title: Cognitive behavioral therapy for shift workers with chronic insomnia.
abstract: OBJECTIVE
  Shift work is a challenge in the screening and treatment of chronic insomnia. The aim of this study was to examine the implementation and effectiveness of a cognitive behavioral group intervention for insomnia (CBT-I) among shift workers with chronic insomnia. We also studied whether insomnia symptoms and intervention effects differed on work days and days off.
  
  
  METHODS
  The study design was a non-randomized group intervention, including a waiting period prior to CBT-I as a control condition. A total of 19 media workers who worked irregular hours and had non-organic insomnia with features of psychological insomnia completed the study. We followed up with the results for a period of 6 months. Outcomes were assessed using a sleep diary, questionnaires, and actigraphy. The CBT-I groups were led by trained nurses of occupational health services (OHS).
  
  
  RESULTS
  The post-intervention results showed significant improvements in self-reported and actigraphic sleep onset latency, and in self-reported sleep efficiency, sleep quality, and restedness. In addition, the perceived severity of insomnia, sleep-related dysfunctional cognitions, psychiatric and somatic symptoms, and the mental component of health-related quality of life improved significantly. The improvements lasted and even strengthened over the follow-up period. The participants generally slept significantly better on days off than on work days, but the treatment improved sleep on both.
  
  
  CONCLUSIONS
  The study showed that non-pharmacological treatment of insomnia can be implemented among shift workers with chronic insomnia, and delivery of the treatment by trained OHS nurses yields promising results. Some caution, however, is needed when interpreting the results because of the non-randomized study design and small sample size.
authors.affiliation: Finnish Institute of Occupational Health (FIOH), Topeliuksenkatu 41 a A, Helsinki, Finland. heli.jarnefelt@ttl.fi
authors.forename: Heli
authors.initials: H
authors.lastname: Järnefelt
authors.forename: Rea
authors.initials: R
authors.lastname: Lagerstedt
authors.forename: Soili
authors.initials: S
authors.lastname: Kajaste
authors.forename: Mikael
authors.initials: M
authors.lastname: Sallinen
authors.forename: Aslak
authors.initials: A
authors.lastname: Savolainen
authors.forename: Christer
authors.initials: C
authors.lastname: Hublin
mesh_terms: D056044:Actigraphy; D000328:Adult; D015928:Cognitive Behavioral Therapy; D005260:Female; D006801:Humans; D008297:Male; D011788:Quality of Life / Q000523:psychology; D007319:Sleep Initiation and Maintenance Disorders / Q000628:therapy*; D011795:Surveys and Questionnaires; D014940:Work Schedule Tolerance / Q000523:psychology