported confidence in the feasibility of integrating pragmatic treatment components into a daily ward routine (two brief interactions with each patient each week), as well as pointing to challenges such as patient adherence.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Health care providers reported that the overall additional effort surrounding SLEEPexpert was feasible, however, more extensive with severely affected patients.

    “The health care providers reported that the overall additional effort surrounding SLEEPexpert was feasible, however, more extensive with severely affected patients.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    ISI cutoff scores indicate that all patients suffered from insomnia at pre-assessment, with most categorized as moderately severe to severe insomnia.

    “ISI cutoff scores (Panel A) indicate that all patients suffered from insomnia (score ≥ 8) at pre-assessment, with most categorized as moderately severe to severe insomnia (score ≥ 15).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The majority of patients reported exhaustion as a result of insomnia affecting their emotional state, followed by dysfunctional thoughts and irritability.

    “Furthermore, the majority of patients reported exhaustion as a result of insomnia affecting their emotional state, followed by dysfunctional thoughts and irritability (Panel D).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Medication changes were heterogeneous: seven patients had no change, four had an increase in dosage, four received a decreased dosage, and two successfully underwent benzodiazepine withdrawal during observation.

    “Seven patients had no change in medication; four patients had an increase in dosage; four patients received a decreased dosage with two successfully undergoing benzodiazepine withdrawal during the time of observation.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingnone given

    The contact used existing resources, ensuring implementation into routine care.

    “The contact used existing resources, ensuring implementation into routine care.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    The overall success of standard treatment is perceived to be limited due to patients' extended bedtimes.

    “Furthermore, the overall success of standard treatment is perceived to be limited due to patients’ extended bedtimes.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Qualitative content analyses of the evaluative interviews prior to discharge in 15 patients resulted in six categories best representing the data.

    “Qualitative content analyses of the evaluative interviews prior to discharge (n = 15 patients) resulted in six categories best representing the data (Figure 5).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    The nursing team reported confidence in the feasibility of integrating pragmatic treatment components into a daily ward routine.

    “The nursing team reported confidence in the feasibility of integrating pragmatic treatment components into a daily ward routine (two brief interactions with each patient each week), as well as pointing to challenges such as patient adherence.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationnone given

    Insomnia in inpatient psychiatric care often remains untreated or overtreated with hypnotics, which bears the risk of adverse effects and dependency.

    “Rather, insomnia in inpatient psychiatric care often remains untreated or overtreated with hypnotics, which bears the risk of adverse effects and dependency.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    Other work described insurmountable obstacles for implementing bedtime restriction in inpatient psychiatric care, such as limited cooperation of patients and insufficient health care resources.

    “However, other work described insurmountable obstacles for implementing bedtime restriction in inpatient psychiatric care, such as limited cooperation of patients and insufficient health care resources on the investigated wards [12].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [12] de Niet G, et al Applicability of two brief evidence-based interventions to improve sleep quality in inpatient mental health care. Int J Ment Health Nurs. 2011; 20(5): 319– 327. 21418492 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The majority of patients with mental disorders suffer from insomnia symptoms.

    “The majority of patients with mental disorders suffer from insomnia symptoms [2]”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [2] Bei B, et al Treating insomnia in depression: insomnia related factors predict long-term depression trajectories. J Consult Clin Psychol. 2018; 86(3): 282– 293. 29504795 PMC5841584 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Around one-third of patients with mental disorders meet diagnostic criteria for insomnia disorder.

    “around one-third meet diagnostic criteria for insomnia disorder (ID) [3]”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [3] Seow LSE, et al Evaluating DSM-5 Insomnia Disorder and the treatment of sleep problems in a psychiatric population. J Clin Sleep Med. 2018; 14(2): 237– 244. 29394962 PMC5786843 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Comorbid insomnia disorder worsens the course of mental disorders and reduces quality of life.

    “Comorbid ID has been shown to worsen the course of mental disorders and to reduce quality of life [5].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [5] Hertenstein E, et al Insomnia as a predictor of mental disorders: a systematic review and meta-analysis. Sleep Med Rev. 2019; 43: 96– 105. 30537570 source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    Current guidelines identify cognitive behavioral therapy for insomnia as first-line treatment.

    “Current guidelines identify cognitive behavioral therapy for insomnia (CBT-I) as first-line treatment, usually composed of education, relaxation, behavioral change, and cognitive components [6].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [6] Riemann D, et al European guideline for the diagnosis and treatment of insomnia. J Sleep Res. 2017; 26: 675– 700. 28875581 source

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    The sleep window can be prolonged or shortened by 30 minutes if sleep efficiency is at least 90% or below 90%, respectively.

    “The sleep window can be prolonged or shortened by 30 minutes, if sleep efficiency (total sleep time/time in bed × 100) is ≥90% or <90%, respectively [6].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [6] Riemann D, et al European guideline for the diagnosis and treatment of insomnia. J Sleep Res. 2017; 26: 675– 700. 28875581 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    A mixed procedure combining basic procedures of inductive and deductive analysis was selected.

    “A mixed procedure was selected, combining basic procedures of inductive and deductive analysis.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S4 (based).

    Interpretationnone given

    The development extends prior work that mostly centered on insomnia in the absence of severe mental disorders.

    “This extends prior work that mostly centered on insomnia in the absence of severe mental disorders.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductcitation

    Patients were asked to keep a standard sleep diary throughout participation.

    “Patients were asked to keep a standard sleep diary throughout participation [19].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [19] Carney CE, et al The consensus sleep diary: standardizing prospective sleep self-monitoring. Sleep. 2012; 35(2): 287– 302. 22294820 PMC3250369 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    A coding guideline was developed, including typical anchor examples defining the categories.

    “A coding guideline was developed, including typical anchor examples defining the categories.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductown data

    Patients were given standard questionnaires before the intervention and prior to discharge, including the Insomnia Severity Index, Pittsburgh Sleep Quality Index, and Brief Symptom Inventory.

    “Patients were given standard questionnaires before the intervention and prior to discharge (days 17.9 ± 6.7). This included the Insomnia Severity Index (ISI [20]), the Pittsburgh Sleep Quality Index (PSQI [21]), and the Brief Symptom Inventory (BSI-18 [22]).”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [20] Morin CM, et al The Insomnia Severity Index: psychometric indicators to detect insomnia cases and evaluate treatment response. Sleep. 2011; 34: 601– 608. 21532953 PMC3079939 source

      Not checked in the free run.

    • cites [21] Buysse DJ, et al Recommendations for a standard research assessment of insomnia. Sleep. 2006; 29: 1155– 1173. 17040003 source

      Not checked in the free run.

    • cites [22] Derogatis LR, et al The brief symptom inventory: an introductory report. Psychol Med. 1983; 13(3): 595– 605. 6622612 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Bedtime restriction addresses the homeostatic process and represents the single most effective treatment component of CBT-I.

    “Bedtime restriction addresses the homeostatic process and represents the single most effective treatment component of CBT-I [23].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [23] Miller CB, et al The evidence base of sleep restriction therapy for treating insomnia disorder. Sleep Med Rev. 2014; 18(5): 415– 424. 24629826 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Treatment adherence was measured through monitoring of patients' estimated time in bed and total sleep time.

    “Treatment adherence was measured through monitoring of patients’ estimated time in bed (TIB) and total sleep time (TST).”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Premisereasoning

    Circadian adaptation addresses the circadian process.

    “Circadian adaptation, that is, the adaptation of bedtime to the individual chronotype, addresses the circadian process.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S4 (based).

    Interpretationnone given

    The development appears relevant since most patients with severe mental disorders suffer from comorbid insomnia.

    “The development appears to be relevant since most patients with severe mental disorders suffer from comorbid insomnia.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing), S4 (based).

    Interpretationnone given

    A supportive nursing team appears pivotal in supporting behavioral change.

    “A supportive nursing team appears pivotal in supporting behavioral change.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductcitation

    Interviews were audiotaped, transcribed, and analyzed according to qualitative content analysis as described by Mayring.

    “Interviews were audiotaped, transcribed, and analyzed according to qualitative content analysis as described by Mayring [18].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [18] Mayring P. Qualitative content analysis: theoretical foundation, basic procedures and software solution. Forum Qualitative Social Research. 2014; 45: 79– 104. Retrieved from https://nbn-resolving.org/urn:nbn:de:0168-ssoar-395173

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    The clinical treatment development was reviewed by the Bernese Ethics Committee.

    “The clinical treatment development was reviewed by the Bernese Ethics Committee (BASEC-Nr. Req-2020-00340).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Category scoring was checked and discussed with the second and last author.

    “Category scoring was checked and discussed with the second and last author.”
    Quote in the paperNot a substantial claim
38 of 38

  • The paper relies on this without support.

    Sleep hygiene has been widely implemented in inpatient settings without sufficient therapeutic effects.

    “Specifically, sleep hygiene has been widely implemented in inpatient settings without sufficient therapeutic effects.”

  • The paper relies on this without support.

    Relaxation training and cognitive restructuring are challenging, resource intense, and not suited for all patients due to high levels of anxiety or prior trauma exposure.

    “Moreover, relaxation training and cognitive restructuring are challenging, resource intense, and not suited for all patients due to, for instance, high levels of anxiety or prior trauma exposure.”

  • The paper relies on this without support.

    The human sleep-wake cycle is governed by two principle regulatory processes (homeostatic and circadian).

    “The human sleep-wake cycle is governed by two principle regulatory processes.”

  • The paper relies on this without support.

    The observed pre-post improvements are not solely due to natural course, regression to the mean, or other concurrent treatments.

    “Since the majority of patients reported chronic insomnia that withstood many years of treatment (insomnia duration > 10 years, intermittent/ persistent insomnia not defined), the observed improvement might at least partly be attributed to the SLEEPexpert intervention.”

  • The paper relies on this without support.

    Determining the individual sleep window during the kick-off session based on patient reports and therapist feedback is adequate to circumvent delays without compromising treatment.

    “In contrast to standard procedures (sleep window based on sleep diary entries over a 2-week period), the sleep window here was determined during the kick-off session based on patient reports and therapist feedback (TIB, TST, chronotype, etc.) to circumvent substantial delays in the acute care setting.”
5 of 5

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Statistics recomputed

Every reported test result, recomputed from its test statistic and degrees of freedom. A result shows as not adding up only once an independent check has confirmed it.

  • Consistentt(14) = 4.5reported p < .001 · recomputed p < .001

    “t(14) = 4.5, p < .001”

  • Consistentt(14) = 2.4reported p = .031 · recomputed p = .031

    “t(14) = 2.4, p = .031”

  • Consistentt(14) = -2.9reported p = .011 · recomputed p = .012

    “t(14) = −2.9, p = .011”

  • Consistentt(14) = -1.8reported p = .09 · recomputed p = .093

    “t(14) = −1.8, p = .09”

  • Consistentt(14) = 2.1reported p = .055 · recomputed p = .054

    “t(14) = 2.1, p = .055”

5 of 5

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Primary-diagnosis counts exceed the number of patients

    Minor

    The program-start primary-diagnosis counts sum to 35, although the column contains 21 patients. The evaluation counts similarly sum to 28 for 15 patients; a primary diagnosis should be counted once per patient.

    Reported 21 · recomputed 35

  • Post-treatment insomnia classification conflicts with the reported count

    Minor

    The paper says most of the 15 patients scored below clinically relevant insomnia after treatment, but says only three scored at or below 8. Because a score of 8 or higher is defined as clinically relevant, no more than three could have scored below that threshold.

2 of 2

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Authors
Schneider, C. L., Hertenstein, E., Fehér, K., Maier, J. G., Cantisani, A., Moggi, F., Berger, T., & Nissen, C.
Affiliations
University of Bern (CH)
Corresponding author
Nissen, Christoph
ORCID
Venue
SLEEP Advances
Publisher
Oxford University Press (OUP)
Published
2020
Volume
1
Issue
1
Pages
zpaa005-zpaa005
ISSN
2632-5012 (ISSN-L)
DOI
10.1093/sleepadvances/zpaa005
PMC
PMC10104352
OpenAlex
W3107885848
Cited by
37
References
23
Citations by year
2026: 8 · 2025: 6 · 2024: 8 · 2023: 8 · 2022: 6 · 2021: 1
FWCI
3.63
Type
journal article
Language
en
Open access
Licence
Locations
  • SLEEP Advances (publishedVersion, cc-by-nc-nd)
  • PubMed Central (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
  • Bern Open Repository and Information System (University of Bern) (submittedVersion, cc-by-nc-nd)
  • Open Access CRIS of the University of Bern
Funders
University Hospital of Psychiatry and Psychotherapy
Topics
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
  • Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
  • Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
Keywords
insomnia, psychiatric inpatient care, cognitive behavioral therapy for insomnia, circadian adaptation, self-management, sleep health, severe mental illness, implementation research, feasibility, sleep efficiency, nursing support

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