Sleep education program shows early attention gains in nursing students

A pilot randomized clinical trial at a Spanish university has found that a sleep education program built on principles of cognitive behavioral therapy for insomnia produced notable improvements in attention among first-year nursing students, even though the students’ self-reported sleep quality barely changed. The study, published in BMC Psychology, enrolled 32 first-year nursing students with a mean age of 19.9 years and randomly assigned them to either an intervention group of 14 students or a control group of 18 students. Because the trial was a small pilot, the authors are careful to state that the results do not establish efficacy, but they argue that the preliminary signals justify further investigation, particularly of attentional outcomes.

The intervention consisted of an educational program informed by cognitive behavioral therapy for insomnia, or CBT-I, delivered through active-constructive learning rather than passive lectures. CBT-I is a well-established treatment for people with clinical insomnia, but the researchers note that evidence on preventive sleep education, which incorporates selected CBT-I principles in healthy university populations, remains limited. Poor sleep quality is highly prevalent among nursing students and has previously been associated with reduced cognitive functioning and academic performance, making this group a natural target for prevention-oriented approaches. The trial was registered at ClinicalTrials.gov under identifier NCT05273086.

To measure outcomes, the researchers used two validated instruments administered both before and after the intervention. Subjective sleep quality was assessed with the Pittsburgh Sleep Quality Index, a widely used questionnaire that captures components such as sleep latency, sleep duration, and an overall global score. Attention was measured with the d2 Test of Attention, which yields primary outcomes including Concentration Performance, Total Responses, Total Correct Responses, and Correct Responses in Sequence. Academic performance was evaluated separately by comparing final course grades before and after the intervention period.

The sleep results were modest. The study found no statistically significant between-group differences for sleep outcomes, although the intervention group showed descriptive reductions in sleep latency, meaning the time it takes to fall asleep, along with modest changes in sleep duration and in global PSQI scores. These descriptive shifts suggest a directional pattern that a larger trial could test, but on their own they fall short of demonstrating a reliable effect on how students perceived their own sleep.

The attention findings were far more striking. The intervention group demonstrated greater improvements than the control group across several principal attention outcomes, including Total Responses, Concentration Performance, Total Correct Responses, and Correct Responses in Sequence, with large effect sizes ranging from Hedges’ g of 1.38 to 1.9. In practical terms, effect sizes of this magnitude indicate very substantial differences between the groups in how much their attentional performance changed over the course of the study, although small pilot samples are known to produce unstable estimates that larger trials may not replicate.

Academic performance told a more nuanced story. Final course grades improved significantly within the intervention group, with a p-value of 0.015, but the between-group differences were not statistically significant. This distinction matters: the improvement within the intervention group could reflect the program, natural learning gains over the semester, or other factors, and the lack of a significant between-group contrast means the study cannot attribute the grade improvement specifically to the sleep education program.

The authors conclude that this pilot study provides preliminary signals of improvement in attentional performance following a preventive CBT-I-informed educational intervention, while changes in subjective sleep outcomes were modest and did not demonstrate a significant between-group effect. They explicitly caution that these results do not establish efficacy. Instead, the findings are framed as justification for further investigation, particularly regarding attentional outcomes, and as support for testing structured sleep education within nursing curricula in larger randomized trials.

For the field, the study highlights a recurring challenge in preventive sleep research: interventions informed by CBT-I may influence cognitive performance through mechanisms that are not fully captured by subjective sleep questionnaires. Attention, as measured by the d2 test, responded more clearly than self-reported sleep in this sample, raising the possibility that structured sleep education could affect daytime cognitive functioning even when students’ perceptions of their sleep change only modestly. Confirming that possibility will require larger randomized trials with adequate statistical power, and the registered pilot provides the groundwork those trials can build on.

Subject of Research: A pilot randomized trial testing a CBT-I-informed sleep education program on sleep quality, attention, and academic outcomes in first-year nursing students.

Article Title: Subjective sleep quality and academic outcomes in nursing students through a cognitive-behavioral therapy for insomnia based educational program: a pilot study

Article References: Pérez-Manchón, D., Martín, D., Ruíz-Zaldibar, C., Azpeleta, C., & Gal, B. (2026). Subjective sleep quality and academic outcomes in nursing students through a cognitive-behavioral therapy for insomnia based educational program: a pilot study. BMC Psychology. https://doi.org/10.1186/s40359-026-05749-y

Image Credits: AI Generated

DOI: 10.1186/s40359-026-05749-y

Keywords: sleep quality, cognitive behavioral therapy for insomnia, nursing students, attention, d2 Test of Attention, Pittsburgh Sleep Quality Index, academic performance, pilot randomized trial, sleep education, university students, Subjective, sleep