Background: Shift workers are at an increased risk of developing sleep disorders. The standard therapy recommended for sleep disorders is cognitive behavioural therapy for insomnia (CBT-I). Many of its interventions are based on a regular sleep and wake rhythm, which is difficult to apply for shift workers. We have therefore developed a new therapy manual specifically for shift workers (CBT-I-S), which should be more applicable to their needs. In particular, all interventions that require regularity have been removed, and instead, interventions that address factors that proved to be relevant to sleep in our preliminary study have been integrated. We now want to test this manual for its effectiveness. Methods: A randomised controlled trial with N = 142 will be conducted to compare two conditions: the newly developed therapy manual will be carried out in the experimental group, while cognitive behavioural therapy for insomnia will be employed in the standard group. Both treatments will be conducted online via MS Teams in a group setting with seven sessions each. Data will be collected at three measurement points (pre, post, 6-month follow-up) and analysed using linear mixed models. The study will investigate whether the two treatments have led to significant improvements in total sleep time, sleep onset latency, subjective sleep quality and daytime sleepiness in shift workers. It will also examine whether the new therapy manual is superior to standard therapy in shift workers and whether these effects are stable. Discussion: We assume that interventions designed to address depressive mood, anxiety, worry, rumination, dysfunctional thought patterns and attitudes towards sleep will also improve sleep. If this is indeed the case, these interventions could replace previous ones that require regularity. This could significantly improve the treatment of insomnia in shift workers. Trial registration: German Clinical Trials Registry DRKS DRKS00032086. Registered on August 16, 2023.

Shift workers face a heightened risk of insomnia. Recent research has yielded promising insights, but further progress is necessary to better treat insomnia in this group. The present pilot study evaluates how different characteristics impact sleep in shift workers to develop an innovative therapeutic approach. An online survey was administered to an ad hoc sample of N = 225 (112 shift workers), and correlations were calculated between sleep variables and specific characteristics (e.g., psychological impairment, personality traits, sleep-related behavior, attitudes towards sleep and shift work). Group differences between good/poor sleepers and day/shift work were determined using Mann–Whitney U-tests and Kruskal–Wallis H-tests. Regression was used to identify appropriate predictors. All factors (except perfectionism, chronotype, and importance of sleep) yielded significant results in both correlations and group differences (good/poor sleepers). The two groups of day/shift workers showed only minor differences. Dysfunctional beliefs about sleep, pre-sleep arousal, and depression were identified as predictors of poorer sleep. We conclude that interventions on psychological constraints (anxiety and depression), personality traits (anxiety, concern, emotional instability, and tension), social integration, sleep-related factors (dysfunctional beliefs, especially cognitive pre-sleep-arousal, sleep hygiene) and the attitude toward shiftwork, can replace those on regularity and will build an innovative therapy for shift workers on this basis. Once the newly developed treatment manual is finalized, its efficacy will be assessed through a randomized controlled trial.

Shift workers are at increased risk of insomnia. The standard treatment (cognitive behavioral therapy for insomnia) poses significant challenges for this demographic due to irregular work and sleep schedules. New approaches are still considered insufficient due to high attrition or insufficient effectiveness. Our preliminary study identified sleep-relevant state and trait factors (see secondary outcomes) for incorporation into an innovative manual that addresses sleep in an implicit manner. The objective was to reduce the focus on insomnia and to replace regularity-based interventions. With a sample of 55 insomniacs (67.74% male, mean age 41.62 years), standard and customized treatments were compared using pre-treatment, post-treatment, and three-month follow-up measurements (RCT, self-assessment data). Our linear mixed models revealed the main significant effects of the measurement point for the primary (insomnia severity, sleep quality, sleep onset latency, total sleep time, daytime sleepiness) and the secondary outcomes (selection: anxiety/depression, dysfunctional beliefs, arousal, emotional stability, concern). No main effects of the condition or interaction effects were identified. Non-inferiority and equivalence tests demonstrated that the customized treatment is equivalent to standard therapy, which is a favorable outcome in light of the implicit approach. Consequently, this innovative approach warrants further exploration, incorporating the present results.

Shift workers are at increased risk for insomnia. The standard treatment (cognitive behavioral therapy for insomnia) poses significant challenges for this demographic due to irregular work and sleep schedules. New approaches are still considered insufficient due to high attrition or insufficient effectiveness. Our preliminary study [1] identified sleep-relevant state and trait factors (see secondary outcomes) to incorporate into an innovative manual that addresses sleep in an implicit manner. The objective was to reduce the focus on insomnia and to replace regularity interventions. With a sample of 55 insomniacs (67.74% male, mean age 41.62 years), standard vs. customized treatment were compared at pre-, post-, and 3-month follow-up measurement (RCT, self-assessment data). Linear mixed models revealed significant main effects of the measurement point for the primary (insomnia severity, sleep quality, sleep onset latency, total sleep time, daytime sleepiness) and the secondary outcomes (selection: anxiety/depression, dysfunctional beliefs, arousal, emotional stability, concern). No main effects of the condition or interaction effects were identified. Non-inferiority and equivalence tests demonstrated that the customized treatment is equivalent to standard therapy, which is a favorable outcome in light of the implicit approach. Consequently, this innovative approach warrants further exploration, incorporating the present results.

Sleep starts (SS) are transient phenomena during sleep onset. Although traditionally characterized by sudden muscle jerks, they may also involve sensory, cognitive, emotional, and autonomic experiences. Despite their high prevalence, empirical data on phenomenology and associated characteristics remain limited. This online survey examined SS phenomenology and exploratory associations with demographic, sleep-related, and psychological variables in 194 adults. Participants with self-reported sleep-related movement disorders or relevant medical conditions were excluded. Individuals reporting abrupt awakenings ≥1/week and ≥1 additional symptom formed the SS group (SS frequency ≥1, n = 96); all others the comparison group (SS frequency <1, n = 98). Because SS were operationalized using self-reported symptoms, they could not be distinguished from related sleep-onset phenomena (e.g., exploding head syndrome, hypnagogic hallucinations). Standardized questionnaires (PSQI, ISI, ESS, MZS, HADS) assessed sleep quality, insomnia severity, daytime sleepiness, dysfunctional sleep-related beliefs, and anxiety/depression symptoms. Participants described diverse experiences including motor jerks, falling sensations, dream-like experiences, somatosensory symptoms, autonomic arousal, and emotional reactions, accompanied by alarm, anxiety, and confusion. Compared with controls, the SS group reported poorer sleep quality, greater insomnia severity, stronger dysfunctional sleep-related beliefs, and higher anxiety/depressive symptoms (all p < .05). Exploratory regression analyses indicated that poorer sleep quality, stronger dysfunctional sleep-related beliefs, and higher anxiety symptoms were associated with higher SS frequency, whereas depressive symptoms were not. The final model explained 26.9% of variance (R ² = .269, adjusted R ² = .245). More frequent SS were retrospectively reported during emotional stress, whereas sleep deprivation was perceived as less influential. Although many described SS as manageable, a substantial subgroup reported distress and sleep disruption. This suggests that SS represent heterogeneous sleep-onset experiences associated with subjective sleep disturbance and cognitive-emotional arousal. Although causality cannot be inferred from cross-sectional self-report data, the results highlight potentially relevant links between SS and sleep-related cognitive-emotional processes.

Shift workers face a heightened risk of insomnia. Recent research has yielded promising insights; but further progress is necessary to better treat insomnia in this group. The present pilot study evaluates how different personality traits and states impact sleep in shift workers to develop an innovative therapeutic approach. An online survey was administered to an ad-hoc sample of N = 225 (112 shift workers), and correlations were calculated between sleep variables and specific characteristics (e.g., psychological impairment, personality traits, sleep-related behavior, attitudes towards sleep and shift work). Group differences between good/poor sleepers and day/shift work were determined using Mann-Whitney U-tests and Kruskal-Wallis H-tests. Regression was used to identify appropriate predictors. All factors (except perfectionism, chronotype, and importance of sleep) yielded significant results in both correlations and group differences (good/poor sleepers). The groups day/shift workers showed only minor differences. Dysfunctional beliefs about sleep, pre-sleep arousal, and depression were identified as predictors of poorer sleep. We conclude that interventions on the factors mentioned can replace those on regularity and will build an innovative therapy for shift workers on this basis. Once the treatment manual is finalized, its efficacy will be assessed through a randomized controlled trial.