Background. Over 50% of individuals with multiple sclerosis (MS) have moderate or severe sleep disturbances, insomnia being the most common. In-person cognitive behavioral therapy for insomnia (F2F-CBTi) is currently the first-line treatment for insomnia. However, given potential limitations to access including mobility difficulty, fatigue, or living in a rural area, telehealth-delivered CBT-I (tele-CBTi) has been considered as an alternative treatment. The purpose of this study was to assess the feasibility and treatment effect of tele-CBTi in people with MS and compare it to outcomes from a F2F-CBTi study in individuals with MS. Methods. 11 individuals with MS and symptoms of insomnia participated in 6 weekly CBT-I sessions with a trained CBT-I provider via live video. Insomnia severity (ISI), sleep quality (PSQI), and fatigue severity (FSS and MFIS) were assessed pre- and posttreatment as primary outcomes. Sleep onset latency (SOL), sleep efficiency (SE) and total sleep time (TST) from the PSQI, depression (PHQ-9), anxiety (GAD-7), sleep self-efficacy (SSES), and quality of life (MSIS-29) were also assessed pre- and posttreatment as secondary outcomes. Results. Participants resided in 9 different states. Retention and adherence rates were 100%. There were significant improvements in ISI, PSQI, MFIS, FSS, SOL, SSES, PHQ-9, and MSIS-29, but not SE, TST, or GAD-7. There were no significant differences between the F2F-CBTi group and tele-CBTi group for magnitude of change in the primary outcomes (ISI, PSQI, MFIS, and FSS) or the secondary outcomes (SOL, SE, TST, SSES, PHQ-9, GAD-7, and MSIS-29). Conclusions. Tele-CBTi is feasible and has outcome measures that are similar to that of in-person CBT-I treatment. Tele-CBTi may increase access to insomnia treatment in individuals with MS.

Objective: To determine effective behavioral interventions to improve sleep in people with MS. Methods: Systematic review following PRISMA guidelines. Data Sources: Literature searches were performed in December 2021 in Ovid MEDLINE, CINAHL, and Web of Science along with hand searching for grey literature and cited references. Out of the 837 search results, 830 unique references were reviewed after duplicates were removed. Study Selection: Four reviewers independently reviewed titles and abstracts (two reviewers for each article), and a fifth reviewer resolved discrepancies. The full-text articles (n = 81) were reviewed independently by four reviewers (two for each article) for eligibility, and consensus for inclusion was achieved by a fifth reviewer as needed. Thirty-seven articles were determined eligible for inclusion. Data Extraction: Four reviewers extracted relevant data from each study (two reviewers for each article) using a standard data-extraction table. Consensus was achieved for completeness and accuracy of the data extraction table by a fifth reviewer. Four reviewers (two reviewers for each article) conducted a quality appraisal of each article to assess the risk for bias and quality of the articles and consensus was achieved by a fifth reviewer as needed. Data Synthesis: Descriptions were used to describe types of interventions, sleep outcomes, results, and key components across interventions. Conclusions: The variability in the intervention types, intervention dose, outcomes used, training/expertise of interventionist, specific sample included, and quality of the study made it difficult to compare and synthesize results. Overall, the CBT-I, CBT/psychotherapy, and education/self-management support interventions reported positive improvements in sleep outcomes. The quality appraisal scores ranged from low to high quality indicating potential for bias. Further research is necessary to demonstrate efficacy of most of the interventions.

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