Patients' experiences of group-delivered sleep restriction therapy in primary care: a qualitative study undertaken alongside a randomized controlled trial

Christina Bini; Josefin Bäckström; Kristofer Årestedt; Markus Jansson-Fröjmark; Christina Sandlund

doi:10.1016/j.sleep.2025.106822

Patients' experiences of group-delivered sleep restriction therapy in primary care: a qualitative study undertaken alongside a randomized controlled trial

Sleep Med. 2025 Dec:136:106822. doi: 10.1016/j.sleep.2025.106822. Epub 2025 Sep 23.

Authors

Christina Bini¹, Josefin Bäckström², Kristofer Årestedt³, Markus Jansson-Fröjmark⁴, Christina Sandlund⁵

Affiliations

¹ Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Sweden; Academic Primary Health Care Centre, Region Stockholm, Sweden. Electronic address: christina.bini@ki.se.
² Department of Medical Sciences, Clinical Psychiatry, Uppsala University, Uppsala, Sweden; Department of Health, Education and Technology, Luleå University of Technology, Luleå, Sweden; Department of Health Care Sciences, Marie Cederschiöld University, Stockholm, Sweden.
³ Faculty of Health and Life Sciences, Linnaeus University, Kalmar/Växjö, Sweden; Department of Research, Region Kalmar, Kalmar, Sweden.
⁴ Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden.
⁵ Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Sweden; Academic Primary Health Care Centre, Region Stockholm, Sweden.

PMID: 41014699
DOI: 10.1016/j.sleep.2025.106822

Abstract

Background: Sleep restriction therapy (SRT) is an effective and brief behavioral treatment for insomnia and could serve as a valuable complement to insomnia care. This study explores patients' experiences of being offered and attending group-SRT at their primary care centers, including experiences of feasibility and mechanisms of impact.

Methods: This qualitative study was undertaken alongside a randomized controlled trial on nurse-led group-SRT in Swedish primary care, involving adults with insomnia disorder. Semi-structured interviews were conducted within three months post-intervention with fourteen patients. Verbatim transcripts were analyzed using qualitative content analysis before trial results were examined. The study was guided by the Medical Research Council framework for process evaluation of complex interventions.

Results: The result is presented in two themes: Increased knowledge, motivation, and flexibility in enhancing adherence to group-SRT and Struggles, solutions, and group dynamics: A path to empowerment. Patients found that understanding sleep reinforced their commitment to group-SRT by providing a rationale for participation. Adherence was influenced by treatment flexibility, personal motivation, and group dynamics. Patients experienced that while group-SRT was challenging, it also offered solutions for better sleep. However, life circumstances and depressive symptoms hindered compliance.

Conclusions: Patients' experience of group-SRT were influenced by the patient-provider relationship, motivation, and comorbid depression, all which impacted engagement. This study provides valuable insights into how patients perceive group-SRT, contributing to the refinement of future insomnia treatments. Further research should explore healthcare providers' perspectives on both the challenges and opportunities for implementing group-SRT in primary care.

Keywords: Cognitive behavioral therapy for insomnia; Group treatment; Insomnia; Nursing; Primary care; Sleep initiation and maintenance disorders.

Publication types

Randomized Controlled Trial

MeSH terms

Adult
Aged
Female
Humans
Male
Middle Aged
Motivation
Primary Health Care
Psychotherapy, Group* / methods
Qualitative Research
Sleep Initiation and Maintenance Disorders* / psychology
Sleep Initiation and Maintenance Disorders* / therapy
Sweden