Effectiveness of Internet-Delivered Computerized Cognitive Behavioral Therapy for Patients With Insomnia Who Remain Symptomatic Following Pharmacotherapy: Randomized Controlled Exploratory Trial (Preprint)

BACKGROUND In reality, pharmacotherapy still remains the most common treatment for insomnia. OBJECTIVE This study aimed to examine the effectiveness of our internet-delivered computerized cognitive behavioral therapy (ICBT) program as an adjunct to usual care (UC) compared with UC alone in patients with insomnia who remain symptomatic following hypnotics. METHODS We recruited 23 patients with insomnia who remained symptomatic following pharmacologic treatment including benzodiazepines, and we conducted an exploratory randomized controlled trial. The primary outcome was the Pittsburgh Sleep Quality Index (PSQI) at week 6 of the treatment. Secondary outcomes were sleep onset latency, total sleep time, sleep efficiency, number of awakenings, refreshment and soundness of sleep, anxiety by Hospital Anxiety and Depression Scale, depression measured by the Center for Epidemiologic Studies Depression Scale, and quality of life (QOL) measured by the EuroQol-5D. All parameters were measured at weeks 0 (baseline), 6 (postintervention), and 12 (follow-up). RESULTS The adjusted mean reduction (−6.11) in PSQI at week 6 from baseline in the ICBT plus UC group was significantly (P<.001) larger than the adjusted mean reduction (0.40) in the UC alone group. Significant differences were also found in favor of ICBT plus UC for PSQI, sleep onset latency, sleep efficiency, number of awakenings, and depression at all assessment points. Refreshment, soundness of sleep, anxiety, and QOL improved by week 6 in ICBT plus UC compared with UC alone. There were no reports of adverse events in either group during the study. CONCLUSIONS These results indicated that our 6-week ICBT program is an effective treatment adjunct to UC for improving insomnia and related symptoms even after unsuccessful pharmacotherapy. CLINICALTRIAL University Hospital Medical Information Network Clinical Trials Registry: UMIN000021509; https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000023545 (Archived by WebCite at http://www.webcitation. org/75tCmwnYt).

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361 Relative Effectiveness of Cognitive Behavioral Therapy and its Components in Improving Insomnia Symptoms in Older Adults

SLEEP ◽

10.1093/sleep/zsab072.360 ◽

2021 ◽

Vol 44 (Supplement_2) ◽

pp. A144-A144

Author(s):

Kathleen O’Hora ◽

Beatriz Hernandez ◽

Laura Lazzeroni ◽

Jamie Zeitzer ◽

Leah Friedman ◽

...

Keyword(s):

Older Adults ◽

Cognitive Behavioral Therapy ◽

Behavioral Therapy ◽

Sleep Onset ◽

Post Treatment ◽

Cognitive Behavioral ◽

Sleep Onset Latency ◽

Significant Group ◽

Time Interaction ◽

Insomnia Symptoms

Abstract Introduction The prevalence of insomnia complaints in older adults is 30–48%, compared to 10–15% in the general population. Cognitive Behavioral Therapy for Insomnia (CBT-I) is a first-line, non-pharmacological sleep treatment for Insomnia. However, the relative impact of Behavioral (BT) and Cognitive (CT) components compared to that of CBT-I in older adults is unknown. Methods 128 older adults with insomnia were randomized to receive CBT-I, BT, or CT. Sleep diaries and the Insomnia Severity Index (ISI) were collected pre- and post-treatment and at a 6-month follow-up. We conducted split-plot linear mixed models with age and sex as covariates to assess within and between subject changes to test effects of group, time, and their interaction on ISI, sleep onset latency (SOL), wake after sleep onset (WASO), total sleep time (TST), time in bed (TIB), sleep efficiency (SE), and percent of treatment responders (ISI decrease>7) and remitters (ISI<8). Effect size (d) was calculated by dividing the difference between means by the root-mean-squared error of the mixed effects model. Results All treatments lead to a significant improvement across outcome measures at post-treatment (p’s<0.001) and 6-months (p’s<0.01), with the exception of TIB, response, and remission. For TIB, there was a significant Group x Time interaction (p<0.001): while all treatments significantly reduced TIB post-treatment relative to baseline, CBT-I (p<0.001,d=-2.26) and BT (p<0.001,d=-1.59) performed significantly better than CT (p=0.003, d=-0.68). In contrast, at 6-months CBT-I (p<0.001,d=-1.16) performed significantly better at reducing TIB than CT (p=0.195,d=-0.24) or BT (p=0.023,d=-0.61) relative to baseline. There was also a non-significant trend for a Group x Time interaction for remission status (p=0.062). Whereas, the percentage of remitters within all groups post-treatment did not differ from chance (p>0.234), at 6 months, the percentage of remitters was significantly higher than chance in CBT-I (73.63%,p=0.026) and BT (78.08%,p=0.012), but not CT (47.85%,p=0.826). There were no other significant time or interaction effects (all p>0.05). Conclusion CBT-I and its components are effective in improving subjective insomnia symptoms in older adults. Evidence suggests CBT-I may be superior to either CT or BT alone in improving TIB in older adults. Support (if any) NIMHR01MH101468; MIRECC at VAPAHCS

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A Randomized Controlled Pilot Trial Suggesting That Cathodal Bi-Frontal Transcranial Direct Current Stimulation (tDCS) May Shorten Sleep Onset Latency, and Increase Sleep Efficiency When Applied Before An Afternoon Nap

Brain Stimulation ◽

10.1016/j.brs.2016.11.037 ◽

2017 ◽

Vol 10 (1) ◽

pp. e6

Author(s):

Gregory L. Sahlem ◽

Bashar W. Badran ◽

Emily Peyton ◽

Matthew T. Reeves ◽

Kimberly Leslie ◽

...

Keyword(s):

Direct Current ◽

Transcranial Direct Current Stimulation ◽

Pilot Trial ◽

Sleep Onset ◽

Sleep Efficiency ◽

Sleep Onset Latency ◽

Onset Latency ◽

Direct Current Stimulation ◽

Randomized Controlled

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0470 A Randomized Controlled Trial of Digital Cognitive Behavioral Therapy for Insomnia in Pregnant Women

SLEEP ◽

10.1093/sleep/zsaa056.467 ◽

2020 ◽

Vol 43 (Supplement_1) ◽

pp. A180-A180

Author(s):

D A Kalmbach ◽

A Cuamatzi-Castelan ◽

C V Tonnu ◽

T Roth ◽

R Sangha ◽

...

Keyword(s):

Cognitive Behavioral Therapy ◽

Sleep Quality ◽

Pregnant Women ◽

Sleep Duration ◽

Behavioral Therapy ◽

Depression Scale ◽

Emotional Dysregulation ◽

Cognitive Behavioral ◽

Control Group ◽

Randomized Controlled

Abstract Introduction Over half of pregnant women experience clinical insomnia, which is linked to perinatal depression and cognitive-emotional dysregulation. Despite high rates of prenatal insomnia and known maternal consequences, efficacious insomnia treatment options for this population are woefully scant. Early evidence from randomized controlled trials (RCTs) support the efficacy of face-to-face cognitive-behavioral therapy for insomnia (CBTI) for prenatal insomnia. Yet, as many patients are unable to access this specialist-driven care, a critical need exists to increase its accessibility. This RCT examined the efficacy digital CBTI via mobile health app in pregnant women with insomnia. Methods Single-site RCT. Ninety-one pregnant women (29.03±4.16 years) nearing/entering the third trimester who screened positive for clinical insomnia on the Insomnia Severity Index (ISI) were randomized to digital CBTI or digital sleep education control. Blinded assessments were performed before treatment, after treatment (during pregnancy), and 6 weeks after childbirth. The ISI, Pittsburgh Sleep Quality Index (PSQI), Edinburgh Postnatal Depression Scale (EPDS), and Pre-Sleep Arousal Scale’s Cognitive factor (PSAS-C) served as study outcomes. Results From pre to posttreatment, CBTI patients reported reductions in ISI (-4.91 points, p<.001) and PSQI (-2.98 points, p<.001) and increases in nightly sleep duration by 32 minutes. Sleep symptoms did not change during pregnancy in the control group. After childbirth, CBTI patients, relative to controls, slept longer by 40 minutes per night (p=.01) and reported better sleep maintenance. No pre or postnatal treatment effects on depression or cognitive arousal were observed. Conclusion Digital CBTI improves sleep quality and increases sleep duration during pregnancy and after childbirth. Digitally delivered interventions have potential to improve the health of new and expectant mothers, but CBTI likely needs to be tailored for perinatal patients to optimize outcomes. Support This study was funded by the American Academy of Sleep Medicine (198-FP-18, PI: Kalmbach).

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