Neurological Institute Outcomes
Sleep Disorders
Insomnia
Insomnia is a common sleep disorder, characterized by the inability to initiate or maintain sleep or early morning awakening despite the opportunity to sleep. Cognitive behavioral therapy for insomnia (CBT-I), which does not involve sedative-hypnotic medications, is one of the most effective treatments for insomnia. Traditionally, CBT-I has been provided by a behavioral sleep medicine specialist in individual or group therapy sessions. Patients are evaluated and treated for insomnia with CBT-I by a behavioral sleep medicine expert at the Sleep Disorders Center. Meta-analyses have shown better and more durable outcomes in insomnia patients using CBT-I compared with using sedative-hypnotic medications alone.
Improvement in Insomnia-Related Symptoms Following Individual CBT-I
2020 – 2021
CBT-I = cognitive behavioral therapy for insomnia, ESS = Epworth Sleepiness Scale, ISI = Insomnia Severity Index, PHQ-9 = Patient Health Questionnaire, PROMIS = Patient-Reported Outcomes Measurement Information System, TST = total sleep time
289 patients had at least 2 visits in 2020–2021 with ESS data available for analysis. Among those patients whose baseline ESS score ≥ 10 (N = 85), 44.7% (N = 38) showed improvement, 47.1% (N = 40) remained stable, and 8.2% (N = 7) worsened. Median duration of follow-up was 175 days (range, 27-702). Clinically meaningful change was defined as a total point change of 3, based on one-half the standard deviation.¹
337 patients had at least 2 visits in 2020–2021 with PROMIS Sleep Disturbance data available for analysis. Among those patients whose baseline PROMIS Sleep Disturbance T-score ≥ 55 (N = 270), 54.4% (N = 147) showed improvement, 40.7% (N = 110) remained stable, and 4.8% (N = 13) worsened. Median duration of follow-up was 176 days (range, 2-702). Clinically meaningful change was defined as a total point change of 5, based on one-half the standard deviation.¹
317 patients had at least 2 visits in 2020–2021 with ISI data available for analysis. Among those patients whose baseline ISI score ≥ 10 (N = 281), 58.4% (N = 164) showed improvement, 33.8% (N = 95) remained stable, and 7.8% (N = 22) worsened. Median duration of follow-up was 158 days (range, 13-707). Clinically meaningful change was defined as a total point change of 3, based on one-half the standard deviation.¹
366 patients had at least 2 visits in 2020–2021 with PHQ-9 data available for analysis. Among those patients whose baseline PHQ-9 score ≥ 10 (N = 163), 37.4% (N = 61) showed improvement, 55.8% (N = 91) remained stable, and 6.7% (N = 11) worsened. Median duration of follow-up was 239 days (range, 21-688). Clinically meaningful change was defined as a total point change of 5, based on one-half the standard deviation.²
321 patients had at least 2 visits in 2020–2021 with PROMIS Mental Health data available for analysis. Among those patients whose baseline PROMIS Mental Health score ≤ 45 (N = 178), 31% (N = 57) showed improvement, 59.8% (N = 110) remained stable, and 9.2% (N = 11) worsened. Median duration of follow-up was 296 days (range, 3-691). Clinically meaningful change was defined as a total point change of 5, based on one-half the standard deviation.¹
320 patients had at least 2 visits in 2020–2021 with PROMIS Physical Health data available for analysis. Among those patients whose baseline PROMIS Physical Health score ≤ 45 (N = 178), 25.8% (N = 46) showed improvement, 60.7% (N = 108) remained stable, and 13.5% (N = 24) worsened. Median duration of follow-up was 303 days (range, 3-702). Clinically meaningful change was defined as a total point change of 5, based on one-half the standard deviation.¹
163 patients had at least 2 visits in 2020–2021 with TST data available for analysis. Among those patients whose baseline TST ≤ 24 hours (N = 163), 45.4% (N = 74) showed improvement, 36.8% (N = 60) remained stable, and 17.8% (N = 29) worsened. Median duration of follow-up was 226 days (range, 7-671). Clinically meaningful change was defined as a total point change of 1, based on one-half the standard deviation.¹
Improvement in Insomnia-Related Symptoms Following Computer-Based CBT-I (N = 2351)
2011 – 2021
PIRS = Pittsburgh Insomnia Rating Scale
The Go! to Sleep program is an innovative web-based cognitive behavioral therapy program targeted toward insomnia that has been shown to improve insomnia symptoms in an interventional trial.
For 2351 patients enrolled between 2011 and 2021, the Pittsburgh Insomnia Rating Scale (PIRS) improved overall from 35 to 21.5, with findings most pronounced in those who had a baseline PIRS score of ≥ 20 (ie, worse insomnia rating compared with those with a baseline score of < 20); these patients’ scores improved from 36.7 to 22.3.
Program features include ability to access the program from a variety of mobile devices as well as a provider-based platform that allows providers to view patient data and track progress through the program.
