Insomnia
Conditions
Brief summary
The overall objective of this study is to conduct a randomized effectiveness-implementation trial to test the non-inferiority of tele-Brief Behavioral Treatment for Insomnia vs. tele-Cognitive-Behavioral Therapy for Insomnia among socioeconomically disadvantaged adults with insomnia in the primary care setting.
Interventions
BEHAVIORALTele-Brief Behavioral Treatment for Insomnia
Brief Behavioral Treatment for Insomnia (BBTI) comprises of up to five weekly intervention visits by phone, delivered by a variety of practitioners without formal training in sleep.
BEHAVIORALTele-Cognitive-Behavioral Therapy for Insomnia
Cognitive-Behavioral Therapy for Insomnia (CBTI) is a multicomponent strategy delivered by trained mental health clinicians over 6 to 12 weeks.
Sponsors
Brigham and Women's Hospital
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Aged 18 years or older * Meet clinical diagnostic criteria for insomnia (DSM-V criteria) * Insomnia severity score \> 10 * Eligible to receive care through publicly-supported medical assistance (e.g. Commonwealth Connector plan; MassHealth. For participants \>65 years old on Medicare, they will be asked about insurance coverage prior to initiating Medicare, OR * Identify as racial or ethnic minority * Has capacity for informed consent (SDT\<9)
Exclusion criteria
* Untreated, current major depressive disorder (PHQ-8≥ 20) * History of bipolar disorder or psychosis * Active alcohol abuse (Alcohol Use Disorders Identification Test, AUDIT-C) or drug abuse (Drug Abuse Screening Test, DAST-2 ≥1) * Excessive daytime sleepiness (Epworth Sleepiness Scale score ≥ 16) * Seizure within the past 1 year * Main sleep period outside of 8pm - 11am * Regular nightshift work (5 overnight shifts/month, defined as working between midnight-5am) * Untreated, previously diagnosed moderate to severe sleep apnea * Severe medical condition, which may require hospitalizations over the next 6 months * Active suicidal ideation, if elicited passively during screening * Pregnant or planning to become pregnant (self-reported) * Participation in other studies that may impact the benefit or safety of the intervention, as determined by the study PI
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Insomnia severity index, ISI | 3 months | The Insomnia Severity Index is a 7-item self-report questionnaire assessing the nature, severity, and impact of insomnia in the last month. A 5-point Likert scale is used to rate each item (e.g., 0 = no problem; 4 = very severe problem), yielding a total score ranging from 0 to 28. The total score is interpreted as follows: absence of insomnia (0-7); sub-threshold insomnia (8-14); moderate insomnia (15-21); and severe insomnia (22-28). |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Insomnia severity index, ISI | 6- and 12-months | The Insomnia Severity Index is a 7-item self-report questionnaire assessing the nature, severity, and impact of insomnia in the last month. A 5-point Likert scale is used to rate each item (e.g., 0 = no problem; 4 = very severe problem), yielding a total score ranging from 0 to 28. The total score is interpreted as follows: absence of insomnia (0-7); sub-threshold insomnia (8-14); moderate insomnia (15-21); and severe insomnia (22-28). |
| Quality of Life and Symptoms - Patient-Reported Outcomes Measurement Information System (PROMIS) Global Health | 3-months | The PROMIS Global Health measures assess an individual's physical, mental and social health. The measure produces two scores: Physical and Mental Health from 4 items each. Item responses are combined to yield a T-score with a population mean of 50 and standard deviation of 10. |
| Quality of Life and Symptoms - Generic-quality of life | 3-months | Generic-quality of life will be assessed by the change in the Euroqol - 5 Dimensions (EQ-5D) questionnaire. The questionnaire comprises of 5 dimensions: mobility, self-care, usual activities, pain/discomfort and anxiety/depression. Each dimension has 3 levels: no problems, some problems, and extreme problems. There is no total score or range. |
| Generalized Anxiety Disorder (GAD-7) | 3-months | GAD-7 measures self-reported anxiety disorder. The measure includes 7-items with higher scores indicating anxiety. The minimum score is 0 and the maximum score is 21. |
| Patient Health Questionnaire for depression (PHQ-8) | 3-months | PHQ-8 measures self-reported current depression. The measure includes 8-items with higher scores indicating depression. The minimum score is 0 and the maximum score is 24. |
| Patient-Reported Outcomes Measurement Information System (PROMIS) Sleep Impairment, 8a | 3-months | PROMIS Sleep Impairment measures self-reported perceptions of alertness, sleepiness, and tiredness during usual waking hours, and the perceived functional impairments during wakefulness associated with sleep problems or impaired alertness during the past seven days. The measure includes 8-items with higher scores indicating greater sleep impairment. The minimum score is 8 and the maximum score 40. Item responses are combined to yield a T-score with a population mean of 50 and standard deviation of 10. |
| Patient-Reported Outcomes Measurement Information System (PROMIS) Sleep Disturbance, 8b | 3-months | PROMIS Sleep Disturbance measures self-reported sleep quality and associated daytime functioning during the past seven days. The measure includes 8-items with higher scores indicating greater sleep disturbance. The minimum score is 8 and the maximum score is 40. Item responses are combined to yield a T-score with a population mean of 50 and standard deviation of 10. |
| Diary reported sleep duration | 3-months | Self-reported sleep duration with be measured using sleep diary |
| Diary-reported sleep efficiency | 3-months | Self-reported sleep efficiency with be measured using sleep diary |
| Number of participants with hypnotic use self-reported from the sleep diary | 3-months | Hypnotic use will be measured by the number of participants who self-reported use on the sleep diary |
Countries
United States
Contacts
CONTACTSuzanne Bertisch, MD, MPH
Outcome results
None listed