(PS6-B38) How to Treat Insomnia in Healthcare Workers with Atypical Work Schedules? Preliminary Report on the Efficacy of Behavioral Therapy for Insomnia in Shift Work: A Randomized Control Trial

Introduction

The nature of work of healthcare workers places them at risk for insomnia, anxiety, depression and trauma-related stress. Working on atypical work schedules puts them at an even higher risk for sleep and mental health disorders. This is especially true during the COVID-19 pandemic since they are required on the frontlines and consistently working under duress. In normal times, 33% of shift workers suffer from shift work disorder (SWD) involving insomnia and/or sleepiness related to their work schedule. Most SWD treatments rely on light therapy or pharmacology. Few studies explored CBT-I efficacy for insomnia in shift work and reported promising results.

Objectives

The study evaluates the efficacy of a behavioral therapy adapted for SWD (BT-SWD).

Methods

Forty-three healthcare night shift workers (mean age 34 y.o.; 77% women) meeting SWD criteria were randomized to either BT-SWD or waitlist control groups. Recruitment ended in the first months of the COVID-19 pandemic. Eight participants dropped-out while waiting. Participants completed the Epworth Sleepiness Scale, the Insomnia Severity Index, the State-Trait Anxiety Inventory and the Beck Depression Inventory-II before and after treatment and sleep diaries throughout the experimentation. BT-SWD involves sleep restriction therapy and stimulus control for insomnia, as well as fixed sleep periods in the dark for shift workers. BT-SWD was applied first to night sleep, then to day sleep, and finally to naps, in that order. It includes 6 sessions of 50 min delivered in 8 weeks. A mixed MANOVA was done on questionnaires scores with group (BT-SWD or waitlist) as the between-subject factor and time as the within subject factor.

Results

A multivariate interaction effect was significant, F(6,21) = 8.24, p< .001. A univariate interaction effect was observed for depression (p=.042), trait anxiety (p=.021) and insomnia severity, for night sleep (p=.027) and day sleep (p< .001), indicating that the participants in BT-SWD group presented lower scores compared to those in the waitlist group. The BT-SWD group had significantly less severe insomnia, for day sleep during night work (p< .001) and night sleep during days off (p< .001). There was no significant difference between the groups on sleepiness.

Conclusions

BT-SWD is effective at reducing insomnia severity as well as levels of trait anxiety and depression. Results are more ambiguous for sleepiness. The waitlist group led to significant attrition in the context of shift work. Further analyses are needed to determine BT-SWD efficacy on sleep variables. BT-SWD can be used to positively impact mental health of healthcare workers during or after a pandemic. However, since face-to-face treatment is not ideal for either a pandemic or for workers on atypical work schedules, an eHealth BT-SWD application is under development and will be tested in the near future.

Disclosure

The study was supported by a CIHR grant #110254 awarded to the first author

The authors declare no conflict of interest