Hailey Meaklim

This joint position statement of Australian sleep and primary care organizations provides information to healthcare providers on the management of adults with insomnia symptoms in Australia. Perspectives of sleep researchers, psychologists, sleep physicians, general practitioners, pharmacists, nurses, advocacy and implementation experts, and people with lived experience of insomnia are represented. Insomnia may present as an acute disorder (lasting up to 3 months) or a chronic disorder (lasting for 3 months or longer). Untreated insomnia is associated with lowered mood, daytime function, productivity, and quality of life. Insomnia assessment and diagnosis is based on self-reported symptoms. Insomnia occurring in the context of other conditions should be considered a “comorbid condition” that requires concurrent and targeted assessment and management. Recommendations about healthy sleep practices (sleep hygiene) are not an adequate stand-alone treatment for chronic insomnia. Multi-component Cognitive Behavioral Therapy for insomnia (CBTi) is the recommended “first-line” treatment for insomnia. There is evidence that CBTi is effective in a range of settings, in the presence of comorbid conditions, and when delivered in different modalities (e.g. individual sessions, group settings, tele-health, self-guided digital programs). Other evidence-based psychological and behavioral therapies may be appropriate for specific presentations, and in people that do not respond to CBTi. Medicines used for insomnia management are not recommended as the “first-line” treatment for insomnia but may be appropriate in conjunction with CBTi or as second-line treatment if CBTi is not effective or appropriate. Sleep medications may be considered in people with acute insomnia that is caused by a clear precipitant (e.g. bereavement, medical crisis, psychosocial stressors) and resulting in significant distress and/or functional impairment. If used, specific benzodiazepines and “z-drugs” may be indicated for up to 2–4 weeks of use at the lowest effective dose, melatonin may be used for up to 13 weeks, and dual orexin receptor antagonists are generally only recommended for chronic insomnia. Sedating antihistamines, antidepressants, antipsychotics, cannabinoids, and complementary medications are not recommended. Collaboration between people with insomnia and a range of clinicians is important for the management of insomnia and associated sleep, mental, and physical health conditions. Collaboration between sleep and primary care organizations has led to the development and implementation of healthcare provider education programs on insomnia assessment and management.

Objectives: Sleep-wake state discrepancy, the discrepancy between self-reported and objective sleep measures, is commonly experienced in poor sleep and insomnia. While perfectionism is implicated in insomnia, its relationship to sleep-wake state discrepancy has not been investigated. This study aimed to assess the association between sleep-wake state discrepancy and perfectionism and explore whether dysfunctional sleep beliefs and pre-sleep arousal mediate that relationship. Methods: Sixty adult participants from community and clinical populations were conveniently sampled (85% females, mean age 30.28 ± 11.13 years, 38% with insomnia symptoms). Sleep-wake state discrepancy measures were calculated using data from actigraphy and sleep diary collected over 14 days. The Frost Multidimensional Perfectionism Scale (FMPS), Hewitt–Flett Multidimensional Perfectionism Scale (HFMPS), Dysfunctional Beliefs about Sleep (DBAS), and Pre-sleep Arousal Scale (PSAS) were also collected. Results: High perfectionism levels were associated with high levels of sleep-wake state discrepancy. Concern over Mistakes and Doubts about Actions correlated with sleep onset latency discrepancy with small effects (r = 0.26 and 0.29, respectively). Doubts about Actions was associated with sleep onset latency discrepancy. Furthermore, pre-sleep arousal and cognitive pre-sleep arousal mediated relationships between sleep onset latency discrepancy and Concern over Mistakes and Doubts about Actions. Conclusions: Concern over Mistakes and Doubts about Actions relate to a poorer perception of sleep relative to objective sleep measures. During sleep onset, cognitive pre-sleep arousal appears to mediate relationships between perfectionism and sleep-wake state discrepancy. Therefore, perfectionism may be an important cognitive-emotional factor to consider when assessing and treating sleep-wake state discrepancy that commonly accompanies insomnia.

Perfectionism is recognized as a transdiagnostic process contributing to psychopathology (Egan et al., 2011; Limburg et al., 2017). Perfectionism is generally defined as having excessively high sta...

Insomnia is highly comorbid with mental health conditions, yet graduate psychology students receive limited training in sleep and insomnia management. An online introductory sleep workshop focused on insomnia management with Cognitive Behavioral Therapy for Insomnia (CBT-I) was developed for Australian graduate psychology students to address this training gap. However, some students reported difficulties applying CBT-I knowledge to clinical practice. This study explored the barriers and facilitators to implementing CBT-I knowledge into graduate psychology students' practice post-workshop. Semi-structured interviews were conducted with 15 graduate psychology students who attended an online introductory sleep and CBT-I workshop. Data were analyzed using reflexive thematic analysis. Facilitators of CBT-I implementation included: (1) Helpful workshop resources; (2) Increased awareness of the importance of sleep's role in mental health; (3) Enhanced self-efficacy with introductory sleep skills (e.g. sleep history taking); and (4) Knowing where to access further training. Barriers included: (1) Limited ongoing training and clinical supervision; (2) Accessibility challenges; (3) Clinical implementation challenges; and (4) Constraints of being a graduate student. The introductory workshop facilitated the development of introductory CBT-I skills among graduate psychology students, but ongoing training and supervision are needed to enhance implementation and expand Australia's CBT-I workforce.

Perfectionism is an important factor in insomnia development and maintenance. Previous studies exploring the relationship between perfectionism and insomnia have predominantly relied on self-reported sleep measures. Therefore, this study sought to assess whether actigraphy-measured sleep parameters were associated with perfectionism. Sixty adults (85% females, mean age 30.18 ± 11.01 years) were sampled from the Australian general population. Actigraphy-derived objective sleep measures, subjective sleep diary measures, the Frost Multidimensional Perfectionism Scale (FMPS), Hewitt-Flett Multidimensional Perfectionism Scale (HFMPS) and Depression, Anxiety and Stress Scale 21 (DASS-21) were collected. High perfectionism levels were associated with poor sleep, but these relationships differed between objective and subjective measures. Perfectionism via FMPS total score and subscales of Concern over Mistakes, Doubts about Actions, Personal Standards and Self-oriented Perfectionism correlated with subjective sleep onset latency and sleep efficiency with moderate effects (r = .26 to .88). In contrast, perfectionism via HFMPS total score and subscales of Socially Prescribed Perfectionism and Parental Expectations predicted objective sleep onset latency and sleep efficiency. Additionally, stress mediated the relationships between objective sleep efficiency and Concern over Mistakes and Doubts about Actions. Perfectionism demonstrated stronger associations with subjective than objective sleep measures. Higher Parental Expectations and Socially Prescribed Perfectionism may increase one's vulnerability to objectively measured poor sleep. Therefore, perfectionism may be important in preventing and treating insomnia.

The study aimed to characterize insomnia symptom trajectories over 12 months during a time of stress and uncertainty, the coronavirus disease 2019 (COVID-19) pandemic. It also aimed to investigate sleep and psychological predictors of persistent insomnia symptoms. This longitudinal cohort study comprised 2069 participants with and without insomnia symptoms during the first year of the pandemic. Participants completed online surveys investigating sleep, insomnia, and mental health at four timepoints over 12 months (April 2020–May 2021). Additional trait-level cognitive/psychological questionnaires were administered at 3 months only. Six distinct classes of insomnia symptoms emerged: (1) severe persistent insomnia symptoms (21.65%), (2) moderate persistent insomnia symptoms (32.62%), (3) persistent good sleep (32.82%), (4) severe insomnia symptoms at baseline but remitting over time (2.27%), (5) moderate insomnia symptoms at baseline but remitting over time (7.78%), and (6) good sleep at baseline but deteriorating into insomnia symptoms over time (2.85%). Persistent insomnia trajectories were predicted by high levels of sleep reactivity, sleep effort, pre-sleep cognitive arousal, and depressive symptoms at baseline. A combination of high sleep reactivity and sleep effort reduced the odds of insomnia remitting. Higher sleep reactivity also predicted the deterioration of good sleep into insomnia symptoms over 12 months. Lastly, intolerance of uncertainty emerged as the only trait-level cognitive/psychological predictor of insomnia trajectory classes. Insomnia was more likely to persist than remit over the first year of the COVID-19 pandemic. Addressing sleep reactivity and sleep effort appears critical for reducing insomnia persistence rates after times of stress and uncertainty.

Despite the negative impact of poor sleep on mental health, evidence-based insomnia management guidelines have not been translated into routine mental healthcare. Here, we evaluate a state-wide knowledge translation effort to disseminate sleep and insomnia education to graduate psychology programs online using the RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) evaluation framework. Using a non-randomized waitlist control design, graduate psychology students attended a validated 6-hour online sleep education workshop delivered live as part of their graduate psychology program in Victoria, Australia. Sleep knowledge, attitudes, and practice assessments were conducted pre- and post-program, with long-term feedback collected at 12 months. Seven out of ten graduate psychology programs adopted the workshop (adoption rate = 70%). The workshop reached 313 graduate students, with a research participation rate of 81%. The workshop was effective at improving students’ sleep knowledge and self-efficacy to manage sleep disturbances using cognitive behavioral therapy for insomnia (CBT-I), compared to the waitlist control with medium-to-large effect sizes (all p < .001). Implementation feedback was positive, with 96% of students rating the workshop as very good-to-excellent. Twelve-month maintenance data demonstrated that 83% of students had used the sleep knowledge/skills learned in the workshop in their clinical practice. However, more practical training is required to achieve CBT-I competency. Online sleep education workshops can be scaled to deliver cost-effective foundational sleep training to graduate psychology students. This workshop will accelerate the translation of insomnia management guidelines into psychology practice to improve sleep and mental health outcomes nationwide.

Study objectives: Despite the negative impact of poor sleep on mental health, evidence-based insomnia management guidelines have not been translated into routine mental healthcare. Here, we evaluate a state-wide knowledge translation effort to disseminate sleep and insomnia education to graduate psychology programs online using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) evaluation framework. Methods: Using a non-randomized waitlist control design, graduate psychology students attended a validated six-hour online sleep education workshop delivered as part of their graduate psychology program in Victoria, Australia. Sleep knowledge, attitudes, and practice assessments were conducted pre- and post-program, with long-term feedback collected at 12 months. Results: Seven out of ten graduate psychology programs adopted the workshop (adoption rate = 70%). The workshop reached 313 graduate students, with a research participation rate of 81%. The workshop was effective at improving students’ sleep knowledge and self-efficacy to manage sleep disturbances using Cognitive Behavioral Therapy for Insomnia (CBT-I), compared to the waitlist control with medium-to-large effect sizes (all p <.001). Implementation feedback was positive, with 96% of students rating the workshop as very good-to-excellent. Twelve-month maintenance data demonstrated that 83% of students had used the sleep knowledge/skills learned in the workshop in their clinical practice. However, more practical training is required to achieve CBT-I competency. Conclusion: Online sleep education workshops can be scaled to deliver cost-effective foundational sleep training to graduate psychology students. This workshop will accelerate the translation of insomnia management guidelines into psychology practice to improve sleep and mental health outcomes nationwide.