1. 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

2. 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),

3. 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),
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),

4. 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.

5. 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.

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

7. 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)

8. 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),
Adan, A., & Almirall, H. (1991). Horne & Östberg Morningness-Eveningness Questionnaire: A reduced scale. Personality and Individual Differences, 12,

9. 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

10. Results

11. Results

12. Results

13. Results

14. Results

15. Results

16. Results

17. 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)

18. 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

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

20. 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