0400 Examining the Effectiveness of Telehealth Delivered Cognitive Behavioral Treatment of Insomnia

Abstract

Abstract Introduction Cognitive behavioral therapy for insomnia (CBT-I) has been shown to be an effective tool in improving symptoms of insomnia, however access is limited. One option for increasing access is the use of telehealth. We conducted a randomized trial comparing CBT-I delivered in-person to over video telehealth and found that telehealth treatment was non-inferior on self-reported insomnia severity. The objective of this study was to extend this analysis to secondary outcomes of subjective and objective measures of sleep as further assessment of the efficacy of telehealth compared to in-person treatment. Methods Individuals with DSM-5 insomnia disorder (n=60) were randomized to telehealth CBT-I, in person CBT-I, or 8-week waitlist control, although this analysis only compared the CBT-I groups. CBT-I was delivered over 6-8 weekly sessions by video telehealth or in-person in an outpatient clinic. Follow-up assessment was at 2 weeks post-treatment. Both objective and subjective outcomes of sleep efficiency (SE), sleep onset latency (SOL), wake after sleep onset (WASO), and total sleep time (TST) were collected via actigraphy and sleep diaries. Random effects mixed models were used to determine the effects of group, treatment, and their interaction. Results The mean change in SE, SOL, WASO, and TST for objective measures from baseline to follow-up was 0.43% and -17.7 minutes, -6.8 minutes, -31.0 minutes, respectively, for in person CBT-I and 0.01%, -15.1 minutes, -2.1 minutes, -9.5 minutes, respectively, for telehealth. For subjective measures, the mean change was 0.16% and -27.0 minutes, -22.7 minutes, 28.9 minutes, respectively, for in person CBT-I and 0.15%, -23.4 minutes, -23.4 minutes, 51.6 minutes respectively for telehealth. The differences between the CBT-I groups were not statistically significant, nor were there significant interaction effects. Conclusion In both objective and subjective measures of insomnia, there is no evidence that outcomes from telehealth delivery of CBT-I is worse than in person treatment. Subjective effects were much larger than objective effects for insomnia possibly indicating a discrepancy between how sleep and more particularly insomnia is perceived by oneself and measured in the lab. Support (if any) This research was supported by grant 167-SR-17XYZ from the American Sleep Medicine Foundation and a Doris Duke Charitable Foundation Clinical Scientist Development Award.