Digital cognitive behaviour therapy for insomnia in individuals with self-reported insomnia and chronic fatigue: A secondary analysis of a large scale randomized controlled trial

Lina Stålesen Ramfjord; Patrick Faaland; Jan Scott; Simen Berg Saksvik; Stian Lydersen; Øystein Vedaa; Nikolaj Kahn; Knut Langsrud; Tore C Stiles; Lee M Ritterband; Allison G Harvey; Børge Sivertsen; Håvard Kallestad

doi:10.1111/jsr.13888

Digital cognitive behaviour therapy for insomnia in individuals with self-reported insomnia and chronic fatigue: A secondary analysis of a large scale randomized controlled trial

J Sleep Res. 2023 Oct;32(5):e13888. doi: 10.1111/jsr.13888. Epub 2023 Mar 22.

Authors

Lina Stålesen Ramfjord^{1

2}, Patrick Faaland^{1

2}, Jan Scott^{1

3}, Simen Berg Saksvik¹, Stian Lydersen⁴, Øystein Vedaa^{5

6}, Nikolaj Kahn², Knut Langsrud^{1

2}, Tore C Stiles⁷, Lee M Ritterband⁸, Allison G Harvey⁹, Børge Sivertsen^{1

5

10}, Håvard Kallestad^{1

2}

Affiliations

¹ Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway.
² St Olavs University Hospital, Trondheim, Norway.
³ University of Newcastle, Newcastle, UK.
⁴ Department of Mental Health, Regional Centre for Child and Youth Mental Health and Child Welfare, Norwegian University of Science and Technology, Trondheim, Norway.
⁵ Department of Health Promotion, Norwegian Institute of Public Health, Bergen, Norway.
⁶ Department of Psychosocial Science, University of Bergen, Bergen, Norway.
⁷ Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway.
⁸ Center for Behavioral Health and Technology, Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, Charlottesville, Virginia, USA.
⁹ Department of Psychology, University of California, Berkely, California, USA.
¹⁰ Department of Research & Innovation, Helse Fonna HF, Haugesund, Norway.

PMID: 36945882
DOI: 10.1111/jsr.13888

Abstract

Insomnia is associated with fatigue, but it is unclear whether response to cognitive behaviour therapy for insomnia is altered in individuals with co-occurring symptoms of insomnia and chronic fatigue. This is a secondary analysis using data from 1717 participants with self-reported insomnia in a community-based randomized controlled trial of digital cognitive behaviour therapy for insomnia compared with patient education. We employed baseline ratings of the Chalder Fatigue Questionnaire to identify participants with more or fewer symptoms of self-reported chronic fatigue (chronic fatigue, n = 592; no chronic fatigue, n = 1125). We used linear mixed models with Insomnia Severity Index, Short Form-12 mental health, Short Form-12 physical health, and the Hospital Anxiety and Depression Scale separately as outcome variables. The main covariates were main effects and interactions for time (baseline versus 9-week follow-up), intervention, and chronic fatigue. Participants with chronic fatigue reported significantly greater improvements following digital cognitive behaviour therapy for insomnia compared with patient education on the Insomnia Severity Index (Cohen's d = 1.36, p < 0.001), Short Form-12 mental health (Cohen's d = 0.19, p = 0.029), and Hospital Anxiety and Depression Scale (Cohen's d = 0.18, p = 0.010). There were no significant differences in the effectiveness of digital cognitive behaviour therapy for insomnia between chronic fatigue and no chronic fatigue participants on any outcome. We conclude that in a large community-based sample of adults with insomnia, co-occurring chronic fatigue did not moderate the effectiveness of digital cognitive behaviour therapy for insomnia on any of the tested outcomes. This may further establish digital cognitive behaviour therapy for insomnia as an adjunctive intervention in individuals with physical and mental disorders.

Keywords: chronic fatigue; digital cognitive behaviour therapy for insomnia; insomnia; moderator; randomized controlled trial; sleep difficulties.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Chronic Disease
Cognitive Behavioral Therapy*
Fatigue*
Female
Humans
Male
Middle Aged
Self Report
Sleep Initiation and Maintenance Disorders* / therapy
Surveys and Questionnaires
Treatment Outcome