title: No pain, no gain: an exploratory within-subjects mixed-methods evaluation of the patient experience of sleep restriction therapy (SRT) for insomnia.
abstract: OBJECTIVE
  To explore the patient experience of Sleep Restriction Therapy (SRT) for insomnia, with particular focus on elucidating possible side-effects, challenges to adherence and implementation and perceptions of benefit/impact.
  
  
  METHODS
  To fully investigate the patient experience of sleep restriction therapy for insomnia we designed a within-subjects mixed-method study, employing sleep and daytime functioning questionnaires, assessments of sleep-restriction-related side-effects, prospective qualitative audio-diaries and post-treatment semi-structured interviews. University of Glasgow Sleep Centre. Eighteen patients with Primary Insomnia (mean age=42; range 18-64). Patients took part in a 4-week brief sleep restriction intervention, involving two group sessions and two subsequent follow-up phone calls in the home environment.
  
  
  RESULTS
  Sleep diaries and global measures of insomnia severity and sleep quality, as expected, demonstrated robust improvements at both post-treatment and 3-month follow-up (all large effect sizes). Daytime functioning/health-related quality of life variables similarly evidenced strong treatment effects (moderate to large effect sizes). Reported side-effects were common, with ≥50% of patients reporting impairment in 8 out of 12 listed symptoms as a consequence of initiating treatment. The four most common side-effects were 'fatigue/exhaustion' (100%), 'extreme sleepiness' (94%), 'reduced motivation/energy' (89%) and 'headache/migraine' (72%) [Mean number of symptoms per patient=7.2 (2.4); range 3-11]. Intriguingly, both side-effect frequency and ratings of side-effect interference were associated with baseline to post-treatment improvements in sleep quality. Qualitative real-time audio-diaries during week 1 of treatment and post-treatment interviews provided rich accounts of side-effects associated with acute SRT implementation; general challenges surrounding treatment implementation and adherence/non-adherence; and modifications to sleep parameters, daytime functioning and perceptions of sleep/sleep period.
  
  
  CONCLUSIONS
  This work has important implications for the delivery of SRT, particularly concerning awareness of possible 'adverse events' and likely implementation/adherence challenges. Findings also pave the way for testable hypotheses concerning possible mechanisms of action involved in sleep restriction treatment.
authors: University of Glasgow Sleep Centre, Sackler Institute of Psychobiological Research and Institute of Neuroscience and Psychology, College of Medical, Veterinary and Life Sciences, University of Glasgow, Scotland, UK. s.d.kyle@clinmed.gla.ac.uk
authors: Simon D
authors: SD
authors: Kyle
authors: Kevin
authors: K
authors: Morgan
authors: Kai
authors: K
authors: Spiegelhalder
authors: Colin A
authors: CA
authors: Espie
mesh_terms: D000223:Adaptation, Psychological; D000293:Adolescent; D000328:Adult; D001521:Behavior Therapy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D017060:Patient Satisfaction; D036301:Qualitative Research; D011788:Quality of Life; D012890:Sleep; D012892:Sleep Deprivation / Q000523:psychology* / Q000628:therapy*; D007319:Sleep Initiation and Maintenance Disorders / Q000523:psychology* / Q000628:therapy*; D011795:Surveys and Questionnaires; D055815:Young Adult