Treating insomnia in people who are incarcerated: a feasibility study of a multi-component treatment pathway
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Accepted version
Author(s)
Type
Journal Article
Abstract
Around 60% of people who are incarcerated have insomnia; 6-10 times more prevalent than the general population. Yet, there is no standardised, evidence-based approach to insomnia treatment in prison. We assessed the feasibility of a treatment pathway for insomnia in a high-secure prison to inform a future randomised controlled trial (RCT) and initial efficacy data for sleep and mental health outcomes. We used a within-subjects pre-post design. The stepped-care pathway included: self-management with peer support, environmental aids, and cognitive behavioural therapy for insomnia (CBTi). Assessment measures for insomnia, wellbeing, mood, anxiety, suicidality, overall health, sleepiness, fatigue, and cognitive functioning were administered at baseline and pathway exit. Feasibility criteria included eligibility to participate, CBTi uptake and assessment completion. Forty-two adult males who are incarcerated were approached of which 95.2% were eligible. Of those deemed eligible, most participated (36/40, 90.0%). Most who completed baseline completed post-assessments (28/36, 77.8%) and of these, most showed improvements in their subjective sleep (27/28, 96.4%). Large reductions were found from pre- to post-treatment in insomnia severity (d=-1.81, 95% CIs 8.3 to 12.9) and 57.0% reported no clinically significant insomnia symptoms at post-assessment. There was no overall change in actigraphy-measured sleep. Large treatment benefits were found for depression, anxiety, wellbeing, and cognitive functioning, with a medium benefit on suicidal ideation. The treatment pathway for insomnia in prison was feasible and may be an effective treatment for insomnia in people who are incarcerated, with additional promising benefits for mental health. A pragmatic RCT across different prison populations is warranted.
Date Issued
2024-01-20
Date Acceptance
2024-01-09
Citation
Sleep Advances, 2024
ISSN
2632-5012
Publisher
Oxford University Press
Journal / Book Title
Sleep Advances
Copyright Statement
© The Author(s) 2024. Published by Oxford University Press on behalf of Sleep Research Society.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License
(http://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and
reproduction in any medium, provided the original work is properly cited
This is an Open Access article distributed under the terms of the Creative Commons Attribution License
(http://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and
reproduction in any medium, provided the original work is properly cited
Copyright URL
Publication Status
Published online
Article Number
zpae003
Date Publish Online
2024-01-20