Brief Behavioral Treatment For Insomnia Research Articles

0391 Effects of Brief Behavioral Treatment for Insomnia on Insomnia and Sleep Quality in Cancer Survivors

0391 Effects of Brief Behavioral Treatment for Insomnia on Insomnia and Sleep Quality in Cancer Survivors

0420 Clinician Experience with Implementing Brief Behavioral Treatment for Insomnia

0420 Clinician Experience with Implementing Brief Behavioral Treatment for Insomnia

0344 Behavioral Treatment of Insomnia with Concurrent Nocturia

Abstract Introduction Behavioral therapy has proved effective for insomnia in older adults. However, its efficacy has not been examined among those with nocturia (awakening to urinate) which is the most common cause of insomnia in this age group. Thus we assessed the impact of behavioral sleep treatment on sleep in older adults with nocturia. Methods Fifty-six community-dwelling older adults (mean age, 72±6 years; 64% women) with nocturia frequency ≥2 per night were randomized to receive Brief Behavioral Treatment for Insomnia (BBTI) or information-only control (IC). We determined the impact of BBTI on sleep, sleep quality, and nocturia as assessed by a 3-day voiding and sleep diary. Participants concurrently wore a single-channel, EEG device Z-machine® for objective in-home sleep assessment. Insomnia Severity Index (ISI) was used to assess insomnia symptoms. Results Participants had a mean nocturia frequency of 2.2±0.7/night at baseline. Time in bed (TIB) decreased by 42±76 minutes among the BBTI group, but total sleep time (TST) increased by 20±95. Significant differences ± standard error between BBTI and IC in pre- to post-intervention changes were observed for TIB (-41±18 minutes, p=.03) but not TST (27±18, p=.14). Compared to the IC group, the BBTI group also showed a greater improvement in ISI (-3.3±1.4, p=.02) as well as objectively measured sleep onset latency (-9.8±3.5, p=.008), latency to deep sleep (-19±11, p=.08), and percentage of total sleep time spent in deep sleep (8.4±3.1, p=.01). BBTI also decreased nocturia frequency to a greater extent (-0.49±0.20, p=.02) Conclusion BBTI improves insomnia symptoms, objective sleep measures, and nocturia in older adults with frequent sleep interruptions related to nocturia. Treatment for insomnia may be an important addition to current treatments for nocturia. Support (if any) NIA AG 060292

0822 Sleep and Nighttime Urine Production

Abstract Introduction Nocturia (waking from sleep to urinate) is the most common cause of sleep interruption among older adults and nocturnal polyuria (NP; increased sleep time urine production) is its most common cause. Conversely, poor sleep with repeated awakenings contributes to both nocturia and NP. However, whether a behavioral intervention to reduce repeated awakenings can improve nocturia and NP has not been examined in a clinical trial. The current study assesses the effect of Brief Behavioral Treatment for Insomnia (BBTI) on nocturia and NP in older adults. Methods Fifty-six community-dwelling older adults (mean age, 72±6 years; 64% women) with nocturia frequency ≥2 per night were randomized to receive BBTI vs information-only control (IC). All participants completed a 3-day voiding and sleep diary to assess nocturia, and sleep. Participants with a nocturnal polyuria index (NPi; percent of 24-hour urine volume excreted at night) ≥35% were considered to have NP. Results At baseline, nocturia frequency correlated with total sleep time (r=.54, p< 0.001) and duration of the first uninterrupted sleep period (FUSP, r=-.40, p=0.004) after adjusting for age and body mass index. BBTI significantly improved nocturia frequency compared to the IC group (-1.0±0.7 vs -0.3±0.9; p=.02). FUSP increased by 54±77 minutes in the BBTI group and NPi decreased by 7.1±13.2%, but these changes were not significantly different from the IC group. Change in NPi correlated with change in FUSP (r=-.36, p=.01; longer FUSP associated with lower NPi), but not with change in total sleep time (r=-.04, p=.7). Conclusion In older adults with nocturia, behavioral treatment directed solely at sleep also improves nocturia. Improving sleep continuity in the first half of the night and increasing FUSP, but not total sleep time, may also improve NP. Support (if any) NIA AG060292

Adapting Brief Behavioral Treatment for Insomnia for Former National Football League Players: A Pilot Study

ABSTRACT Objectives Insomnia is highly prevalent among persons with chronic pain. Although cognitive behavioral therapy for insomnia is recommended as first-line treatment for insomnia, it is underutilized. We tested the feasibility of a potentially scalable alternative – Brief Behavioral Therapy for Insomnia (BBTI) for former National Football League (NFL) players, a group with a high prevalence of chronic pain. We assessed changes in sleep, pain, and psychological health. Methods Single-arm clinical trial of an adapted telephone-delivered BBTI intervention in 40 former NFL players with insomnia. We collected data on changes in sleep, pain, and psychological health outcomes. Results Among former players (30% racial/ethnic minorities), BBTI was both acceptable and feasible. BBTI was associated with improvements in sleep disturbance (primary exploratory sleep outcome, mean T-score change −6.2, 95% CI: −7.6, −4.8), sleep-related impairment (mean T-score change −5.7, 95% CI: −7.9, −3.5) and insomnia severity (mean change −5.3, 95% CI: −6.8, −3.5) post-intervention. Improvements were maintained at 2-months. BBTI was also associated with improvements in pain interference and intensity, but not psychological health. Conclusion An adapted telephone-delivered BBTI is acceptable and feasible among retired players with a range of insomnia symptoms and shows promise for improving sleep and pain. These data support the need for future trials assessing BBTI’s effect on both sleep and pain outcomes.

Brief behavioral treatment for insomnia: Treatment schedule and training feasibility in the military.

Insomnia is a threat to the well-being and combat readiness of military service members. Brief Behavioral Treatment for Insomnia (BBTI) is effective in treating insomnia, but the treatment schedule is difficult to implement in the Military Health System due to shorter appointment windows than what is offered in civilian settings. In the present study, 23 behavioral health providers were trained in a version of BBTI adapted for use within the Military Health System. Training was conducted remotely via a 2-day webinar, followed by 12 weekly telephone consultations with a trainer. Surveys were conducted before and after the 2-day webinar, and after the consultation period. Training led to increases in target knowledge scores and self-rated confidence in administering BBTI. All providers reported implementing the treatment with multiple patients during the 12-week period, and all providers reported that the intervention was more effective than their usual treatment method. All behavioral health providers also reported that they were likely to use BBTI in the future when treating patients with insomnia, and that they would advertise their BBTI skills to primary care providers to encourage insomnia referrals. Although conducted with a small sample size, the current study gives provisional support for (a) feasibility of implementing the adapted version of BBTI within the Military Health System and (b) feasibility of training the adapted BBTI to behavioral health providers via remote learning methodology. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Brief behavioral treatment for insomnia decreases trauma-related nightmare frequency in veterans.

Trauma-related nightmares are highly prevalent among veterans and are associated with higher-severity insomnia and posttraumatic stress disorder. Cognitive behavioral therapy for insomnia (typically 6-8 sessions) has been shown to reduce trauma-related nightmares. Brief behavioral treatment for insomnia (BBTI, 4 sessions) has been found to be comparable to CBT-I in decreasing insomnia severity; however, the effects of BBTI on nightmares have not been investigated. The current study tested the effects of BBTI on both trauma-related nightmares and nontrauma-related bad dreams using an active control group treated using progressive muscle relaxation therapy. In addition, we tested whether baseline trauma-related nightmare frequency and baseline nontrauma-related bad dream frequency moderated changes in insomnia severity. Participants were 91 military veterans with insomnia disorder randomized to BBTI or progressive muscle relaxation therapy. Participants reported insomnia severity on the Insomnia Severity Index and reported trauma-related nightmare frequency and nontrauma-related bad dream frequency on the Pittsburgh Sleep Quality Index-PTSD Addendum. We found that BBTI significantly reduced trauma-related nightmares from baseline to posttreatment, whereas progressive muscle relaxation therapy did not. However, reductions in trauma-related nightmares were not maintained at the 6-month follow up. Neither BBTI nor progressive muscle relaxation therapy reduced nontrauma-related bad dreams from baseline to posttreatment. We also found that neither baseline trauma-related nightmare frequency nor baseline nontrauma-related bad dream frequency moderated changes in insomnia symptom severity. Findings from the current study suggest that BBTI may help reduce trauma-related nightmares. Further research is needed to better understand the potential mechanisms underlying how improved sleep may reduce trauma-related nightmares. Registry: ClinicalTrials.gov; Name: Brief Behavioral Insomnia Treatment Study (BBTI); URL: https://clinicaltrials.gov/ct2/show/NCT02571452; Identifier: NCT02571452. Ranney RM, Gloria R, Metzler TJ, Huggins J, Neylan TC, Maguen S. Brief behavioral treatment for insomnia decreases trauma-related nightmare frequency in veterans. J Clin Sleep Med. 2022:18(7):1831-1839.

Veterans' experiences with and perspectives on insomnia treatment: A qualitative study.

Qualitative interviews were conducted with veterans to understand their experiences and perceptions about insomnia and its treatment, with a focus on cognitive-behavioral therapy for insomnia (CBT-I) and brief behavioral treatment for insomnia (BBTI). There is a lack of knowledge about veterans' understanding of this prevalent disorder, yet their experiences and perceptions can influence treatment delivery and treatment outcomes. The Department of Veterans Affairs (VA) can improve insomnia care by considering and responding to this valuable information from veteran stakeholders. Twenty veterans with an insomnia diagnosis or complaint were interviewed about their experiences with insomnia, its treatment, and their preferences for care. Transcripts from the audio-recorded interviews were independently analyzed by 2 coders using content analysis, and discrepancies were resolved through negotiated consensus. The 20 veterans were mostly male (85%), older (60.4 years ± 9.0), and white (60%). Experiences with insomnia and perspectives regarding treatment focused on (a) insomnia symptoms, (b) comorbid symptoms, (c) seeking treatment, (d) intervention experiences, (e) intervention preferences and expectations, and (f) patient attributes. Barriers to care included a lack of knowledge about treatment and a lack of options that fit veterans' preference for delivery. These results provide insight into veterans' experiences with and perspectives on insomnia treatment that is crucial to the support, development, and implementation of interventions. A focus on increasing knowledge of, and expectations for, insomnia treatments as well as offering multiple delivery options has the potential to improve utilization and access to quality insomnia care. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

A pilot randomized clinical trial of Brief Behavioral Treatment for Insomnia to reduce problematic cannabis use among trauma-exposed young adults

BackgroundInsomnia symptoms may be an important etiological factor for substance use disorders; however, whether improving sleep leads to reductions in problematic substance use among at-risk populations remains unclear. MethodAs such, the current pilot study used a randomized controlled design to test the effects of Brief Behavioral Treatment for Insomnia (BBTI) against a waitlist control among a sample of trauma-exposed young adults with elevated insomnia symptoms who regularly use cannabis (N = 56). Results: Intent-to-treat multilevel modeling analyses indicated that BBTI may be more efficacious than waitlist control in reducing self-reported insomnia symptoms, with large effects three months post-treatment (d = 1.34). Further, our initial evidence suggested that BBTI resulted in reductions in cannabis-related problems with medium to large effects at three months post-treatment (d = 0.75). The current pilot analyses indicated BBTI also reduced cravings to use cannabis to reduce negative emotions in response to trauma cues with a large effect size. ConclusionThis pilot study suggests BBTI may be efficacious not only in improving insomnia symptoms among cannabis users but also in reducing cannabis-related problems and cravings over three months. Future research should replicate these results in a larger, fully powered sample with improved follow-up rates designed to test temporal mediation using multimethod assessments of insomnia symptoms and problematic cannabis use. Overall, BBTI may be a promising intervention for trauma-exposed cannabis users to improve sleep and reduce cannabis-related problems.

658 Adjusting Fire - Piloting an Online Sleep Class in a U.S. Air Force Population in Response to COVID-19 Patient Care Restrictions

IntroductionSleep problems remain problematically prevalent among U.S. service members. In 2015 over 60% of sampled service members reported getting less than 7 hours of sleep per night, 31.4% getting 5 hours or less, and nearly 50% reported subthreshold insomnia symptoms on the Pittsburgh Sleep Quality Index. Ongoing COVID-19 service delivery restrictions necessitate a rapid shift to virtual health solutions and illuminate barriers to the delivery of sleep interventions. This process improvement pilot was a proof-of-concept during uncertain times.MethodsFrom September to January 2020, 10 weekly 1-time, 60-min virtual sleep classes were held over Microsoft Teams. Interventions were consistent with Motivational Interviewing and Brief Behavioral Treatment for Insomnia. Participants completed the STOP BANG and Insomnia Severity Index (ISI) before each class, and accomplished the ISI again at a 2-week contact during which they rated progress toward problem resolution and were offered additional clinical services as-needed.ResultsForty-six participants attended the class. 67% responded to the post-class survey. 74% responded to the two-week follow-up. A majority (84%) indicated either agreement or strong agreement with the statement ’I plan to CHANGE a behavior or TRY an intervention I learned to better my sleep’, and many proceeded to establish a more consistent sleep schedule (n=14; 45%), remove electronics from the bedroom (n=13; 42%), and/or go to bed only when sleepy (n=11; 35%). 84% would recommend this class to others with similar concerns. Scaled from 1 (‘no change’) to 10 (‘full resolution’), participants reported having derived modest benefit from the intervention (M = 4.1, SD=1.7). Eleven (35%) denied need for additional sleep-related services, and 84% expressed intent to recommend the class to others with similar concerns.ConclusionResults suggest a military population is receptive to a 1-time, virtual sleep class consistent with social distancing strictures. This service provided patients rapid access to care while contemporaneously reducing demand for time-intensive one-to-one appointments. As hypothesized, receipt of the intervention was associated with intention to modify sleep-relevant behavior, and with meaningful progress toward resolution of sleep difficulty as assessed at 2-week follow-up. Broadly disseminated, this intervention could introduce an internet-based, stepped-care approach to management of sleep insufficiency across the DoD.Support (if any):

Impact of a brief behavioral treatment for insomnia (BBTi) on metacognition in older adults

IntroductionBrief (≤4 sessions) behavioral treatment for insomnia (BBTi) improves insomnia symptoms in older adults. Findings for BBTi-related improvements in objective cognition are mixed, with our recent trial reporting no effects. Metacognition (appraisal of one's own performance) has not been examined. This study examined the effects of BBTi on metacognition in older adults with insomnia. MethodsOlder adults with insomnia [N = 62, Mage = 69.45 (SD = 7.71)] were randomized to 4-weeks of BBTi (n = 32; psychoeducation, sleep hygiene, stimulus control, sleep restriction, relaxation, review/maintenance) or self-monitoring control (SMC; n = 30; social conversations). Throughout the study (2 week baseline, 4 week treatment, 2 week post-treament, 2 week 3-month followup), participants completed daily paper/pencil cognitive tasks (measuring verbal memory, attention, processing speed and reasoning) and provided daily metacognition ratings of their performance in four areas: quality, satisfaction, compared to same age peers, compared to own ability. Two-week averages of metacognitive ratings were calculated for baseline, treatment-first half, treatment-second half, post-treatment, and 3-month follow-up. Multilevel Modeling examined treatment effects (BBTi/SMC) over time on metacognition, controlling for age and sex. ResultsA significant group by time interaction (p = 0.05) revealed consistent improvements over time in better metacognitive ratings relative to same age peers for BBTi. Specifically, baseline ratings [mean (M) = 51.21, standard error (SE) = 3.15] improved at first half of treatment (M = 56.65, SE = 3.15, p < 0.001), maintained improvement at second-half of treatment (p = 0.18), showed additional improvement at post-treatment (M = 60.79, SE = 3.15, p = 0.02), and maintained improvement at follow-up (M = 62.30, SE = 3.15; p = 0.02). SMC prompted inconsistent and smaller improvements between baseline (M = 53.24, SE = 3.29) and first-half of treatment (M = 56.62, SE = 3.28; p = 0.004), with additional improvement at second-half of treatment (M = 59.39, SE = 3.28; p = 0.02) that was maintained at post-treatment (p = 0.73) and returned to levels observed at first-half of treatment (M = 57.78, SE = 3.21; p = 0.55). Significant main effects of time (all ps < 0.001) for other metacognition variables (Quality, Satisfaction, Compared to own ability) indicated general improvements over time for both groups. DiscussionMetacognition generally improved over time regardless of treatment. BBTi selectively improved ratings of performance relative to same age peers. Repeated objective testing alone may improve metacognition in older adults with insomnia. Better understanding of metacognition and how to improve it has important implications for older adults as metacognitive complaints have been associated with mild cognitive impairment.

Reducing Barriers to Behavioral Treatments for Insomnia: A Qualitative Examination of Veterans’ Perspectives of BBTI

ABSTRACT Objective: Although behavioral treatments are recommended for treating insomnia disorder, these treatments are not the most commonly provided treatments due to numerous barriers (e.g., treatment length, time limitations). Brief Behavioral Treatment for Insomnia (BBTI) was developed, in part, to help overcome these barriers. The purpose of the current study was to qualitatively examine the treatment experiences of veterans with insomnia disorder participating in BBTI. Methods: All veterans (n=46) who were randomized to receive BBTI as part of a randomized clinical trial participated in 10-20 minute semi-structured interviews one week after completing treatment. Rapid analysis procedures were used for qualitative analysis. Results: Thirteen qualitative themes were identified: BBTI provided veterans with the skills they believed they needed to continue improving independently post-treatment; beginning BBTI with in-person sessions was valued; phone sessions helped participation; veterans did not perceive that they could cover the same content during phone and in-person sessionsl; materials could be more portable; BBTI created accountability; BBTI required discipline and willingness; BBTI facilitated buy-in; BBTI was aligned with military culture; loved ones could provide important support; BBTI could be improved with more personalization; BBTI challenged expectations of mental health; and BBTI improved awareness of health behaviors beyond sleep. Conclusions: BBTI was successful in overcoming barriers to behavioral insomnia treatment and interviews identified critical treatment aspects that should be maintained to preserve acceptability (e.g., in-person session first). Areas in which BBTI did not fully meet the needs of veterans and targets for improvement (e.g., ameliorating understanding and expectations of phone sessions) were also identified.

A single-case multiple baseline design for treating insomnia in eating disorders: The TIRED study.

The purpose of this trial is to evaluate the novel use of an empirically supported treatment for sleep problems for people with residual insomnia disorder following ED treatment. Participants (N = 6) will complete a single-case multiple baseline study using Brief Behavioral Treatment for Insomnia (Buysse et al., Archives of Internal Medicine, 171, 2011, 887-895; Troxel et al., Behavioral Sleep Medicine, 10, 2012, 266-279). Participants will complete pre- and post-treatment evaluations of insomnia severity, sleep efficiency, daytime fatigue, ED symptoms, depressive symptoms, and anxiety symptoms. Throughout treatment, participants will complete daily diaries of sleep indices (sleep latency, wake after sleep onset, total sleep time, and sleep efficiency). The primary outcome will be treatment effects on insomnia severity, measured by the Insomnia Severity Index. Secondary outcomes include sleep efficiency and daytime fatigue. Exploratory outcomes include ED-related impairment and symptoms, anxiety symptoms, and depression symptoms. We will provide subject-level graphs of sleep indices and ED symptoms throughout treatment. Additionally, treatment effects will be examined at one- and three-month follow-up. Although insomnia treatments have been evaluated in other psychiatric disorders, there has yet to be a study examining behavioral interventions for insomnia in EDs. Results of this study will inform the development and application of interventions for residual insomnia symptoms in this population.

Brief behavioral treatment for insomnia improves psychosocial functioning in veterans: results from a randomized controlled trial.

Our goal was to compare brief behavioral treatment for insomnia (BBTI) to a progressive muscle relaxation training (PMRT) control condition among veterans with insomnia, examining psychosocial functioning as a primary outcome and sleep-related outcomes, mood, cognition, and pain as secondary outcomes. Veterans were randomly assigned to either BBTI or PMRT (N = 91; 24-74 years; M = 49 years). BBTI consisted of two in-person (60-min and 30-min sessions) and two telephone sessions (20-min each), and the PMRT control condition was matched to BBTI for session duration and type. Veterans were assessed through clinical interview at baseline and self-report measures at pre-, mid-, and posttreatment, as well as 6-month follow-up for the BBTI condition to assess sustained response. Measures also included continuous sleep monitoring with sleep diary. Intent-to-treat analyses demonstrated that individuals who completed BBTI versus PMRT reported greater improvements in work, home, social and cognitive functioning, insomnia symptom severity, mood, and energy. Improvements in psychosocial functioning, insomnia symptoms, and mood were maintained 6-months following BBTI treatment completion. Veterans who received BBTI improved and maintained gains in psychosocial functioning, insomnia, and mood. BBTI is a treatment that can be implemented in primary care, mental health, or integrated care settings and provide symptom relief and improved functioning among those with insomnia, one of the most commonly reported mental health problems among veterans. NCT02571452.

0489 Initial Results from the Hypertension with Unsatisfactory Sleep Health (HUSH) Clinical Trial for Primary Care Patients with Insomnia and Comorbid Hypertension (INS-HTN)

Abstract Introduction Insomnia is commonly comorbid with, and may contribute to, hypertension. Cognitive-behavioral treatments improve insomnia, but their effects on hypertension are uncertain, and they are often unavailable in primary care practices, where most INS-HTN patients are treated. We evaluated the efficacy of Brief Behavioral Treatment for Insomnia (BBTI) and Sleep Healthy Using the Internet (SHUTi) compared to enhanced usual care (EUC) on insomnia and home blood pressure (HBP) in primary care patients with INS-HTN. Methods Patients were recruited via electronic health records from 67 primary care practices and randomized 2:2:1 to BBTI delivered via telephone/videoconferencing; SHUTi, an automated, web-based CBT-I program; or EUC including a patient education video. Assessments included self-report questionnaires, home sleep apnea testing, and one week of sleep diary and HBP, measured at Baseline and 9 weeks/ 6 months post-treatment. The primary outcome was the Patient-Reported Outcomes Measurement Information System (PROMIS) Sleep Disturbance scale. Linear mixed models were fitted for continuous variables on the intent-to-treat sample (n=548), adjusting for age and sex. Chi-square tests were used for proportions. Results Patients were 61.8±11.3 years old, 67.2% female, and 55.9% were taking hypnotics. Insomnia Severity Index (ISI) was 15.4±4.4, Apnea-Hypopnea Index 9.8±11.4, and HBP 130±14/81±9. BBTI and SHUTi were significantly better than EUC (p≤.002) at 9 weeks and 6 months on PROMIS Sleep Disturbance and Sleep-Related Impairment scales, ISI, and diary sleep efficiency, but had inconsistent effects on PROMIS depression and anxiety scales (p=0.001-0.9). Greater proportions of BBTI and SHUTi vs. EUC-treated patients had 9-week and 6-month ISI scores &amp;lt;8 (p=.01, p=.04) and ISI changes scores ≥7 (p=.002, p=.003). HBP did not significantly differ by intervention group. Conclusion BBTI and SHUTi improved insomnia, but did not reduce HBP in patients with INS-HTN. These interventions appear suitable for dissemination and implementation in primary care, but may have limited effects on comorbid symptoms and conditions. Support NHLBI UH2/UH3 HL125103

0503 Reductions in Sleep and Daily Rhythm Variability Following Brief Behavioral Treatment for Insomnia

Abstract Introduction Brief behavioral treatment for insomnia (BBTI) is efficacious for insomnia symptoms. Here we examine whether BBTI reduces sleep and daily rhythm variability and whether reductions in variability result in improved functioning and quality of life. Methods Ninety-one Veterans with insomnia (49.3±18.7yrs; 18.7% female) were randomized to one of two treatment conditions: BBTI or progressive muscle relaxation training (PMRT; control condition). Variability was assessed using sleep diaries and actigraphy. The sleep diary outcome variables included bedtime variability, wake time variability, and total sleep time variability; actigraphy variables included interdaily stability, intradaily variability, and total sleep time variability. Functioning was assessed using the Work and Social Adjustment Scale. Quality of life was assessed using the Hotel Dieu-16 Scale. Results Compared to PMRT, BBTI resulted in a greater reduction in subjective total sleep time variability (F1,90=6.61, p&amp;lt;0.01, partial η 2=0.13) and a greater increase in interdaily stability (F1,78=12.41, p&amp;lt;0.01, partial η 2=0.25). There was a greater decrease in intradaily variability following PMRT (F1,78=27.96, p&amp;lt;0.01, partial η 2=0.42). Across the entire sample, reductions in subjective wake time variability were associated with improved functioning (F1,88=4.43, p=0.04, η 2=0.05) and reductions in subjective total sleep time variability were associated with improved quality of life (F1,89=4.91, p=0.03, partial η 2=0.05). Conclusion There was significant improvement in the stability of sleep-wake rhythms following BBTI, suggesting that BBTI not only treats insomnia, but also may stabilize circadian rhythms. Interestingly, PMRT resulted in greater intradaily variability reductions than BBTI. One explanation is that due to BBTI stimulus control guidelines, individuals were getting out of bed in the middle of the night more frequently and thus, these awakenings were better captured by actigraphy. Reductions in wake time and total sleep time variability were associated with improved functioning and quality of life, further demonstrating the importance of stable sleep-wake rhythms. Support VA Rehabilitation Research and Development Grant # RX001539-01A2

0531 Efficacy of a Single 4 Hour CBT-I Workshop in a Community Sample with Self-Reported Insomnia Symptoms

Abstract Introduction Cognitive behavioral treatment for insomnia (CBT-I) is the first line of treatment for insomnia. However, experts have noted that the expanded use of CBT-I is limited by the small number of specialty-trained clinicians, as well as the duration and cost of individual treatment sessions (usually 6-8). One solution is a single-session educational group format delivered by a trained health educator rather than a licensed clinician. Our objective was to evaluate the efficacy of group CBT-I delivered by a Ph.D. level health educator to community dwelling individuals with self-reported insomnia symptoms. Methods Participants were referred from clinicians, our website, and social media postings. Participants completed the Insomnia Severity Index, provided information on type of sleep aid use and frequency, and the presence of co-morbid conditions prior to and 1-month post attendance of a single 4-hour CBT-I workshop. Results Participants (N = 31) were 58 ± 12 years of age (range 29 - 80); 11 Males, 20 Females; 90.6% white; 66% married; 71.8% at least a college graduate; and 34.3% had an average income of &amp;gt; $100K. Comorbidities included pulmonary disease (6%), GI disease (9.6%), endocrine disease (9.6%), and headaches (25.8%). Insomnia Severity Index scores significantly improved from baseline (19.6 ± 5.06) to 1-month (FU 13.7 ± 6.33) (t = 21.9, P &amp;lt; .001)). Similarly, frequency of sleep aid use significantly dropped (χ 2 = 105.7, p = .017). Subjective improvement in sleep was reported as the following: 12.5% much better, 56.3% better, 25% the same, and .03% worse. Conclusion These data indicate that a single 4-hour CBT-I workshop delivered by a health educator can significantly reduce insomnia symptoms, improve subjective sleep quality, and reduce sleep aid use among community dwelling adults with self-reported insomnia symptoms within 1-month. These data extend what has been shown primarily in older adults. That is, brief behavioral treatment for insomnia can be acceptable and efficacious to anyone reporting insomnia symptoms. Support The Insomnia Clinic

Brief Behavioral Treatment for Insomnia vs. Cognitive Behavioral Therapy for Insomnia: Results of a Randomized Noninferiority Clinical Trial Among Veterans

The goal of this study was to compare a brief behavioral treatment for insomnia (BBTI), which has fewer sessions (4), shorter duration (<30–45 minutes), and delivers treatment in-person plus phone calls to cognitive behavioral therapy for insomnia (CBTI), which has 5 in-person sessions. The hypothesis was BBTI would be noninferior to CBTI. The Reliable Change Index was used to establish a noninferiority margin (NIM) of 3.43, representing the maximum allowable difference between groups on the pre-post Insomnia Severity Index change (ΔISI). Sixty-three veterans with chronic insomnia were randomized to either BBTI or CBTI and veterans in both groups had significant reductions of their insomnia severity per the ISI and improved their sleep onset latency, total wake time, sleep efficiency, and sleep quality per sleep diaries. While CBTI had a larger pre-post ΔISI, this was not significantly different than ΔISI BBTI and was less than the NIM. However, the 95% confidence interval of the between group pre-post ΔISI extended beyond the NIM, and thus BBTI was inconclusively noninferior to CBTI. Limitations, such as small sample size and high rate of dropout, indicate further study is needed to compare brief, alternative yet complementary behavioral insomnia interventions to CBTI. Still, evidence-based brief and flexible treatment options will help to further enhance access to care for veterans with chronic insomnia, especially in non-mental-health settings like primary care.

Nurse-Delivered Brief Behavioral Treatment for Insomnia in Lung Cancer Survivors: A Pilot RCT

ABSTRACT Objective/Background: Insomnia occurs in 50 to 80% of lung cancer survivors. Cognitive behavioral therapy is the standard treatment for insomnia (CBTI); however, treatment length and lack of psychologists trained in CBTI limits access. Brief Behavioral Treatment for Insomnia (BBTI), a nurse-delivered modified CBTI, is proposed. This feasibility pilot study sought to compare the BBTI intervention to attention control Healthy Eating Program (HEP) for insomnia in lung cancer survivors. Participants: The participants comprised adults, 21 years of age or older with insomnia and stage I/II non-small cell lung cancer, more than 6 weeks from surgery and living in Western NY. Methods: Participants (n = 40) were randomly assigned to an experimental (BBTI) or attention control condition (Healthy Eating Program). Thirty participants completed the study. Results: Participants were 66 years of age (± 7.6; range 53–82), 40% (n = 16) male, 87.5% (n = 35) Caucasian, 50% (n = 20) married, BMI 27.7 (± 5.8), and 12% (n = 5) never smokers. Baseline sleep diary sleep efficiency, ISI and other baseline covariates were balanced between the groups. Sleep efficiency improved ≥85% in BBTI group (p = .02), but not in HEP control group (p = 1.00). Mean ISI for BBTI and attention control were 6.40 ± 4.98 and 14.10 ± 4.48 (p = .001) respectively. In addition, BBTI group mean total FACT-L score improved by 6.66 points from baseline while HEP group score worsened (p = .049). Conclusions: BBTI is a practical, evidence-based, clinically relevant intervention that improved sleep and quality of life in lung cancer survivors with insomnia. Additional research to evaluate efficacy, duration, and implementation strategies are essential.

Pilot randomized trial of brief behavioral treatment for insomnia in patients with heart failure

BackgroundInsomnia is prevalent among patients with heart failure (HF) and is associated with reduced physical and mental functioning, including possible exacerbation of cognitive deficits. ObjectivesThis study evaluated the effects of Brief Behavioral Treatment for Insomnia (BBTI) on insomnia and related factors among HF patients. MethodsTwenty-three HF patients with insomnia (70% women; 65% white; Mage = 55.7 ± 11.3 years; NYHA Class II = 70%) were randomized to a behavioral intervention (BI; n = 12) or sleep monitoring (SM; n = 11) group. Sleep, cognitive functioning, quality of life, distress, self-care, and functional status were assessed pre- and post-intervention. ResultsBI participants experienced reduced insomnia and increased sleep quality and efficiency, with 58% demonstrating clinically meaningful improvements in insomnia and 25% achieving remission of insomnia symptoms. Depression and anxiety also improved in BI participants. ConclusionsBBTI was tolerated well within this symptom-limited patient population and was associated with reduced symptoms of insomnia and distress.