Insomnia Disorder Clinical Trial
— Tele-Self CBTIOfficial title:
Provider Supported Self-Help Cognitive Behavioral Therapy for Insomnia (Tele-Self-CBTI)
Verified date | April 2023 |
Source | VA Office of Research and Development |
Contact | n/a |
Is FDA regulated | No |
Health authority | |
Study type | Interventional |
Insomnia is one of the most common complaints among service-members and Veterans of recent military conflicts. Insomnia has been shown to play a causal role in mental health, hypertension, obesity, and other health conditions, increasing risk for all-cause mortality. Cognitive-Behavioral Therapy for Insomnia (CBTI) produces both short-term and sustained resolution of insomnia with fewer adverse side effects than medications, but access to behavioral sleep medicine expertise within the VA is very limited. The proposed study is compares Tele-Self CBTI to Health Education Control for improved insomnia severity among treatment-seeking Veterans with Insomnia. In this study, 200 participants will be randomized with a 50/50 chance for either Tele-Self CBTI or a Health Education Control condition. Eligible participants are Veterans who are: a) prescribed sleep medications; b) diagnosed with insomnia; and/or c) referred for clinic-based CBTI (but not yet treated) for insomnia. Participants will be identified using electronic health records (EHR) and telephone interviews. Participants' sleep will be assessed at three time points, at Baseline, 8 weeks and 6 months after Baseline. Tele-Self CBTI consists of: 1) Self-management via homework with a workbook, and 2) telephone-based nurse support. Participants will complete 6 weekly readings. The 6 weekly telephone contacts will be 20 minutes through a study nurse. Patients randomized to Health Education Control (HEC) will receive a health education workbook on 6 health topics and 6 weekly phone calls from a study nurse. All participants will continue to receive usual medical care while participating in study. Following completion of the 6 month study, Health Education group participants interested in additional help for their sleep will be referred to the Durham VA Behavioral Sleep Medicine Clinic.
Status | Completed |
Enrollment | 178 |
Est. completion date | April 1, 2023 |
Est. primary completion date | December 16, 2022 |
Accepts healthy volunteers | No |
Gender | All |
Age group | 18 Years and older |
Eligibility | Inclusion Criteria: - Meets diagnostic criteria for Insomnia Disorder - Receives care through the Durham VAMC or catchment area. Exclusion Criteria: - Severe Obstructive Sleep Apnea with treatment non-adherence - Unstable co-morbid sleep disorder determined via chart review - e.g., rule out for Narcolepsy, rule out for Shift Work Disorder - Current or prior participation in CBTI - Excessive daytime sleepiness - Nighttime or rotating shift work within the last year - Psychotic disorder diagnosis - Bipolar disorder diagnosis - Recreational substance use - Current alcohol abuse - Severe depression or suicidality - Dementia diagnosis - Cognitive impairment - Epilepsy diagnosis - Seizure disorder diagnosis - Lack of proficiency in the English language - Hearing impairment that impedes telehealth intervention - Unable to complete study procedures |
Country | Name | City | State |
---|---|---|---|
United States | Durham VA Medical Center, Durham, NC | Durham | North Carolina |
Lead Sponsor | Collaborator |
---|---|
VA Office of Research and Development |
United States,
Kang JM, Chatterjee A, Rosdahl JA, Bosworth HB, Woolson S, Olsen M, Sexton M, Kirshner M, Muir KW. Health Literacy and Success with Glaucoma Drop Administration. Ophthalmol Glaucoma. 2022 Jan-Feb;5(1):26-31. doi: 10.1016/j.ogla.2021.05.004. Epub 2021 May — View Citation
Muir KW, Rosdahl JA, Hein AM, Woolson S, Olsen MK, Kirshner M, Sexton M, Bosworth HB. Improved Glaucoma Medication Adherence in a Randomized Controlled Trial. Ophthalmol Glaucoma. 2022 Jan-Feb;5(1):40-46. doi: 10.1016/j.ogla.2021.04.006. Epub 2021 Apr 20. — View Citation
Rosdahl JA, Hein AM, Bosworth HB, Woolson S, Olsen M, Kirshner M, Hung A, Muir KW. Randomized controlled trial of an education-based intervention to improve medication adherence: Design considerations in the medication adherence in glaucoma to improve car — View Citation
Ulmer CS, Bosworth HB, Zervakis J, Goodwin K, Gentry P, Rose C, Jeffreys AS, Olsen MK, Weidenbacher HJ, Beckham JC, Voils CI. Provider-supported self-management cognitive behavioral therapy for insomnia (Tele-Self CBTi): Protocol for a randomized controll — View Citation
Ulmer CS, McCant F, Stechuchak KM, Olsen M, Bosworth HB. Prevalence of insomnia disorder and sleep apnea in a sample of veterans at risk for cardiovascular disease. J Clin Sleep Med. 2021 Jul 1;17(7):1441-1446. doi: 10.5664/jcsm.9228. — View Citation
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Primary | Insomnia Severity | Insomnia Severity Index (ISI): The ISI is recommended as the standard for self-reported insomnia symptoms, and will be used as the primary outcome measure. The ISI is a 7-item questionnaire providing a global measure of perceived insomnia severity. Each item is rated on a 5-point Likert scale and the total score ranges from 0-28. The following guidelines are recommended for interpreting the total score: 0-7 (no clinical insomnia), 8-14 (sub threshold insomnia), 15-21 (insomnia of moderate severity), and 22-28 (severe insomnia). In clinical samples, a cut off score of 11 was shown to have the greatest sensitivity and specificity for correctly identifying study participants meeting criteria for insomnia diagnosis. | Baseline to Week 8 | |
Secondary | Subjective Sleep Onset Latency, Wake after Sleep Onset, and Sleep Efficiency | Sleep Diary: The investigators will use the Consensus Sleep Diary (CSD) to assess the impact of Tele-Self CBTI on sleep onset latency (SOL); wake after sleep onset (WASO); and sleep efficiency (SE). An Interactive Voice Response (IVR) approach will be used to collect sleep diary data during each of the three 2-week assessment periods. Diary data will be averaged across each 2-week assessment period to determine diary-based SOL, WASO and SE. | Baseline to Week 8 | |
Secondary | Objective Wake after Sleep Onset, Total Sleep Time, and Sleep Efficiency | Wrist Actigraphy: The investigators will use Actiwatch? (Respironics, Inc.) wristwatch style actigraphs for collecting objective sleep data. Actiwatches contain a calibrated accelerometer that samples, digitizes, and stores movement activity. When interfaced with a computer, a scoring algorithm provides estimates of various sleep parameters. The investigators will average data across each two-week assessment period to determine actigraphy-based WASO, Total Sleep Time (TST) and SE. | Baseline to Week 8 |
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