Insomnia in College Students: Email-Delivered CBT Intervention

Marlene Morales

Exercise Science, Health and Wellness, BS

Dr. Yu-Ping Chang, PhD, Associate Dean for Research and

Scholarship

University at Buffalo School of Nursing

Introduction

• Prevalence: 50% of college students

report daytime sleepiness and 70%

attain insufficient sleep

• Intervention: Email delivered

Cognitive Behavioral Therapy is a cost

effective, non-pharmacological

treatment shown to improve sleep

outcomes in college students

Physiology of Sleep:

Sleep Wake Cycle

• 1. Homeostatic Sleep Drive

• 2. Circadian Rhythm

• Inadequate sleep

hygiene

-Stimulants

-Alcohol

-Technology

-Stress

• Sleep Disorders

•All contribute to an

irregular sleep schedule

Causes of Insomnia in College Students

Terminology: Insomnia & Cognitive Behavioral Therapy

(CBTi)

Insomnia

•Dissatisfaction with sleep quantity/quality with one or more of the following symptoms: difficulty initiating sleep, difficulty maintaining sleep and early-morning awakening (DSM-5)

Cognitive Behavioral Therapy (6 Interventions)

•Stimulus Control, Sleep Restriction, Sleep Hygiene, Relaxation Training, Cognitive Reconstructing, Relapse Prevention

Effects of Insomnia on Cognitive, Emotional and overall

Health

Cognitive

Low GPA

Drowsy Driving

Emotion

Depression

Stress

Immune & Health

Decreased cytokines

Hypertension

Metabolic Syndrome (obesity)

Method: Participation Eligibility/Screening tool and

Setting

Setting

University at Buffalo

Participants

Full-time Student at UB

Age 18-24

Score >7 on Insomnia

Severity Index

Internet Access

Excluded

Taking Medications to treat insomnia or

other psychiatric condition

Psychiatric condition i.e PTSD

Sleep disorder i.eSleep apnea

Intervention Group

6 weekly email-delivered

interventions

Pre, Post,

4 week F-U

Control Group

1 time website referral

Pre, Post,

4 week F-U

Study Design

Procedure

4 week post test6 week post testPre-testScreen & Consent

Week1 : Stimulus Control

z

Week 2: Sleep Restriction

Week 3: Sleep Hygiene

Week 4: Relaxation Technique

Week 5: Cognitive

Reconstruction

Week 6: Relapse

Prevention

Outcome Measures Cronbach’sAlpha

16-Item Dysfunctional Beliefs and Attitudes about Sleep (DBAS)

.77

Pittsburgh Sleep Quality Index (PSQI) .83

Epworth Sleepiness Scale (ESS) .79

Sleep Hygiene Index (SHI) .66

Alcohol Use Disorders Identification Test (AUDIT) .85

Table 1 Demographic Characteristics of Patient Sample (N = 49)

Frequency Percent (%)

Assignment Intervention

Control

30

19

61.2%

38.8%

Gender Male

Female

18

31

36.7%

63.3%

Race Caucasian

Asian

African American/Black

Hispanic

Other

5

30

8

4

2

10.2%

61.2%

16.3%

8.2%

4.1%

College Year Freshman

Sophomore

Junior

Senior

Graduate Student

3

12

14

14

6

6.1%

24.5%

28.6%

28.6%

12.2%

Living Environment House

Apartment

Dorm

16

19

14

32.7%

38.8%

28.6%

Occupation Yes

No

19

30

38.8%

61.2%

Marital Status Single 49 100%

Age Mean (±SD)

Range

20.61(±1.656)

17-25

Table 2 Baseline Sleep Characteristics of the Sample

Mean SD Interpretation

DBAS 96.18 21.14 Total scores range from 0 to 160,

the higher the score representing

a higher degree of dysfunctional

beliefs and attitudes about sleep

PSQI 9.88 3.07 A global sum of “5” of greater

indicates a “poor” sleeper

ESS 10.94 4.08 0-7: unlikely that participant is

abnormally sleepy

8-9: average amount of daytime

sleepiness

10-15: sleepiness may be

excessive depending on the

situation, may want to consider

medical attention

16-24: excessively sleepy and

should consider seeking medical

attention

SHI 44.39 6.38 Total scores range from 0 to 52,

with a higher score representing

poorer sleep hygiene.

Next Steps

• SPSS data analysis and entry to compare control and intervention groups from baseline for completion by Spring 2017

• Recruit a total of at least 60 participants

References• The Prevalence of Sleep Disorders in College Students: Impact on Academic Performance. (2010). Journal of

American College Health, 59(2), 91–97.

• Trockel, M., Manber, R., Chang, V., Thurston, A., & Tailor, C. B. (2011). An e-mail delivered CBT for sleep-health

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Medicine, 7(3), 276–281. doi:10.5664/JCSM.1072

• Hershner, S. D., & Chervin, R. D. (2014). Causes and consequences of sleepiness among college students.

Nature and Science of Sleep, 6, 73–84. doi:10.2147/NSS.S62907 Holmqvist, M., Vincent, N., & Walsh, K. (2014).

Web- vs telehealth-based delivery of cognitive behavioral therapy for insomnia: a randomized controlled trial.

Sleep Medicine, 15(2), 187- 195. doi:10.1016/j.sleep.2013.10.013.

• Taylor, D. J., Zimmerman, M. R., Gardner, C. E., Williams, J. M., Grieser, E. A., Tatum, J. I., Bramoweth, A. D.,

Francetich, J. M., & Ruggero, C. (2014). A pilot randomized controlled trial of the effects of cognitive-behavioral

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10.1016/j.beth.2013.12.010.

• Spivey, A. (2010). Lose sleep, gain weight: another piece of the obesity puzzle. Environmental health

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AcknowledgementsMentor & Primary Investigator

-Dr. Yu-Ping Chang, PhD, RN, Associate Dean for Research & Scholarship

Research Assistant Colleagues

-Alex Salinas

-Terrika Pereira

Funding

-Coletta A. Klug fund

Robert E. McNair Post Baccalaureate Program

-Program Director Dr. Susan Ott

- Project Coordinator Heather Hagenbuch

Questions

Marlene Morales Exercise Science, Health and Wellness, BS

Research Interests: Nursing Geriatrics, Disease Prevention and Management

marlenem@buffalo.edu