The PSP Sleep Course: An Online Sleep Intervention for Public Safety Personnel With Self-reported Sleep Difficulties.

Background:

Public safety personnel (PSP) refer to individuals who ensure the safety and security of their citizens (e.g., border services officers, correctional workers, firefighters, paramedics, police). These occupations often require long and irregular hours (e.g., shift work) which can negatively impact daily functioning and work performance. PSP also experience increased exposure to potentially psychologically traumatic events (PPTEs) which can increase risk for mental health challenges (e.g., anxiety, depression, posttraumatic stress). These occupational stressors can also lead to sleep disturbance among PSP. Contributing factors to PSP sleep difficulties include long work hours, varying shift work, high stress, and exposure to PPTEs. Some evidence suggests that certain sectors are more susceptible to sleep difficulties, with correctional workers, paramedics, and Royal Canadian Mounted Police (RCMP) experiencing more difficulties than firefighters and police officers.

To improve access to effective psychological treatment, internet-delivered cognitive behavioural therapy (ICBT) has emerged as a structured online alternative to face-to-face cognitive behavioural therapy (CBT) in which treatment materials are delivered periodically over several months. The approach can be offered with or without therapist support. Research supports the effectiveness of ICBT for conditions like depression, anxiety, alcohol misuse, and insomnia with outcomes comparable to face-to-face therapy. Moreover, there is evidence that PSP benefit from transdiagnostic and PTSD-specific ICBT but to date there are no studies exploring Internet-delivered cognitive behaviour therapy for insomnia (ICBTi) among PSP.

Individuals who experience sleep disturbances are more likely to report increased physical (e.g., illness, poor health, pain) and mental challenges (e.g., anxiety, depression), as well as decreased work performance, daily functioning, and quality of life. PSP similarly experience these effects of sleep disturbances.

ICBTi is an evidence-based treatment for insomnia and sleep difficulties. Studying this among PSP is important as access to specialized psychological services, such as CBTi, is often limited, even though CBTi is a well-established treatment, and generally preferred over medication. ICBTi offers a promising approach for expanding access to evidence-based treatment for insomnia. The current study aims to explore the extent to which this ICBTi program, called the Sleep Course will be used by PSP, found to be acceptable and effective. Findings will shape long-term practices of working with PSP, contribute to a broader understanding of how ICBTi can address insomnia in PSP, and address the personal and societal impacts of untreated insomnia.

Research purpose:

The purpose of this research project is to offer and evaluate an ICBTi program called the PSP Sleep Course - offered in self- or therapist-guided options. The PSP Sleep Course is an intervention targeting sleep concerns. It comprises of 4 online lessons that provide: 1) psychoeducation on sleep (week 1); 2) information on sleep restriction and stimulus control strategies (week 2); 3) information on thought monitoring and challenging and worry time (week 4); and 4) behavioural strategies including activity scheduling and wind down and up routines (week 6).

To take part in the PSP Sleep Courses, all prospective participants will undergo online screening to assesses a variety of demographic and clinical characteristics pre-treatment to ensure eligibility and collect baseline information. Eligible participants who are interested in the self-guided version of the Course will be immediately enrolled into the Course. Eligible participants who are interested in the therapist-guided version of the Course will then complete a telephone screen with a PSPNET registered therapist to ensure eligibility and answer questions before Course enrollment. Those who do not meet initial inclusion criteria will be given the option of scheduling a phone interview with a clinician to further discuss their eligibility.

Lessons will be released gradually in a standardized order over 7 weeks with regular automatic emails and messages informing clients about upcoming lessons. Supplementary resources can be accessed at any time but are recommended as follows: Lesson 1 Myth-busting; Lesson 2 Shift Work, Diet, Medication & Exercise; Lesson 3 Relaxation and Nightmares; and Lesson 4 Maintaining Progress. Materials are presented in a didactic (i.e., text-based with visual images) and case-enhanced learning format (i.e., educational stories demonstrate the application of skills). Each of the 4 lessons offer Do-It-Yourself Exercises that facilitate skill acquisition for all clients.

Participants in the therapist-guided version of the PSP Sleep Course can email their assigned therapist at any time for 7 weeks, with the possibility of extending care up to 12 weeks. Participants who request support will be contacted by their therapist by secure emails on their designated check-in dates. Therapists will offer support and encouragement related to the PSP Sleep Course content and answer any client questions. Therapists will also contact clients by phone if therapists are concerned about client safety, if clients have not logged in to the PSP Sleep Course, or if clients request a phone call instead of email.

The primary research questions to be answered are:

• What will be the uptake and completion of the PSP Sleep Courses?
• What are the baseline demographic and clinical characteristics of participants in the PSP Sleep Courses?
• How acceptable is the PSP Sleep Courses as assessed via participants' ratings and feedback?
• Will the PSP Sleep Courses result in significant reductions on sleep-related and secondary measures?

Significance:

The data collected will shape long-term practices within PSPNET, which provides ICBT to PSP, and has potential to significantly enhance service delivery. The research will also provide valuable insights for other online clinics regarding the potential of offering ICBTi to PSP. By exploring the program's use, client characteristics, acceptability, and effectiveness, this study will contribute to a broader understanding of how ICBTi can be offered to PSP ultimately improving access to evidence-based treatment for insomnia.

Inclusion criteria

• 18 years of age or older
• Canada resident
• Trainee, staff, or retired public safety personnel (PSP)
• Willingness to learn information and skills to manage sleep difficulties
• Have internet access
• Consent to the PSP Sleep Course

Exclusion criteria

• Current severe medical or psychiatric disorder (e.g. current and recent mania or psychosis, recent hospitalization for mental health concerns, actively suicidal, medical condition client thinks will interfere with treatment, severe substance use)
• Unable to read and understand English. (All content is provided in English and staff is English speaking; pending findings of the research PSPNET will explore translating the course into French)