Currently submitted to: JMIR Research Protocols
Date Submitted: Oct 5, 2026
Open Peer Review Period: Oct 6, 2026 - Dec 1, 2026
(currently open for review)
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Enhancing the Insomnia Coach Mobile App to Address Alcohol Use Problems for Veterans: Beta Test Results and Study Protocol for a Pilot Randomized Controlled Trial
ABSTRACT
Background:
American military veterans who served since September 11, 2001 (post-9/11 veterans) are at particularly high risk of alcohol misuse and alcohol use disorder (AUD), which often co-occurs with insomnia. Cognitive behavioral therapy for insomnia (CBT-I) is the gold-standard treatment for veterans with insomnia, and Insomnia Coach, a VA mobile app based on CBT-I, has shown feasibility, acceptability, and efficacy for improving sleep. However, Insomnia Coach has only been tested with veterans without AUD, leaving its efficacy for veterans with co-occurring AUD unclear.
Objective:
We report findings from Phase 1 (development) and Phase 2 (beta test) of our study, in which we added brief alcohol intervention content to Insomnia Coach and evaluated its usability, feasibility, and acceptability among veterans with both insomnia and AUD symptoms. We then outline the study protocol for Phase 3, our upcoming pilot randomized controlled trial (RCT).
Methods:
In Phase 1, we developed brief alcohol intervention content informed by the literature and expert consultation. In Phase 2, beta-test participants (N = 20) used the original Insomnia Coach app for two weeks, then gave feedback on the new, to-be-added, brief alcohol intervention content via semi-structured interview. Insomnia and alcohol outcomes were assessed pre- and post-intervention (1 month after baseline). In Phase 3, we will conduct a pilot RCT with 130 post-9/11 veterans with insomnia and AUD symptoms, randomized to Enhanced Insomnia Coach or a sleep hygiene mobile-enabled website control.
Results:
Beta-test participants showed significant reductions in insomnia symptoms and use of alcohol as a sleep aid, with small-to-moderate improvements in drinking frequency, sleep quality, and alcohol consequences. Usability and app quality ratings were favorable, and qualitative feedback on visual appeal, app features, information quality, and confidentiality informed app refinements. The RCT will evaluate whether Enhanced Insomnia Coach improves insomnia and AUD symptoms among veterans not currently accessing insomnia care. We will assess insomnia symptoms and alcohol quantity and frequency at baseline, 4-, 8-, 12-, and 16-weeks. Secondary outcomes include sleep quality, alcohol-related consequences, and receipt of more formal treatment for insomnia or other mental health concerns. We will test moderation by sex, race/ethnicity, PTSD, depression, and cannabis use disorder.
Conclusions:
These beta-test findings support the feasibility and acceptability of Enhanced Insomnia Coach and justify testing its efficacy in the planned pilot RCT. If effective, Enhanced Insomnia Coach could offer a scalable, low-burden option for addressing co-occurring insomnia and alcohol misuse among veterans outside traditional VA care settings. Clinical Trial: NCT06487793 on 6/27/24
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