Overcoming Insomnia: Impact on Sleep, Health and Work of Online CBT-I

The ISI will be used to assess self-reported levels of insomnia severity. Range is 0-28. Higher values represent higher levels of insomnia symptom severity.

Sleep diaries will be used to get daily information about: Sleep duration, sleep onset latency, wake after sleep onset, number of awakenings, bed time, rise time, time for final awakening before rise time, medication used, alchohol/drug use, variability. Individuals keep a record for at least 10 of 14 consecutive days.

The HADS will be used to assess levels of anxiety and depression. The HADS comprises 14 items (higher values indicate higher symptom severity) pertaining to non-vegetative symptoms of anxiety and depression, which makes it a suitable measure of general psychological distress in populations likely to have physical comorbidities (e.g. general practice and liaison psychiatry settings).

The SF-12 is an abbreviated version of the MOS 36-item short-form health survey (SF-36), and measures the individuals' perceived physical and mental health status. The SF-12 is scored using the recommended MOS software program that creates two summary scores, mental health (MCS12), and physical health (PCS12). The scores are represented as T-scores that are linear transformations with a mean of 50 and a standard deviation of 10 in the general U.S. population.

The DBAS is a self-report questionnaire designed to identify maladaptive sleep- and insomnia-related cognitions. Patients are given a list of 16 statements reflecting different beliefs and attitudes about sleep, and they are asked to indicate on a 10-point scale how much they agree with the statements. Higher scores indicate higher levels of endorsement of beliefs.

The CFQ comprises 11 items addressing physical and psychological fatigue, and two items addressing the duration and the intensity of fatigue complaints. Higher values indicate higher levels of fatigue.

The BIS comprises six items that assesses symptoms of insomnia based on the insomnia criteria found in the Diagnostic and Statistical Manual of Mental Disorders-IV-TR (American Psychiatric Association). Higher values indicate higher levels of insomnia severity.

The MEQ is the most widely used measure of chronotype (so-called 'morningness' or 'eveningness'), and gives an indication of the respondents preferred (as opposed to actual) rise-time and bed-time. Higher scores indicate higher levels of morningness.

A 20-item checklist of common medical conditions and any impact on work or personal life. Also used in the Helseundersøkelsen Nordtrøndelag study (the HUNT study).

Presence of psychiatric conditions will be assessed with an 8-item checklist of common psychiatric conditions based on a template used for physical health in the Helseundersøkelsen Nordtrøndelag study (the HUNT study).

A self-report checklist (yes/no) of nine sites on the body where one can experience pain.

The AUDIT-C scale comprises of three items and will be used to assess the frequency and quantity of alcohol consumption where higher scores indicate higher levels of use.

Height will be recorded at baseline and weight will be recorded at baseline, post-intervention, 6 and 24 months to allow estimation of body mass index (kg/m^2) at these time points.

Level of self-reported physical activity is measured using six items (from the HUNT study) that assess frequency, intensity and duration of the activity.

Objective data on days with sick leave will be determined with data from the NIA, a national Norwegian registry which records all periods of sick leave >13 days, as well as information on all disability pension awards.

Objective data on the use and type of specialist health care services will be determined using the NPR, a national Norwegian registry which contains information about all patients who are waiting for, or have received treatment, as outpatients in the specialist health service. The data retrieved from the NPR include diagnoses (according to ICD-10 criteria), name of health care provider, service use (e.g. outpatient appointments) and hospital admission and discharge dates.

Medication use will be determined from NorPD, a national health register comprising information on all prescriptions dispensed at Norwegian pharmacies (since January 2004). The NorPD provides detailed information that will allow us to identify the medication, its class, and information on dispensed prescriptions (which can be used as a proxy for medication consumption).

A self-report 10-item questionnaire that records what help or treatments that have been sought.

Free text where participants report reason for medication use, dosage, timing, and adherence.

Subjective reports of health care service use will be assessed with 5 items recording use of primary and secondary health services.

A self-report 7 item questionnaire that assess absence from work and loss of productivity due to health problems.

2 items recording self-perceptions of any negative effects of health status on work or leisure activities.

The acceptability of online interventions after completion of the programs will be assessed with the Internet intervention evaluation which comprises two questionnaires used in SHUTi research: the Internet Intervention Utility Questionnaire (UQ) and the Internet Intervention Impact Questionnaire (IQ).

Self-report ratings of how much daily time participants spend, and how much time they spend while in bed, on different five different types of electronic media.

To assess views regarding the interventions, we will ask participants to complete the NEQ. The NEQ is a self-report measure that contains 32 items that are scored on a five point Likert-scale (0-4) where higher scores indicate higher levels of negative effects. After each item, the individual is asked whether they consider the effect to be caused by the treatment received or caused by other circumstances (yes/no), as well as one open-ended question.

A self-report questionnaire has been developed in order to assess patients continued use of sleep strategies after the intervention. The questionnaire comprises 6 items assessing how many times each week the last month patients have used 6 different therapeutic techniques used in Cognitive Behavior Therapy for Insomnia (incl. kept a stable rise time, refrained from sleeping during daytime, used the bed and the bedroom only for sleeping, practiced sleep restriction, got out of the bed when unable to fall asleep within 15-20 minutes, and kept a sleep diary), how useful each technique was on a 0 to 10 scale where higher score indicates higher level of usefulness, and whether the patients have used the technique regularly since terminating treatment (yes/no).