Tailored Treatment of Insomnia in Social and Health Care Sector Shift Workers in Occupational Health Care

Insomnia Severity Index (ISI) contains seven items about insomnia during the last month [item scale 0 (not at all) -4 (very severe)]. The sum of the scores serves as the ISI score.

Insomnia symptoms are assessed by sleep diary. It is completed using a mobile phone app (Experience Sampling Platform - movisensXS - movisens GmbH). The sleep diary contains questions about the timing of the sleep period, sleep onset latency, wake after sleep onset, number of awakenings after sleep onset, sleep quality, time spent in bed, restedness after sleep, use of sleep-promoting medication, working times, recovery from work, naps and their timing. Total sleep time and sleep efficiency are calculated from the responses. The averages will serve as the outcomes. Participants will keep the sleep diary for 1-2 weeks at each measurement period.

Insomnia symptoms are also assessed using the Actigraphy Link GT9X. Actigraphy recording is conducted for 1-2 weeks at the same time as the sleep diary. From the actigraphy data, we analyse sleep onset latency, wake after sleep onset, total sleep time, sleep efficiency, naps and their timing. The averages will serve as the outcomes.

Shift-specific questions on insomnia and sleepiness (SS-Q) -questionnaire measures separately sleepiness and insomnia symptoms in three different shifts (morning, evening and night shifts) and while on holiday over two weeks [item scale 1 (never) - 5 (always)]. Shift work disorder (SWD) cases has to report sleepiness and/or insomnia "never" or "rarely" while on holiday and the never or rarely occurring symptom "often" or "always" in connection to some shift type/types. SWD score [0 (no SWD) or 1(SWD case)] is used as outcome.

The Ford Insomnia Response to Stress Test (FIRST) contains nine items about insomnia reactivity in potentially stressful situations [item scale 1 (not likely) - 4 (very likely)]. The sum of the scores serves as the FIRST score.

Sleep-related Beliefs and Attitudes about Sleep (DBAS-16) -questionnaire contains 16 items to assesses sleep-related dysfunctional cognitions [item scale 0 (strongly disagree) - 10 (strongly agree)]. The average of the scores serve as the DBAS score.

The Epworth Sleepiness Scale (ESS) contains eight items to measure the subject's general level of daytime sleepiness in different situations [item scale 0 (would never nod off) - 3 (high chance of nodding off)]. The sum of the scores serves as the ESS score.

The Patient Health Questionnaire (PHQ-9) contains nine items to measure depression severity [item scale 0 (not at all) - 3 (nearly every day)]. The sum of the scores serves as the PHQ-9 score.

The GAD-7 contains seven items measuring the severity of the symptoms of generalised anxiety disorder [item scale 0 (not at all) - 3 (nearly every day)]. The sum of the scores serves as the GAD-7 score.

The Burnout Assessment Tool (BAT-12) contains 12 items measuring burnout symptoms [item scale 1 (never) - 5 (always)]. The average of the scores serves as the BAT-12 score.

EuroHIS-8 contains 8 items measuring the quality of life [item scale 1 (worst outcome) - 5 (best outcome)]. The sum of the scores serves as the EUROHIS-8 score.

Power, M. (2003). Development of a common instrument for quality of life. In A. Nosikov & C. Gudex (edit.), EUROHIS: Developing Common Instruments for Health Surveys (145-159). Amsterdam, Holland: IOS Press.

Work ability measure includes an item measuring self-rated work ability (item scale 0 (not at all) - 10 (very good)].

The recovery measure includes an item measuring recovery from work [item scale 1 (badly) - 5 (well)]. In this study, recovery is measured separately in four different shifts (morning, day, evening and night shifts).

Participants' experiences of the implementation of the interventions are assessed using the Acceptability of Intervention Measure, the Intervention Appropriateness Measure, and the Feasibility of Intervention Measure [each with four items and a scale 1 (completely disagree) - 5 (completely agree)]. The average of each measure serves as a acceptability, appropriateness and feasibility measure of implementation.

Participants rate the global effectiveness of the treatment in improving their overall life situation and well-being using a question from the Consumer Reports survey [item scale 1 (not at all) - 7 (decisive impact)].

Questions about age, gender, marital status, educational level, shift work related issues (e.g. shift schedules and number of different shifts per month), comorbid conditions, medications and chronotype.

Participants assess perceived helpfulness and feasibility of each treatment session on a rating scale from 0 (not at all helpful/easy) to 100 (extremely helpful/easy) and answers open-questions about helpfulness and feasibility.