About this trial
Insomnia is a prevalent sleep disorder associated with numerous adverse health outcomes, including fatigue, irritability, and impaired daytime functioning. Despite the availability of effective pharmacological and psychological treatments, relatively few individuals with insomnia seek professional help, highlighting the need for accessible and acceptable non-pharmacological interventions. Sleep hygiene education (SHE) has the potential to address this gap due to its simplicity, low cost, and ease of self-administration. Building on our previously registered pilot-testing protocol, this study aims to examine the effectiveness of a theory-based SHE program integrated with behavior change techniques in a larger community population. Furthermore, it remains unclear whether theory-based SHE is inferior to gold-standard interventions such as cognitive behavioral therapy for insomnia (CBT-I) delivered via digital applications. Therefore, this study will also compare the effectiveness of theory-based SHE with a CBT-I app using a three-arm randomized controlled trial design.
Eligibility criteria
This trial does not accept healthy volunteersQualifiers
Hong Kong residents
Ethnic Chinese aged 18-65 years with the ability to communicate in Cantonese or Putonghua
Who fulfil the DSM-5 diagnostic criteria for insomnia disorder according to a validated diagnostic tool, the Brief Insomnia Questionnaire
Scored at least 10 points in the Insomnia Severity Index
Disqualifiers
Any current diagnosis fulfilling the DSM-IV criteria of a major depressive disorder, generalized anxiety disorders, post-traumatic stress disorder, panic disorder, substance use disorders, or schizophrenia as screened using the Chinese version of the Structured Clinical Interview for DSM-IV
Other sleep disorders, including circadian rhythm disorder, narcolepsy, obstructive sleep apnoea (OSA), and restless leg syndrome (RLS)/periodic leg movement disorder (PLMD) as determined based on cut-off scores (≥ 7 on narcolepsy; ≥ 8 on circadian rhythm disorder; ≥ 15 on OSA; ≥ 7 on RLS/PLMD) using SLEEP-50. If in doubt, subjects will be referred to our team psychiatrist (KF Chung) for further assessment
Any current medical conditions or side-effects of medication that are contributing significantly to the subject's insomnia
Taking medications or currently participating in other psychotherapies for insomnia or other psychiatric disorders
Trial design
Parallel
Treatments tested in this trial
Sleep Hygiene Education
BehavioralParticipants in this group will receive a structured six-week SHE intervention. The intervention includes two weekly 2-hour group-based, face-to-face educational sessions (total 4 hours) conducted in a classroom at the School of Nursing, The Hong Kong Polytechnic University, followed by four weekly individualized telephone consultations lasting approximately 10 minutes each. During the educational sessions, participants will receive education on insomnia and evidence-based sleep hygiene practices, and will develop individualized behavior change plans to support sustained implementation of sleep hygiene practices. The subsequent telephone consultations will reinforce adherence to these plans by reviewing progress, discussing barriers, and providing tailored feedback.
CBT-I Apps
BehavioralParticipants in this group will receive a CBT-I program consisting of six weekly modules delivered in the Chinese language through a smartphone application proACT-S. The duration of each module is around 45 to 60 min with interactive features. The self-help CBT-I treatment content in proACT-S is based on the Chinese translated version of a well-established CBT-I treatment manual. The self-help CBT-I treatment content is designed to alter dysfunctional cognitive beliefs and maladaptive behaviors that perpetuate insomnia. The self-help CBT-I treatment content CBT-I aims at changing dysfunctional cognitive beliefs and maladaptive behaviors that contribute to the maintenance of insomnia.
Treatment groups
Trial outcomes
Primary outcomes
The Insomnia Severity Index (ISI)
The Insomnia Severity Index has 7 items that measured the severity of insomnia complaints and related daytime impairments. The total score ranges between 0 and 28, with the higher scores indicating more severe insomnia. Total score will be used.
Secondary outcomes
Sleep Onset Latency Measured By Sleep Diary
Participants will be asked to record their daily sleeping-waking schedule using a standard sleep diary. Sleep onset latency (SOL) is defined as the time (minutes) taken to fall asleep after going to bed. The average value over 7 consecutive nights will be calculated.
Wake After Sleep Onset Measured By Sleep Diary
Participants will be asked to record their daily sleeping-waking schedule using a standard sleep diary. Wake after sleep onset (WASO) is defined as the total time (minutes) awake after initial sleep onset during the night. The average value over 7 consecutive nights will be calculated.
Sleep Efficiency Measured By Sleep Diary
Participants will be asked to record their daily sleeping-waking schedule using a standard sleep diary. Sleep efficiency (SE) is defined as the percentage of time in bed spent asleep. The average percentage over 7 consecutive nights will be calculated.
Total Sleep Time Measured By Sleep Diary
Participants will be asked to record their daily sleeping-waking schedule using a standard sleep diary. Total sleep time (TST) is defined as the total duration (minutes) of sleep per night. The average value over 7 consecutive nights will be calculated.
Sponsors and contacts
Click on the lead sponsor to view all of their trials.
This trial is not recruiting at the moment. You can still explore other options: