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Summary: The current study determined the extent to which sleep–wake state discrepancy impairs the efficacy of cognitive behavioural therapy for insomnia in a real‐world clinical sample. Sleep–wake state discrepancy occurs when there is an inconsistency between a person's subjective and objective sleep, and is a common phenomenon amongst patients with insomnia. Limited information is available on the effectiveness of cognitive behavioural therapy for insomnia in treating patients who experience significant sleep–wake state discrepancy in "real‐world" samples. In the present study, all patients with insomnia received cognitive behavioural therapy for insomnia through an outpatient insomnia program (N = 386; mean age = 51.96 years, SD = 15.62; 65.97% [N = 254] female). Prior to treatment, participants completed a polysomnography sleep study and sleep diary, which was used to calculate sleep–wake state discrepancy. At pre‐treatment, post‐treatment and 3‐month follow‐up, participants completed the Insomnia Severity Index and other questionnaires, and 1 week of sleep diaries from which sleep‐onset latency, wake after sleep onset and other sleep variables were calculated. There were no differences in self‐reported sleep‐onset latency, wake after sleep onset or Insomnia Severity Index scores at post‐treatment or 3‐month follow‐up between quintiles of sleep–wake state discrepancy. These results indicate that sleep–wake state discrepancy at pre‐treatment does not predict treatment response to cognitive behavioural therapy for insomnia. Future research could examine multi‐night assessments of sleep–wake state discrepancy to determine whether variations in discrepancy may relate to pre‐treatment insomnia severity and cognitive behavioural therapy for insomnia outcomes. [ABSTRACT FROM AUTHOR]

Background Aims Methods Results Conclusions Insomnia is a prevalent condition in Australia that increases the risk of depression and anxiety symptoms. Cognitive behaviour therapy for insomnia (CBT‐i) is the recommended ‘first line’ treatment but is accessed by a minority of people with insomnia.To improve CBT‐i access in Australia, we aimed to develop and test a self‐guided interactive digital CBT‐i program.An online randomised controlled trial was conducted from August 2022 to August 2023 to investigate the effect of digital CBT‐i, versus digital sleep education control, on symptoms of insomnia (ISI), depression (PHQ‐9), anxiety (GAD‐7), fatigue, sleepiness and maladaptive beliefs about sleep at 8‐week follow‐up. The control group accessed the intervention after the 8‐week follow‐up. Questionnaires were additionally administered at 16 and 24 weeks. Intent‐to‐treat mixed models and complete‐case chi‐squared analyses were used.Participants included 62 adults with insomnia symptoms (age M (SD) = 52.5 (16.3), 82% female, ISI = 18.6 (2.9)). There were no between‐group differences in baseline characteristics or missing 8‐week data (14.5%). After adjusting for baseline scores, CBT‐i was associated with lower insomnia (Diffadj (95% CI) = 7.32 (5.0–9.6), P < 0.001, d = 1.64), depression (3.36 (1.3–5.4), p = 0.002, d = 0.84), fatigue (5.2 (2.5–7.9), P < 0.001, d = 1.00) and maladaptive beliefs about sleep (11.0 (4.1–18.0), P = 0.002, d = 0.82), but not anxiety symptoms at 8 weeks (1.84 (−0.1 to 3.8), p = 0.060, d = 0.50). Compared to control, CBT‐i was associated with greater rates of insomnia remission (ISI <8; 0.0%, vs 40.0%, P < 0.001) and response at 8 weeks (ISI reduction ≥6; 7.1% vs 72.0%, P < 0.001). Improvements in insomnia and depression were maintained at 24 weeks in the CBT‐i group.This interactive digital CBT‐i program resulted in large and sustained improvements in symptoms of insomnia, depression, fatigue and maladaptive beliefs about sleep in Australian adults with insomnia symptoms. Implementation programs are required to increase digital CBT‐i access and uptake. [ABSTRACT FROM AUTHOR]

Summary: Comorbid insomnia and sleep apnoea (COMISA) is a highly prevalent and debilitating sleep disorder. Cognitive behavioural therapy for insomnia (CBTi) may be an appropriate treatment for COMISA; however, no previous study has systematically reviewed and meta‐analysed literature reporting on the effect of CBTi in people with COMISA. A systematic literature search was conducted across PsychINFO and PubMed (n = 295). In all, 27 full‐text records were independently reviewed by at least two authors. Forward‐ and backward‐chain referencing, and hand‐searches were used to identify additional studies. Authors of potentially eligible studies were contacted to provide COMISA subgroup data. In total, 21 studies, including 14 independent samples of 1040 participants with COMISA were included. Downs and Black quality assessments were performed. A meta‐analysis including nine primary studies measuring the Insomnia Severity Index indicated that CBTi is associated with a large improvement in insomnia severity (Hedges' g = −0.89, 95% confidence interval [CI] −1.35, −0.43). Subgroup meta‐analyses indicated that CBTi is effective in samples with untreated obstructive sleep apnoea (OSA) (five studies, Hedges' g = −1.19, 95% CI −1.77, −0.61) and treated OSA (four studies, Hedges' g = −0.55, 95% CI −0.75, −0.35). Publication bias was evaluated by examining the Funnel plot (Egger's regression p = 0.78). Implementation programmes are required to embed COMISA management pathways in sleep clinics worldwide that currently specialise in the management of OSA alone. Future research should investigate and refine CBTi interventions in people with COMISA, including identifying the most effective CBTi components, adaptations, and developing personalised management approaches for this highly prevalent and debilitating condition. [ABSTRACT FROM AUTHOR]

Summary: Research with 'good sleepers' is ubiquitous, yet there are no standardised criteria to identify a 'good sleeper'. The present study aimed to create and validate a questionnaire for identifying good sleepers for use in research studies known as the Good Sleeper Scale‐15 items (GSS‐15). Data were derived from a population‐based survey of Australian adults (n = 2,044). A total of 23 items were chosen for possible inclusion. An exploratory factor analysis (EFA) was conducted on ~10% of the survey dataset (n = 191) for factor identification and item reduction. A confirmatory factor analysis (CFA) was conducted on the remaining data (n = 1,853) to test model fit. Receiver operating characteristic curves and correlations were conducted to derive cut‐off scores and test associations with sleep, daytime functioning, health, and quality‐of‐life. The EFA identified six factors: 'Sleep Difficulties', 'Timing', 'Duration', 'Regularity', 'Adequacy', and 'Perceived Sleep Problem'. The CFA showed that model fit was high and comparable to other sleep instruments, χ2 (63) = 378.22, p < 0.001, root mean square error of approximation = 0.05, with acceptable internal consistency (α = 0.76). Strong correlations were consistently found between GSS‐15 global scores and outcomes, including 'a good night′s sleep' (r = 0.7), 'feeling un‐refreshed' (r = −0.59), and 'experienced sleepiness' (r = −0.51), p < 0.001. Cut‐off scores were derived to categorise individuals likely to be a good sleeper (GSS‐15 score ≥40) and those very likely to be a good sleeper (GSS‐15 score ≥45). The GSS‐15 is a freely available, robust questionnaire that will assist in identifying good sleepers for the purpose of sleep research. Future work will test relationships with other sleep measures in community and clinical samples. [ABSTRACT FROM AUTHOR]

Introduction: We aimed to explore trends and sociodemographic patterns in benzodiazepine (BZD) (by half‐life) and Z‐drugs prescribing in Australian general practice. Methods: This open cohort study used de‐identified electronic health records of 1.4 million patients (50,812,413 consultations) from 402 Australian practices (MedicineInsight 2011–2018). Annual prescribing frequency and changes over time were estimated according to sex, age, socioeconomic position and rurality. Results: Between 2011 and 2018, the prescribing of very short‐acting BZD increased from 0.10 to 0.29 per 1000 consultations (average annual change +17.2% [95% CI 9.6; 25.3]), while it declined for short‐intermediate (from 38.5 to 26.6 per 1000 consultations; annual change −5.1% [95% CI −5.6; −4.5]), long‐acting BZD (from 24.1 to 21.6 per 1000 consultation; annual change −1.5% [95% CI −2.2; −0.8]) and Z‐drugs (from 4.6 to 4.0 per 1000 consultations; annual change −1.9% [95% CI −3.0; −0.7]). Short‐intermediate‐acting BZD prescribing was three times more frequent among women aged 65+ years than younger women, and long‐acting BZD three‐to‐four times more likely among younger than older men. Z‐drugs prescribing was higher among women aged 45–64 years than younger or older females. Short‐intermediate‐ and long‐acting BZD were more likely prescribed for patients from more disadvantaged areas, and Z‐drugs in more advantaged areas. There were no disparities by rurality. Discussion and Conclusions: Although most BZD and Z‐drugs prescriptions declined over time, short‐intermediate BZD prescriptions remained higher among older women and long‐acting BZD more frequent among younger men, especially for those living in more disadvantaged areas. Targeted interventions could reduce the prescribing of BZD and Z‐drugs in these groups. [ABSTRACT FROM AUTHOR]