Einar Bredeli, Stud.Psychol Mats Lien, Stud.Psychol The European Society for Research on Internet Interventions (ESRII) Chronic insomnia in morningness and eveningness individuals, and short and long term effects of online cognitive behavioral therapy Kanskje få frem navnene på forskergruppen også (det kan være interessant for publikum å vite) – Einar Bredeli, Mats Lien, Børge Sivertsen, Håvard Kallestad og Øystein Vedaa Einar Bredeli, Stud.Psychol Mats Lien, Stud.Psychol Department of psychosocial science University of Bergen

Background Morningness individuals («early larks») prefer to go to bed early in the evening and wake up early in the morning. (Natale & Cicogna, 2002) Eveningness individuals («night owls») get tired later in the evening (e.g. 00:00-02:00) and wake up later in the morning or afternoon Photo: SHUTi Natale, & Cicogna. (2002). Morningness-eveningness dimension: Is it really a continuum? Personality and Individual Differences, 32(5), 809-816.

Background Morningness individuals («early larks») prefer to go to bed early in the evening and wake up early in the morning. (Natale & Cicogna, 2002) Eveningness individuals («night owls») get tired later in the evening (e.g. 00:00-02:00) and wake up later in the morning or afternoon Photo: SHUTi Eveningness individuals with insomnia reported more dysfunctional sleep related cognitions and more pathological symptoms such as depression compared to morningness types Natale, & Cicogna. (2002). Morningness-eveningness dimension: Is it really a continuum? Personality and Individual Differences, 32(5), 809-816. Ong, J., Huang, J., Kuo, T., & Manber, R. (2007). Characteristics of insomniacs with self-reported morning and evening chronotypes. Journal of Clinical Sleep Medicine : JCSM : Official Publication of the American Academy of Sleep Medicine, 3(3), 289-94.

Background Cognitive behavioral therapy for insomnia (CBTi) is the recommended first-line treatment for chronic insomnia (Mitchell et al. (2012). Meta-analysis reported significant improvements in insomnia severity and a range of sleep diary outcomes from online cognitive behavioural therapy for insomnia (eCBTi) (Zachariae et al. 2016). Mitchell, M., Gehrman, P., Perlis, M., & Umscheid, C. (2012). Comparative effectiveness of cognitive behavioral therapy for insomnia: A systematic review. Bmc Family Practice, 13, Bmc Family Practice, 2012 May 25, Vol.13. Zachariae, Robert, Lyby, Marlene S., Ritterband, Lee M., O&Amp;Apos, & Toole, Mia S. (2016). Efficacy of internet-delivered cognitive-behavioral therapy for insomnia – A systematic review and meta-analysis of randomized controlled trials. Sleep Medicine Reviews, 30, 1-10.

Online CBTi comparable to the effects found for face-to-face CBTi Background Cognitive behavioral therapy for insomnia (CBTi) is the recommended first-line treatment for chronic insomnia (Mitchell et al. (2012). Meta-analysis reported significant improvements in insomnia severity and a range of sleep diary outcomes from online cognitive behavioural therapy for insomnia (eCBTi) (Zachariae et al. 2016). Online CBTi comparable to the effects found for face-to-face CBTi Mitchell, M., Gehrman, P., Perlis, M., & Umscheid, C. (2012). Comparative effectiveness of cognitive behavioral therapy for insomnia: A systematic review. Bmc Family Practice, 13, Bmc Family Practice, 2012 May 25, Vol.13. Zachariae, Robert, Lyby, Marlene S., Ritterband, Lee M., O&Amp;Apos, & Toole, Mia S. (2016). Efficacy of internet-delivered cognitive-behavioral therapy for insomnia – A systematic review and meta-analysis of randomized controlled trials. Sleep Medicine Reviews, 30, 1-10.

The aim of this study Investigate if morningness and eveningness individuals with chronic insomnia respond differently to online cognitive behavioural therapy for insomnia (eCBTi).

N=200 Randomisation N=95 N=86 N=51 N=68 Post-questionnaire Inclusion: 1. Media interviews 2. Online insomnia Test 3. Phone interview Inclusion criteria: Age 18 years or older Fluent in Norwegian language Internet access Meeting diagnostic criteria for insomnia according to DSM-IV. Exclusion criteria: Presence of another known and untreated sleep disturbance Night work Presence of a serious mental illness Receiving other psychological treatment N=200 Pre-questionaire Sleep diary (14d) Randomisation N=95 N=86 Experiment: SHUTi (CBTi) (6 weeks) Control: «sleep hygiene» (6 weeks) N=51 Post-questionnaire Questionnaire and sleep diary (14d) Control group out N=68 18 month follow up: Questionnaire and Sleep diary (14d)

Method Insomnia patients (N=95) received access to eCBTi (Sleep Healthy Using the Internet, SHUTi) over 9 weeks. Patients were characterised as morning or eveningness individuals based on a median split of the Horne-Östberg Morningness Eveningness Questionnaire (MEQ) (Horne & Östberg (1976). Photo: SHUTi Ritterband, L., Thorndike, F., Gonder-Frederick, L., Magee, J., Bailey, E., Saylor, D., & Morin, C. (2009). Efficacy of an Internet-Based Behavioral Intervention for Adults With Insomnia. Archives of General Psychiatry, 66(7), 692-698. Adan, A., & Almirall, H. (1991). Horne & Östberg Morningness-Eveningness Questionnaire: A reduced scale. Personality and Individual Differences, 12, 241-253.

Method Assessed with sleep diaries for 10 days and questionnaires (e.g. Insomnia Severity Index, Bergen Insomnia Scale, Hospital Anxiety and Depression Scale (HADS), Dysfunctional Beliefs and Attitudes about Sleep Scale (DBAS) etc.) A mixed model repeated-measures analysis was conducted to examine the short and long term effects of CBTi treatment, using the intention to treat principle. Photo: SHUTi

Results

Results

Results

Results

Results

Results

Results

More «Sleep Onset Latency» (SOL) Discussion Morningness individuals with insomnia Eveningness individuals with insomnia More «Wake After Sleep Onset» (WASO) and shorter «Total Sleep Duration» (TSD) More «Sleep Onset Latency» (SOL)

Discussion Morningness individuals with insomnia Eveningness individuals with insomnia More «Wake After Sleep Onset» (WASO) and shorter «Total Sleep Duration» (TSD) More «Sleep Onset Latency» (SOL) Both groups had significant short and long term effect of treatment

Discussion Despite different insomnia symptomalogy for morningness and eveningness individuals, they do not respond differently to online CBTi.

Acknowledgment: Research Group: Øystein Vedaa Department of Psychosocial Science, University of Bergen, Bergen, Norway Børge Sivertsen Norwegian Institute of Public Health, Bergen, Norway Håvard Kallestad Norwegian University of Science and Technology, Department of Neuroscience, Trondheim, Norway