0403 Tele-Self CBTI: Provider Supported Self-Management Cognitive Behavioral Therapy for Insomnia

Abstract

Introduction: Insomnia is pervasive among Veterans, but Veteran access to the standard of care (CBTI) is limited. Self‐management CBTI requires fewer provider resources and Veterans prefer provider support with self‐management. Prior self‐management CBTI findings may not generalize to Veterans since individuals with mental health disorders, which are prevalent among Veterans, were largely excluded from these trials. Moreover, support was provided by mental health providers in past trials; an approach that isn't feasible within the VA where mental health providers are overextended. Tele‐Self CBTI, the combination of self‐management CBTI and phone‐based provider support, could increase Veteran access to CBTI. Methods: To assess the feasibility of Tele‐Self CBTI, we randomized Veterans with Insomnia Disorder (69% with a mental health condition) to Tele‐Self CBTI (N=8) or a Health Education Control (HEC: N=8); both involving weekly nurse phone contacts (up to 20 minutes). Assessments occurred at Baseline and Week 7 and included: one week of interactive voice response sleep diaries and actigraphy, and self‐report measures assessing insomnia severity; depression; fatigue; and quality of life. Treatment acceptability (interviews) and acquisition of CBTI knowledge (questionnaire) were assessed at study completion. Results: Veteran feedback on Tele‐Self CBTI was favorable. Nurse support was particularly appealing to Veterans. All enrolled Veterans (100% in both arms) completed the study, and 98% of sleep diaries were completed. Although underpowered to infer efficacy, preliminary findings suggest evidence of a “signal?. With few exceptions, Tele‐Self CBTI scores moved in a favorable direction from baseline, including insomnia severity (down 23%), depression (down 32%), fatigue (down 12%), wake after sleep onset (down 17 minutes), sleep efficiency (up 9%), time in bed (down 36 minutes), and acquisition of CBTI concepts (up 24%). In contrast, HEC scores regressed on most measures. Conclusion: The study protocol was feasible and acceptable to Veterans. Tele‐Self CBTI may be a viable option for increasing Veteran access to CBTI. Future efficacy studies are pending.