Can Cognitive Behavioral Therapy (CBT)-Insomnia be enhanced with clinical-grade, at-home sleep monitoring?: A Pilot study

Intervention: 4-8, weekly or fortnightly, 60 minute sessions of individually administered CBT-Insomnia (mostly in person, but telehealth sessions will be provided if required) that will be augmented with the use of a clinical grade, at-home sleep monitoring device (Somfit - see below). Participants can attend sessions weekly or fortnightly depending on convenience and clinical need as discussed with the treating clinician. Sessions will be held at two clinic urban locations in Perth, Western Australia: one university psychology training clinic, and one private behavioural sleep medicine clinic. Number of sessions will be determined by clinician's discretion of when appropriate CBT-Insomnia material has been delivered. -Therapy will be administered by clinical psychologists and supervised clinical psychology trainees. - number of sessions attended and dates of attendance will be recorded. - within the Somfit-CBT-I software, clinicians can indicate key CBT-Insomnia strategies that they have covered in each session. -Participation at the university trial site involves no cost to participants. Usual fees apply for participation at the private clinic. -Participants will be asked to complete questionnaire assessment measures at baseline, post-treatment and 3-month follow-up. These will take approximately 30minutes and include sleep log, Insomnia Severity Index, Depression Anxiety Stress Scales, and the Fatigue Assessment Scale. -Participants will be asked to wear the Somfit device for 5-7 nights at the above timepoints in order to gain an objective measurement of their sleep. -clinicians and participants will decide together how frequently to wear the Somfit device during the CBT-Insomnia treatment. CBT-Insomnia: Description of sessions: Clinicians can use their discretion in spending more or less time on particular therapy components, or changes in the ordering of content. Session 1-2 Therapist checks in on the participant’s experience of 7 nights Somfit recording At each therapist’s discretion and timing, they can share with each participant their sleep recording data. Assessment of insomnia history and maintaining factors via semi-structured clinical interview Participant goal setting and motivation for treatment Sleep education: myths and facts Regulation of Sleep – Sleep drive; Body clock; Are you an owl or lark? What is Insomnia? Strategies for improving sleep by changing behaviour – Wind down before bed; Stimulus control; Winding up Plan for the week ahead, including completing the sleep diary daily Therapist to decide whether more sleep studies to be done Session 2-4: Imagery exercise Review plan from last week and sleep diary Time in bed restriction Strategies for managing a busy mind vicious cycle of insomnia; Managing negative thoughts; Review and plan for the week ahead, including completing the sleep diary daily Therapist to decide whether more sleep studies need to be done Session 3-5: Beliefs About Sleep Scale (complete in session) Mindfulness exercise Weekly review of plan and sleep diary Introduction to defusion exercises Beliefs about sleep Daytime tiredness Insomnia cycle for the day Link between tiredness and sleep Maximising daytime energy Review and plan for the week ahead, including completing the sleep diary daily Therapist to decide whether more sleep studies need to be done Session 4-6: Weekly review and sleep diary Life balance and values Keeping your progress going: Blueprint for my sleep; Bad night sleep vs a relapse Planning for setbacks Review and plan for the future Encourage continuation of sleep diary if required in follow-up period Up to 2 additional therapy sessions can be added to consolidate the above content if the participant and therapist agree that this would be helpful for clinical outcomes. SOMFIT The Somfit device is not associated with any risk or harm. Somfit is a wearable, low voltage, battery operated device about the size of a 50c piece. Somfit collects signals such as EEG, heart rate, blood oxygen level, movement, body position, light, and noise. The Somfit device is attached to the participant's forehead through a self-adhesive and disposable skin electrode patch. Wearing the device may take a little getting used to, but most people adjust fairly quickly.