Accepted for/Published in: JMIR Formative Research
Date Submitted: Apr 12, 2021
Date Accepted: Oct 28, 2021
Warning: This is an author submission that is not peer-reviewed or edited.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.
Mobile Intervention to Improve Sleep and Functional Health of Veterans with Insomnia
ABSTRACT
Background:
Insomnia is a prevalent and debilitating disorder among veterans. Cognitive behavioral therapy for insomnia (CBTI) can be effective for treating insomnia, although many cannot access this care. Technology-based solutions and lifestyle changes, such as physical activity, offer affordable and accessible self-management alternatives to in-person CBTI.
Objective:
The primary aim of this study was to extend and replicate prior pilot work to examine if use of a mobile app for CBTI (CBT-i Coach) improved subjective and objective sleep outcomes. The study also investigated if use of CBT-i Coach with adjunctive physical activity would improve sleep outcomes more than CBT-i Coach alone.
Methods:
Thirty-three veterans (mean age=37.6 years) reporting chronic insomnia were randomized to use either 1) CBT-i Coach alone or 2) CBT-i Coach with a physical activity intervention over 6 weeks, with outcome measures of objective and subjective sleep at pre- and post-treatment.
Results:
Although the physical activity manipulation was unsuccessful, both groups of veterans using the CBT-i Coach showed significant improvement from baseline to post-intervention on insomnia (P = .000), sleep quality (P = .000), and functional sleep outcomes (P = .002). Improvements in subjective sleep outcomes were similar in those with and without PTSD, as well as mild to moderate sleep apnea. We also observed a significant but modest increase in objective sleep efficiency (P = .016).
Conclusions:
These findings suggest that use of mobile app-delivered CBTI is feasible and beneficial for improving sleep outcomes for veterans with insomnia, including those with comorbid conditions such as PTSD or mild-to-moderate sleep apnea. Clinical Trial: This pilot trial was registered on ClinicalTrials.gov as NCT03305354.
Citation
