The Role of Dysfunctional Sleep Beliefs in Mediating the Outcomes of Web-Based Cognitive Behavioral Therapy for Insomnia in Community-Dwelling Older Adults: Protocol for a Single-Group, Nonrandomized Trial
Bibliographic record
Abstract
BACKGROUND: Sleeping well is an essential part of good health. Older adult populations report a high rate of sleep problems, with recent studies suggesting that cognitive processes as well as behavioral and hyperarousal-related mechanisms could be important factors in the development and maintenance of insomnia. Individuals who have an asynchronous or uncoupled sleep pattern and sleep appraisal-those who complain about their sleep but do not have poor sleep quality, and vice versa-might show differences in subjective sleep and sleep perceptions and other characteristics that could impact their treatment outcomes following cognitive behavioral therapy for insomnia (CBT-I). OBJECTIVE: The purpose of this protocol is to describe the rationale and methods for a nonrandomized, single-arm trial assessing objective and subjective sleep quality in community-dwelling older adults aged 60-80 years with synchronous sleep patterns and sleep appraisal compared to those in older adults with asynchronous sleep patterns and sleep appraisal. The trial will further examine the role of cognitive, behavioral, and hyperarousal processes in mediating the treatment outcomes of web-based CBT-I. METHODS: This trial aims to recruit a sample of 60 participants, who will be assigned to 1 of 4 sleep groups based on their sleep pattern and sleep appraisal status: complaining good sleepers, complaining poor sleepers, noncomplaining good sleepers, and noncomplaining poor sleepers, respectively. The trial will be completed in 2 phases: phase 1 will assess objective sleep (measured via wrist actigraphy) and subjective (self-reported) sleep. Phase 2 will investigate the impact of a web-based CBT-I program on the sleep outcomes of individuals with uncoupled sleep compared to that of individuals without uncoupled sleep, as well as the mediators of CBT-I. RESULTS: Recruitment began in March 2020, and the last participants were recruited by March 2021. A total of 65 participants completed phases 1 and 2. Data analysis for phase 1 was finished in December 2021, and data analysis for phase 2 was finalized in July 2022. The results for phase 1 were submitted for publication in March 2022, and those for phase 2 will be submitted by the end of December 2022. CONCLUSIONS: This trial will provide guidance on factors that contribute to the variability of sleep in older adults and their sleep outcomes following CBT-I. The outcomes of this study could be valuable for future research attempting to tailor CBT-I to individual needs. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12619001509156; https://tinyurl.com/69hhdu2w. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/32705.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.031 | 0.038 |
| Meta-epidemiology (narrow) | 0.006 | 0.004 |
| Meta-epidemiology (broad) | 0.009 | 0.006 |
| Bibliometrics | 0.003 | 0.003 |
| Science and technology studies | 0.005 | 0.004 |
| Scholarly communication | 0.004 | 0.004 |
| Open science | 0.004 | 0.003 |
| Research integrity | 0.010 | 0.009 |
| Insufficient payload (model declined to judge) | 0.053 | 0.012 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".