Sleep-Mood Intervention Reduces Insomnia Symptoms Among University Students

A 4-week, multicomponent sleep-mood group intervention combining cognitive behavioral therapy for insomnia (CBT-I) and mindfulness led to a significant reduction in insomnia symptoms among university students in the Netherlands but had limited impact on the students’ mental health and quality of life. These are the findings of a studypublished in BMC Psychology.

The Sleep Mood Intervention: Live Effectively (SMILE) program was developed to address the unique challenges faced by university students, including high stress, academic pressures, and sleep disturbances. Researchers conducted a pilot randomized controlled trial to evaluate SMILE’s efficacy in improving insomnia and secondary outcomes such as anxiety, depression, and quality of life.

The study included 35 participants (mean age, 22.8; women, 74.3%) who were randomly assigned in a 2:1 ratio to either the SMILE intervention group (n=23) or a waitlist control group (n=12). Participants included students enrolled at Leiden University who were aged 18 and older with clinically significant insomnia symptoms (Insomnia Severity Index [ISI] ≥10). The SMILE program comprised 4 weekly 2-hour sessions, with each session addressing specific themes such as sleep hygiene, cognitive restructuring, relaxation techniques, and lifestyle factors.

The study’s primary outcomes were changes in ISI scores from baseline to 5 weeks. Secondary outcomes included changes in depressive symptoms (Beck Depression Inventory-II), anxiety (Hospital Anxiety and Depression Scale-Anxiety), and quality of life (Quality of Life Enjoyment and Satisfaction Questionnaire).

Compared with the control group individuals at week 5, participants in the SMILE intervention group showed a significant reduction in insomnia severity (mean ISI score, 10.7 vs 14.7; P =.03; Cohen d=0.83). Compared with 16.7% of control group individuals, 47.8% of students in the intervention group achieved clinical remission (ISI <10).

No significant differences were observed between the groups in the participants’ depression (d=0.02; 95% CI, -0.35 to 0.37), anxiety (d=0.15; 95% CI, -0.16 to 0.53), and quality of life (d=0.09; 95% CI, -0.25 to 0.42), which suggests that while the intervention effectively reduced insomnia symptoms, its broader mental health benefits were less pronounced.

Mediation analysis revealed that the improvement in insomnia severity was significantly associated with a reduction in dysfunctional beliefs and attitudes about sleep (P =.02). However, presleep arousal did not significantly mediate the intervention’s effects (b=-0.68; 95% CI, -2.12-0.03).

Study limitations included a small sample size, lack of long-term follow-up data, single-site design, and reduced participant numbers due to COVID-19 interrupting recruitment. “Multi-component interventions tailored to the needs of university students offer a promising path in improving sleep problems in this population at risk for both sleep and mental health disturbances,” the researchers concluded.

This research was supported by of the Clinical Psychology Department of Leiden University. One study author declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.