Psychological Interventions for Sleep Problems Among Medical and Paramedical Students: A Systematic Review.

Abstract

Sleep problems such as poor sleep quality and insomnia are common issues among medical and paramedical students, which may lead to mental health disorders and impaired academic performance. Despite the availability of different sleep programs and psychological interventions, as well as a few reviews exploring their effects on sleep variables in college students, a systematic review comparing their effectiveness in medical students is still lacking. This systematic review aims to investigate psychological interventions to improve sleep quality and address sleep problems in medical students. Four databases (PubMed, SciDirect, Scopus, and PsycNet) were searched to retrieve original research articles written in English and published from January 1, 2000, to September 30, 2023. Outcome measures were sleep quality, insomnia, sleep behavior, sleep quantity, and sleep-related problems. A total of 19 articles met the inclusion criteria, and 4 categories of interventions were identified (1) sleep hygiene, (2) cognitive behavioral therapy (CBT), (3) a combination of sleep hygiene/CBT with other modalities, and (4) other psychotherapeutic interventions such as progressive muscle relaxation, hypnotherapy, aromatherapy yoga, and mindfulness. Ten studies were randomized control trials, two were quasi-experimental, and the remaining seven were pre- and post-intervention designs (one group only and no control). Overall, both individual CBT and sleep hygiene education led to significant improvement in sleep quality and sleep problems among medical students, but CBT was more effective with consistent positive effects on sleep quality. Nevertheless, significant improvements in sleep quality and sleep-related outcomes were observed in studies combining these psychological interventions. Effective comparisons were limited due to the substantial heterogeneity between the studies. Further research is required to elucidate the type of psychological intervention, optimal mode of delivery, duration, and number of contacts of these interventions, including the moderators to improve sleep quality among medical students.