Restoring effective sleep tranquility (REST): A feasibility and pilot study.
Aaron M Eakman, Arlene A Schmid, Kimberly L Henry and 4 others
PMID 28626295WHAT IT FOUND
An occupational therapist-led 8-week CBT-I program was feasible to deliver: eight veterans completed baseline and seven completed treatment and post-assessment.
Seven reported less insomnia, fewer nightmares, fewer dysfunctional sleep beliefs and better social participation. The study does not show it works.
Key findings
01The program was feasible to deliver: eight veterans completed baseline assessments, seven completed the intervention and post-assessments, attendance averaged 5.9 of seven group sessions and 6.8 of eight one-to-one sessions, and no intervention-related adverse events were reported.
02Seven veterans who completed the 8-week occupational therapist-led program reported reduced insomnia symptom severity, reduced sleep disturbance, reduced nightmares, and fewer dysfunctional sleep beliefs.
03The seven analysed participants also reported greater ability to participate in social roles and activities, while satisfaction with participation and pain interference showed only trends toward improvement.
STILL TO COME
How it was doneWhat they foundWhat it means for OTs
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What it does not show
There was no control group and no randomisation, so the changes cannot be separated from time, natural variation, social contact, mindfulness, diary monitoring or other parts of the program. Only seven veterans were analysed, all male, all White/Caucasian, and all college students, so it says nothing about women, other racial groups, non-student veterans or more diverse settings. The study was designed to test feasibility and pilot outcomes, not efficacy, and the authors describe it as preparation for a future controlled trial. Feasibility criteria were not set before the study, so the judgments about recruitment, attendance, resources and management are post hoc. Two participants reported physician-prescribed medication changes during the program, and researchers did not have direct access to medical records, so medication change could have influenced outcomes in those cases. The paper did not report sleep diary variables such as total sleep time, sleep efficiency, sleep onset latency and awakenings, or follow-up outcomes. The sample had high comorbidity, with mean PCL-C-6 16.5 and mean PHQ-9 12.0, indicating probable PTSD and probable moderate depression, so effects may not apply to veterans without these conditions.
The easy way to misread this
Do not read the improved sleep scores as proof that REST works. There was no control group, only seven veterans were analysed, and the program gave stimulus control, sleep restriction, sleep hygiene, group education, one-to-one therapy, meditation, daily sleep diaries and an activity monitor together, so no single component can be credited.