0404 A Novel Approach to Sleep Disturbances in the Inpatient Psychiatric Setting: Video-Based Cognitive Behavioral Therapy for Insomnia

Abstract

Introduction: Sleep disturbances are common in patients hospitalized for psychiatric disorders. Inpatient psychoeducation/therapy does not focus on sleep complaints. Standard treatment consists of pharmacologic therapy and there is limited data on cognitive behavioral therapy for insomnia (CBT‐I) in this population. The purpose of this study was to assess the efficacy of video‐based CBT‐I on a psychiatric inpatient unit compared to treatment as usual (TAU). Methods: Patients admitted to a psychiatric unit for the first time with any behavioral medicine diagnosis and a sleep disturbance were eligible. Participants were randomly assigned to receive TAU (handout on appropriate sleep practices) or the intervention, which consisted of daily one‐hour sessions. In each session, participants viewed an entertaining professionally made video‐based CBT‐I lesson (6 novel videos encompassing all CBT‐I components) followed by group discussion. Participants completed sleep questionnaires including the Insomnia Severity Index (ISI) and Pittsburgh Sleep Quality Index (PSQI) at intake and discharge along with a daily sleep diary. Results: At the time of analysis, 29 participants had enrolled with 22 receiving the intervention and 7 TAU. The intervention group was mostly male (n=14, 63.6%) and relatively young (median age 20). The average ISI decreased from 15 (SD=6.9) to 12.2 (SD=7.5; t(21)=2.58, p=0.017) and average PSQI decreased from 10.9 (SD=4.6) to 8.8 (SD=4.1; t(21)=3.0, p=0.007) in the intervention group. Reported mean sleep onset time decreased by 11.07 minutes (SD=19.51; t(21)=‐ 2.66, p=0.015), total sleep time increased by 1.33 hours (SD=1.44; t(21)=4.33, p=0.0003), and sleep efficiency improved by 11% (SD=16; t(21)=3.25, p=0.004). Patient feedback regarding the intervention was overwhelmingly positive. The TAU group had some improvement in sleep, but no changes met statistical significance. Conclusion: Video‐based CBT‐I improves insomnia symptoms and sleep quality in psychiatric inpatients. Compared to traditional CBT‐I that is administered in‐person but often unavailable, this novel modality has the potential to improve sleep in a wide variety of clinical settings.