Telemedicine vs. In-person Delivery of Cognitive Behavioral Treatment of Insomnia: a Mixed Methods Analysis

University of Pennsylvania62 enrolled

Overview

Cognitive behavioral therapy for insomnia (CBT-I) has been the 'gold standard' for the treatment of insomnia. There is a need to increase access to treatment, particularly for patients in more rural locations where providers may be scarce. One solution is to utilize telemedicine which is "the use of electronic communications to provide and support health care when distance separates the provider from the patient." So the purpose of the study is to determine if receiving CBT-I by video teleconferencing works just as well as in-person treatment.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

NONE

Enrollment

Conditions

Insomnia Disorder

Interventions

CBT-I in person

Eligibility

Sex: ALLMin age: 21 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Meet current DSM5 criteria for Insomnia Disorder as determined by clinician interview * ISI score greater than 14, with self-reported duration of insomnia of at least 3 months * Ability to read and speak English * Own a personal computer with an internet connection sufficient to utilize the SleepTM and REDCap platform * BMI less than 30 * Between the ages of 21-50 Exclusion Criteria: * Unable or unwilling to provide informed consent * Individuals with an untreated sleep disorder other than insomnia (Individuals with sleep apnea who are adherent with CPAP treatment (average 4 hours use per night) will be eligible to participate) * A clinically unstable medical condition as defined by a new diagnosis or change in medical management in the previous 2 months * Individuals with substance abuse/dependence, bipolar disorder, delirium, dementia, amnestic disorder, schizophrenia, and other psychotic disorders * Individuals with prominent current suicidal or homicidal ideation * Unable to perform tests due to inability to communicate verbally, inability to read and write; less than a 5th grade reading level; visual, hearing, or cognitive impairment * Any use of medications or OTC products that might impact sleep or metabolism

Outcomes

Primary Outcomes

Change in ISI scores

Total score on the Insomnia Severity Index (0-28)

Time frame: Once at baseline assessment and once again at follow-up after CBT-I intervention approximately 9 weeks later

Secondary Outcomes

Change in actigraphic sleep efficiency

Measured using an actigraph wristband

Time frame: Patients will wear the wristband for a week during sleep baseline assessment and again for a week at follow-up, approximately 8 weeks later