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Better Nights, Better Days

An online program developed by a team of sleep experts across Canada

 

Why is the program needed?

Insomnia (i.e., chronic and frequent difficulties falling and/or staying asleep) is highly prevalent among children and youth.1 Insomnia affects many typically developing children and youth, and up to 90% of children and youth with neurodevelopmental disorders (NDD).2 Insomnia results in reduced quantity and/or quality of sleep that causes impairments in daytime functioning and deficits in behavioural and emotional functioning, as well as cognitive and learning abilities.3 Although evidence shows that psychological interventions are effective and should be first-line treatment, less than ~20% of children and youth receive evidence-based interventions to treat their insomnia.4  Digital sleep interventions have been recommended by researchers as a solution to bridge the treatment and knowledge-to-practice gaps.5 Thus, Dr. Corkum, her colleagues, and her trainees have been developing and evaluating digital interventions to support sleep health and treat insomnia in children and youth. These digital interventions were developed using a user-centered design approach which is known to improve the user-experience, intervention effectiveness, and uptake.6

 

What is the Better Nights, Better Days program?

BNBD for Children: The Better Nights, Better Days for Typically Developing Children program is an internet-based eHealth intervention that provides knowledge, healthy sleep practices, and behavioural intervention information to parents of children ages 1-12 years old. It is comprised of 5 sessions, is a self-guided and highly dynamic program, allowing parents to tailor an intervention to their child and family’s needs.7, 8

BNBD for Children with NDD: The BNBD for Children program was modified to meet the needs of children with neurodevelopmental disorders (NDDs) through a series of research studies engaging end-users and knowledge-users.9-12 The Better Nights, Better Days for Children with Neurodevelopmental Disorders program uses a modular transdiagnostic approach to intervention with core information consistent with the BNBD for Children version but addition of general NDD components and diagnostic-specific components.

BNBD for Youth: The Better Nights, Better Days Youth program is a 4-session micro-learning eHealth intervention that shares information about sleep, healthy sleep practices, and cognitive and behavioural strategies. The program was developed with adolescents and young adults to ensure acceptability to this group.13

 

What is the research that supports the program?

BNBD for Children: Results of a Canada-wide RCT of 533 parents found the program improved sleep and daytime functioning outcomes.4 More recently, the BNBD for Children program was modified to incorporate information on the importance of sleep during the COVID pandemic and to also include sleep tips for parents. The Canada-wide hybrid implementation-effectiveness study of 513 parents has recently completed and data analysis is underway.

BNBD for Children with NDD: The Canada-wide RCT of 172 parents has been completed, and interim analysis at four months found the program to be effective in improving sleep and daytime functioning. A Canada-wide hybrid implementation-effectiveness study of 195 parents of the BNBD-NDD program is ongoing and aims to evaluate how parents’ use the program, their satisfaction with the program, and opinions about whether it would be valuable as a program to purchase in the future.

BNBD for Youth: To date, usability and pilot testing have been conducted with junior high and high school students with and without recurrent pain. Usability and pilot testing found the program improved sleep and daytime functioning outcomes in adolescents.13 Next, we will be integrating modifications based on usability feedback and launching a larger scale implementation-effectiveness study.

 

What are the next steps?

The Better Nights, Better Days suite of digital interventions provides a solution to bridge the treatment and knowledge-to-practice gaps for insomnia treatment. Once implementation-effectiveness testing is complete, our goal is to make the suite of digital interventions accessible and available to all parents and youth, improving access to evidence-based treatment of insomnia across Canada.

 

Better Nights, Better Days 

may help provide a more accessible way of delivering health care

 

The Program

Better Nights, Better Days Program Sessions 

Session 1: Introduction 

Introduction to the program and information about how sleep works and how sleep problems develop.

Information for parents about adult characteristics of sleep; how sleep problems develop in adults, and a link to download an adult Sleep Diary from the National Sleep Foundation.  

 

Session 2: Healthy Sleep Practices  

Learn about healthy sleep practices and routines, and how doing things differently during the day and at night can help your child sleep better.

Includes prompts for parents to consider the influence of factors on their own sleep, including their own sleep schedules, bedtime routines, sleep location, use of electronics before bed, exercise and diet, positivity, and sleep associations. 

 

Session 3: Settling to Sleep 

Focus on problems settling to sleep independently at naptime and at bedtime.

Includes evidence-based strategies recommended for adults on improving their ability to fall asleep.

 

Session 4: Going Back to Sleep 

Focus on using tools to help with night-wakings and what to do if your child wakes too early in the morning.

Includes evidence-based strategies recommended for adults to manage to night wakings, napping, and early morning awakenings.

 

Session 5: Looking Back and Ahead 

Review your goals and progress you’ve made during the program, and develop a plan for the future.

Includes descriptions of other sleep problems that adults may experience and guidance for when adults should contact their healthcare provider for assessment and treatment.

 

 

Better Nights, Better Days Program Tools

 

Sleep Diary 

Fill out a daily online sleep diary to track your results and see patterns in your child’s sleep and behaviour as you complete the sessions. 

Weekly Activities and Reviews

Complete activities that will help you make positive changes to improve your child’s sleep.  For instance, learn how to create sleep routines, a healthy sleep environment, and practice techniques to reduce stress.

Track Your Progress

Throughout the program, you'll receive feedback on the positive changes that you're making to your child's sleep.

      

 

Parent Testimonials 

“Your program was a game changer for our child. Night and day the difference it made! We were at our wits end, fighting constantly with our child and ourselves due to sleep deprivation (our child only slept 2hr/24hrs), and then after working with her through your program, she now sleeps 10.5hr a night and is a happy kid in the day. We can't speak more highly of your program and are constantly recommending it to parents in need.”

- Ontario, child 3 years old

“When following tips from Better Nights, Better days, our house runs more smoothly, people are all in better moods and the day goes along in a happier way."

- New Brunswick, child 7 years old

"The best part was that it made a huge difference in improving the quality of sleep we are now getting as a family.”

- British Columbia, child 1 year old

“I loved the program, the modules were easy to follow and kept us on track.”

- Saskatchewan, child 4 years old

 

References

  1. Mindell, J. A., Kuhn, B., Lewin, D. S., Meltzer, L. J., Sadeh, A., & American Academy of Sleep Medicine. (2006). Behavioral treatment of bedtime problems and night wakings in infants and young children. Sleep, 29(10), 1263–1276.
  2. Tietze, A. L., Blankenburg, M., Hechler, T., Michel, E., Koh, M., Schlüter, B., & Zernikow, B. (2012). Sleep disturbances in children with multiple disabilities. Sleep medicine reviews, 16(2), 117-127.
  3. Tomaso, C. C., Johnson, A. B., & Nelson, T. D. (2021). The effect of sleep deprivation and restriction on mood, emotion, and emotion regulation: Three meta-analyses in one. Sleep, 44(6), zsaa289.
  4. Corkum, P., Weiss, S., Hall, W., Brown, C., Chambers, C., Constantin, E., Godbout, R., Hanlon-Dearman, A., Ipsiroglu, O., Reid, G. J., Shea, S., Smith, I. M., Stremler, R., & Witmans, M. (2019). Assessment and treatment of pediatric behavioral sleep disorders in Canada. Sleep Medicine, 56, 29–37. https://doi.org/10.1016/j.sleep.2018.11.007
  5. Soh, H. L., Ho, R. C., Ho, C. S., & Tam, W. W. (2020). Efficacy of digital cognitive behavioural therapy for insomnia: a meta-analysis of randomised controlled trials. Sleep medicine, 75, 315–325.
  6. Weinheimer EA, Chang A, Neubert SW, Wildes JE, Graham AK. Past, current, and future willingness to engage with treatment targets: Applying user-centered design to inform the design of a mobile behavioral intervention. Int J Eat Disord. 2020;53(4):611-617. Doi:10.1002/eat.23252
  7. Corkum, P., Lingley-Pottie, P., Davidson, F., McGrath, P., Chambers, C. T., Mullane, J., … & Weiss, S. K. (2016). Better nights/better days—distance intervention for insomnia in school-aged children with/without ADHD: a randomized controlled trial. Journal of Pediatric Psychology, 41(6), 701-713.
  8. Corkum, P. V., Reid, G. J., Hall, W. A., Godbout, R., Stremler, R., Weiss, S. K., … & Rigney, G. (2018). Evaluation of an internet-based behavioral intervention to improve psychosocial health outcomes in children with insomnia (better nights, better days): protocol for a randomized controlled trial. JMIR Research Protocols, 7(3), e8348.
  9. Ali, N., Rigney, G., Weiss, S. K., Brown, C. A., Constantin, E., Godbout, R., … & Corkum, P. V. (2018). Optimizing an eHealth insomnia intervention for children with neurodevelopmental disorders: a Delphi study. Sleep Health, 4(2), 224-234.
  10. Rigney, G., Ali, N. S., Corkum, P. V., Brown, C. A., Constantin, E., Godbout, R., Hanlon-Dearman, A., Ipsiroglu, O., Reid, G. J., Shea, S., Smith, I. M., Van der Loos, H. F. M., & Weiss, S. K. (2018). A systematic review to explore the feasibility of a behavioural sleep intervention for insomnia in children with neurodevelopmental disorders: A transdiagnostic approach. Sleep medicine reviews, 41, 244–254.
  11. Tan-MacNeill, K. M., Smith, I. M., Jemcov, A., Keeler, L., Chorney, J., Johnson, S., … & Corkum, P. V. (2020a). Barriers and facilitators to treating insomnia in children with autism spectrum disorder and other neurodevelopmental disorders: Parent and health care professional perspectives. Research in Developmental Disabilities, 107, 103792.
  12. Tan-MacNeill, K. M., Smith, I. M., Weiss, S. K., Johnson, S. A., Chorney, J., Constantin, E., … & Corkum, P. V. (2020b). An eHealth insomnia intervention for children with neurodevelopmental disorders: results of a usability study. Research in Developmental Disabilities, 98, 103573.
  13. Tougas, M. (2021). A User-Centered Approach in the Development of an eHealth Sleep Intervention for Adolescents with and without Recurrent Pain. https://dalspace.library.dal.ca/bitstream/handle/10222/80732/TougasMichelle2021.pdf?sequence=3