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

2019 – 2020

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

192 patients had at least 2 visits in 2019–2020 with ESS (Epworth Sleepiness Scale) data available for analysis. Among those patients whose baseline ESS score ≥ 10 (N = 62), 40.3% (N = 25) showed improvement, 56.5% (N = 35) remained stable, and 3.2% (N = 2) worsened. Median duration of follow-up was 197 days (range, 13-603). Clinically meaningful change was defined as a total point change of 3, based on one-half the standard deviation.²

177 patients had at least 2 visits in 2019–2020 with PROMIS Sleep Disturbance data available for analysis. Among those patients whose baseline PROMIS Sleep Disturbance T-score ≥ 55 (N = 149), 57.7% (N = 86) showed improvement, 38.9% (N = 58) remained stable, and 3.4% (N = 5) worsened. Median duration of follow-up was 133 days (range, 22-518). Clinically meaningful change was defined as a total point change of 5, based on one-half the standard deviation.²

196 patients had at least 2 visits in 2019–2020 with ISI data available for analysis. Among those patients whose baseline ISI score ≥ 10 (N = 179), 63.1% (N = 113) showed improvement, 30.2% (N = 54) remained stable, and 6.7% (N = 12) worsened. Median duration of follow-up was 135 days (range, 13-712). Clinically meaningful change was defined as a total point change of 3, based on one-half the standard deviation.¹⁻²

231 patients had at least 2 visits in 2019–2020 with PROMIS Mental Health data available for analysis. Among those patients whose baseline PROMIS Mental Health score ≤ 45 (N = 107), 47.7% (N = 51) showed improvement, 46.7% (N = 50) remained stable, and 5.6% (N = 6) worsened. Median duration of follow-up was 174 days (range, 13-712). Clinically meaningful change was defined as a total point change of 5, based on one-half the standard deviation.²

217 patients had at least 2 visits in 2019–2020 with PHQ-9 data available for analysis. Among those patients whose baseline PHQ-9 score ≥ 10 (N = 121), 33.9% (N = 41) showed improvement, 52.1% (N = 63) remained stable, and 14% (N = 6) worsened. Median duration of follow-up was 255 days (range, 14-686). Clinically meaningful change was defined as a total point change of 5, based on one-half the standard deviation.²⁻³

217 patients had at least 2 visits in 2019–2020 with PROMIS Physical data available for analysis. Among those patients whose baseline PROMIS Physical score ≤ 45 (N = 118), 32.2% (N = 38) showed improvement, 57.6% (N = 68) remained stable, and 10.2% (N = 12) worsened. Median duration of follow-up was 271 days (range, 14-706). Clinically meaningful change was defined as a total point change of 5, based on one-half the standard deviation.²⁻³

119 patients had at least 2 visits in 2019–2020 with TST data available for analysis. Among those patients whose baseline TST ≤ 24 hours (N = 119), 41.2% (N = 49) showed improvement, 45.4% (N = 54) remained stable, and 13.4% (N = 16) worsened. Median duration of follow-up was 229 days (range, 13-705). Clinically meaningful change was defined as a total point change of 1, based on one-half the standard deviation.²

Improvement in Insomnia-Related Symptoms Following Computer-Based CBT-I

2011 – 2020

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 1628 patients enrolled between 2011 and 2020, the Pittsburgh Insomnia Rating Scale (PIRS) improved overall from 34.9 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 36.6 to 22.4.

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.

References
  1. Bastien CH, Vallières A, Morin CM. Validation of the Insomnia Severity Index as an outcome measure for insomnia research. Sleep Med. 2001 Jul;2(4):297-307.
  2. Norman GR, Sloan JA, Wyrwich KW. Interpretation of changes in health-related quality of life: the remarkable universality of half a standard deviation. Med Care. 2003 May;41(5):582-592.
  3. Löwe B, Unützer J, Callahan CM, Perkins AJ, Kroenke K. Monitoring depression treatment outcomes with the Patient Health Questionnaire-9. Med Care. 2004 Dec;42(12):1194-1201.