PONE-D-23-21923“The worst thing is lying in bed thinking ‘I want a cigarette’” Exploration of smoker’s and ex-smoker’s perceptions of sleep during a quit attempt and the use of cognitive behavioural therapy for insomnia to aid cessation.PLOS ONE

Dear Dr. Matthews,

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==============================Please pay close attention to comments left by Reviewer 2 and 3, who recommended Major revisions. ==============================

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Lakshit Jain, MD

Academic Editor

PLOS ONE

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

Reviewer #4: Yes

Reviewer #5: Yes

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: I Don't Know

Reviewer #3: N/A

Reviewer #4: Yes

Reviewer #5: I Don't Know

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3. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: No

Reviewer #3: Yes

Reviewer #4: Yes

Reviewer #5: Yes

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4. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

Reviewer #4: Yes

Reviewer #5: Yes

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5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: The paper exhibits a well-defined and conventional academic structure, adhering to the customary sequence of introduction, methodology, and findings. This organizational approach enhances reader comprehension. Notably, the authors skillfully pinpoint a gap in existing research, offering a coherent rationale for their study. This strategic identification of a research gap contributes to establishing a clear purpose and direction for the research endeavor. Moreover, the paper excels in linking the research questions directly to the themes derived from data analysis. This connection underscores the relevance of the identified themes in addressing the overarching objectives of the study.

Few suggestions for improvement:

The paper should clearly articulate the implications of the findings to existing literature and real-world application. This includes addressing the potential consequences of ailing to adhere to interventions like CBT-I during smoking cessation attempts.

The introduction of the COVID-19 pandemic in “strengths and limitation" at the end and its impact on the participants' smoking and sleep patterns seems disjointed, suggesting a need to either provide sufficient contextual relevance or integration within the main discussion.

Overall, the paper endeavors to fill a gap in the literature by concurrently assessing the psychological impact of quitting smoking on sleep and investigating how behavioral therapy could alleviate those sleep disturbances, potentially improving cessation outcomes.

Reviewer #2: •Only one in 61 twenty smokers who engage in a quit attempt will remain smoke free [3] and 80% of quit 62 attempts will end in relapse within six months.

•Methods: age, sex, current smoking status, ethnicity, highest qualification attained, smoking history, quit-attempt history, e-cigarette use, cessation medication during quit attempts and cigarettes smoked per day. (In addition to this I would have included weight, history of snoring and past/ongoing psych history)

•Result: were mostly female (n= 9) –This was a bit strange (Study feels skewed and rationale for only 20 participants not mentioned)

•Potentially suggesting a prioritization of short-term mental wellbeing over longer-term health impacts. (Highlights the physical dependce of smoking: which the most problematic one)

•Timing of CBT-I and doing it a month before (This was a good suggestion, graded way to quitting smoking, it would be helpful for someone who has less motivation/less will power.

•I find going to things face to face intimidating sometimes and often inconvenient (Highlights digitalization- good for type c and type a people, who might smoke to reduce their anxiety)

•So participants has problem in all phases of sleep (early, middle, and late as well as initiating and maintaining)

•Discussion: Including the recruitment of a diverse range of smokers ranging from low to high levels of nicotine dependence and a nearly equal representation of males and females. (Its biased and only two participants with HIGH nicotine dependence)

•Well highlighted limitations, other than covid causing sleep disturbances, other bio-psycho-social factors should be considered. Isolated insomnia is very common.

•Overall, I feel the theme and aim of the paper is great. Validating their questionnaire, more participants, quantitive results using linear regression, incorporating med and psych factors can make this study robust. Lot of potential to improve.

Reviewer #3: I have read with great interest the article titled '“The worst thing is lying in bed thinking ‘I want a cigarette’” Exploration of smoker’s and ex-smoker’s perceptions of sleep during a quit attempt and the use of cognitive behavioural therapy for insomnia to aid cessation'. The article is well structured and results are presented in a clear concise manner. It presented insights into a very common problem noted when pt's attempt to quit smoking. CBT-I can be a good intervention to use for sleep disturbances associated with quitting smoking. While the study has many strengths there are limitation many of which have been enumerated by the authors. Sleep disturbances can be because of multiple causes. Most commonly sleep disturbances can be because of psychiatric disorders like depression, anxiety, other substance uses etc, medical disorders like thyroid disorders, pain, OSA etc. It is not clear whether these were considered in the inclusion/exclusion criteria. If they were considered, please mention what methods were used to evaluate/assess these conditions. If they were not considered, then it's a major limitation of the study that needs to be appropriately addressed. Please revise accordingly

Reviewer #4: Thank you for the opportunity to review this manuscript that describes a qualitative study looking at the perceptions of sleep among smokers and ex smokers and explores the utility of CBT-I to aid sleep and cessation.

-The background section was overall well written; could be condensed a little bit more.

-In terms of recruitment for the study, could the authors provide more details around whether the participants had a previous understanding/experience of CBT-I or CBT in general. Was this asked for ? The authors do highlight the reliance on using a pre-prepared video as a drawback.

-I think the authors mean ‘vicious’ and not viscous ?

-The results add to the literature by offering ideas on tailoring CBT-I for this purpose.

Overall good study and makes a good addition to the literature.

Reviewer #5: The manuscript by Matthews et al. studies the important topic of smoking cessation, predictors and strategies to prevent relapse.

Strengths of the paper:

- The title is appropriate for the content of the manuscript.

- The introduction to the article is well laid out.

- The methods section clearly describes the study design, subject selection, sample size, etc.

- The discussion and conclusion further elaborate on the study objectives and limitations.

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Reviewer #1: Yes: Aditi Sharma

Reviewer #2: No

Reviewer #3: Yes: Nikhil Tondehal

Reviewer #4: No

Reviewer #5: No

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“The worst thing is lying in bed thinking ‘I want a cigarette’” A qualitative exploration of smoker’s and ex-smoker’s perceptions of sleep during a quit attempt and the use of cognitive behavioural therapy for insomnia to aid cessation.

PONE-D-23-21923R1

Dear Dr. Matthews,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

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Kind regards,

Lakshit Jain, MD

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #1: All comments have been addressed

Reviewer #5: All comments have been addressed

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2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #5: Yes

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3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #5: I Don't Know

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4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #5: Yes

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5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #5: Yes

**********

6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: I am pleased to acknowledge that the authors have effectively addressed all the comments provided by the reviewers in their revised manuscript. The meticulous attention to feedback is evident in the improved clarity, strengthened arguments, and enhanced overall quality of the content. The authors' responsiveness reflects their commitment to producing a high-quality piece of work. With these commendable revisions, I believe the manuscript is now well-prepared for the next stage of the review process.

Reviewer #5: The authors have adequately answered the questions raised by the reviewers, and it is now suitable for publication.

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7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: No

Reviewer #5: No

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