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The Effects of Insomnia Treatment on Overnight Regulation of Emotional Memories and Risk for Mental Disorders

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This project aims to understand and treat insomnia disorder to prevent depression and anxiety. The investigators will use an experimental parallel two-arm repeated measures randomized controlled trial in a cohort of individuals with insomnia to compare the effects of online therapist-guided cognitive behavioural and circadian therapy for insomnia (CBCTi; N=82) versus control (N=27) on subjective and objective sleep and circadian measures as well as symptom and severity of depression and anxiety. The project will involve at-home assessments.

Participants from the CBCTi group will also be invited for two sleep studies and neuroimaging sessions to investigate the effects of CBCTi on neuroimaging and psychophysiological markers of overnight regulation of emotional distress.

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Study details:

This study is a parallel-group randomized controlled trial comparing the effects of online therapist-guided cognitive behavioural and circadian therapy for insomnia (CBCTi) versus control on emotional regulation and risk for mental disorders. To be enrolled in the study, the participants are required to complete an online prescreening survey followed by a telephone screening interview with further questions and to verbally explain to participants what is required of them in this study. After an interview screening, the participants will receive a finger-pulse oximeter by mail to screen for the presence of obstructive sleep apnoea (3 nights at-home).

The device is then returned by pre-paid mail and the recording is analysed to screen for moderate to severe sleep apnoea (oxygen desaturation index ≥ 10). If eligible, the participant will be invited to the Woolcock Institute for a screening visit. The screening visit starts with a consult with a clinician/physician who performs a medical screening, explains the study, answers questions and addresses concerns, and obtains written informed consent.

At the end of the consult, all eligibility criteria have been evaluated and eligible participants are assigned a randomization number i. e. , allocated to either the CBCTi-arm or the control-arm.

The treatment arm consists of an online therapist-guided CBCTi intervention which comprises online sessions to be completed in 8 weeks. The control arm in this study will consist of providing general sleep health information and access to daily sleep diaries. During the screening visit, participants assigned to the CBCTi-arm will be asked to perform in an audio-visual recording while singing along to "Waltzing Matilda" (karaoke style) and asked to give keywords that relate to at least five negative distressing experiences and an equal number of neutral experiences from the same period.

The recording and the keywords will be used to derive the stimuli that are used in the functional MRI tasks (T1 and T2). For both groups, the screening visit is concluded with a demonstration on how to collect data at-home. Both groups will be asked to perform a week of at-home assessment during 4 timepoints: T1 (baseline), T2 (8-weeks post-baseline), T3 (8 months post-baseline) and T4 (20 months post-baseline).

During the week of at-home assessments, the participants complete questionnaires, keep a sleep diary, and wear an actigraphy-watch, and light and temperature sensor (across 7 days). They are also asked to complete at least four overnight polysomnographic recordings. At T1 and T2 only, they also complete a salivary melatonin collection protocol.

Only the participants in the CBCTi arm complete additional in-lab assessments at T1 and T2. They are invited to Macquarie University/Woolcock Institute to undergo overnight sleep studies and neuroimaging sessions. The CBCTi program will be given online via secure platforms and recruitment will primarily be through social media advertisements.

The study will be coordinated from the Woolcock Institute of Medical Research, Sydney, Macquarie Park, New South Wales, 2109, Australia.

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Eligibility criteria

Researchers look for people who fit a certain description, called eligibility criteria. See if you qualify.

Inclusion criteria

  • Diagnosis of insomnia disorder (DSM-V-TR) or ISI score ≥ 10.
  • All sexes and genders.
  • Between 25 and 45 years of age.
  • Able to provide informed consent.
  • Proficient in English.
  • Exclusion criteria

  • Sleep or circadian disorder other than insomnia (e.g., hypersomnolence, periodic limb movement disorder, advanced or delayed sleep phase disorder, moderate to severe sleep apnoea disorder based on previous sleep study with an apnea-hypopnea index ≥ 15 and/or STOP-BANG high-risk score and/or finger-pulse oximetry oxygen desaturation index (ODI) ≥ 10).
  • Any contradictions for MRI (e.g., claustrophobia, presence of metal in body, cochlear implants).
  • Current or history of neurological disorders (e.g., stroke, brain injury).
  • Current or history of any disorder listed in DSM-V other than major depression and anxiety disorders (post-traumatic stress disorder is excluded).
  • Centrally active agents or presence of medical condition that may affect participation.
  • Pregnancy or actively trying to conceive, or lactating.
  • Shift work for at least 2 shifts per week in the past 3 months (i.e., work between 21:00 and 6:00).
  • Travel across time zones over 3 hours difference in the previous 30 days (will require a 1-week adjustment period per hour of time zone travelled).
  • Unwilling to know about potential incidental findings.
  • No consent or adherence to instructions for any part of the study protocol.
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    Eligibility

    Age eligible for study : 25 and older

    Healthy volunteers accepted : No

    Gender eligible for study: All

    Things to know

    Study dates

    Study start: 2024-12-01

    Primary completion: 2027-06-01

    Study completion finish: 2029-06-01

    study type

    Study type

    TREATMENT

    phase

    Phase

      NA

    trial

    Trial ID

    NCT06567210

    Intervention or treatment

    BEHAVIORAL: CBCTi

    BEHAVIORAL: General sleep information

    Conditions

    • Insomnia Chronic
    • Depression, Anxiety
    Image related to Insomnia Chronic
    • Condition: Insomnia Chronic, Depression, Anxiety

    • BEHAVIORAL: CBCTi and other drugs

    • Macquarie Park, New South Wales, Australia

    • Sponsor: Woolcock Institute of Medical Research

    Find a site

    Closest Location:

    Woolcock Institute of Medical Research

    Research sites nearby

    Select from list below to view details:

    • Woolcock Institute of Medical Research

      Macquarie Park, New South Wales, Australia

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    Study Plan

    This section provides details of the study plan, including how the study is designed and what the study is measuring.

    How is the study designed?

    Participant Group/ArmIntervention/Treatment
    EXPERIMENTAL: CBCTi
    • 8-weeks online therapist-guided CBCTi including weekly online modules. Guidance is provided via scheduled and ad hoc communications (e.g., email, messaging, telehealth) between the participant and a clinician/physician
    BEHAVIORAL: CBCTi
    • The program is composed of weekly online modules that include written information and interactive components such as schematics, images, videos, and questions. The content of the modules follows traditional and validated cognitive-behavioural therapy for insomnia protocols including sleep education, behavioural strategies (e.g., stimulus control, bedtime retraining, sleep hygiene), cognitive restructuration approaches (e.g., thought reappraisal, imagery, mindfulness), and relaxation practices (progressive muscle relaxation and autogenic training). In addition, further content aims to stabilize and amplify circadian rhythmicity through light exposure in the morning, daytime moderate physical activity, and evening time warm baths. Participants complete daily sleep diaries throughout the intervention.
    ACTIVE_COMPARATOR: General sleep information
    • For 8 weeks, participants will receive assess to general sleep health information and perform daily sleep diaries.
    BEHAVIORAL: General sleep information
    • General sleep health information and access to daily sleep diaries during 8 weeks

    What is the study measuring?

    Primary outcome

    Primary Outcome MeasurePrimary Outcome DescriptionPrimary Outcome Time Frame
    Insomnia Severity Index (ISI) scoreSelf-report measures of insomnia symptoms and severity. ISI consists of 7 Likert-scale questions with a total score ranging from 0 to 28 (with higher scores indicating more severe insomnia)8 weeks, 8 months, 20 months
    Patient Health Questionnaire-9 (PHQ-9) scoreSelf-report measures of depression symptoms and severity. PHQ-9 consists of 9 Likert-scale questions with a total score ranging from 0 to 27 (with higher scores indicating more severe depression)8 weeks, 8 months, 20 months
    General Anxiety Disorder-7 (GAD-7) scoreSelf-report measures of anxiety symptoms and severity. GAD-7 consists of 7 Likert-scale questions with a total score ranging from 0 to 21 (with higher scores indicating more severe anxiety)8 weeks, 8 months, 20 months

    Secondary outcome

    Secondary Outcome MeasureSecondary Outcome DescriptionSecondary Outcome Time Frame
    EEG sleep efficiency (SE - %)Mean SE derived from at-home sleep recordings (total sleep time/time in bed\*100)8 weeks, 8 months, 20 months
    EEG total sleep time (TST - minutes)Mean TST derived from at-home sleep recordings8 weeks, 8 months, 20 months
    EEG wake duration (minutes)Mean wake after sleep onset (WASO) derived from at-home sleep recordings8 weeks, 8 months, 20 months
    EEG sleep onset latency (SOL - minutes)Mean SOL derived from at-home sleep recordings8 weeks, 8 months, 20 months
    EEG sleep stages (%)Mean time spent in sleep stages (per total sleep period) derived from at-home sleep recordings8 weeks, 8 months, 20 months
    Actigraphy sleep efficiency (%)Mean SE derived from actigraphy recording (total sleep time/time in bed\*100)8 weeks, 8 months, 20 months
    Actigraphy total sleep duration (minutes)Mean TST derived from actigraphy recordings8 weeks, 8 months, 20 months
    Actigraphy wake duration (minutes)Mean WASO derived from actigraphy recordings8 weeks, 8 months, 20 months
    Actigraphy sleep onset latency (minutes)Mean SOL derived from actigraphy recordings8 weeks, 8 months, 20 months
    7-days light exposure (lux)derived from at-home continuous light recording during the day8 weeks, 8 months, 20 months
    Hour of Dim-Light Melatonin Onset (HDLMO - hour)derived from at-home collection of saliva samples8 weeks, 8 months, 20 months
    3-days distal-proximal skin-temperature gradients (DPG)derived from at-home collection of continuous skin temperature (7 locations)8 weeks, 8 months, 20 months
    Self-reported sleep duration (min)Mean TST derived from sleep diaries8 weeks, 8 months, 20 months
    Self-reported wake duration (min)Mean WASO derived from sleep diaries8 weeks, 8 months, 20 months
    Self-reported sleep onset latency (min)Mean SOL derived from sleep diaries8 weeks, 8 months, 20 months
    Self-reported sleep quality (out of 5)Mean sleep quality derived from sleep diaries on a scale from 0 to 4 (very poor sleep to very good sleep)8 weeks, 8 months, 20 months
    Sleep misperception index (SPI - %)SPI derived from subjective TST and objective TST (Subj/Obj\*100)8 weeks, 8 months, 20 months

    Frequently Asked Questions

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    References

    Clinical Trials Gov: The Effects of Insomnia Treatment on Overnight Regulation of Emotional Memories and Risk for Mental Disorders

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