Mobile Intervention to Improve Sleep and Functional Health of Veterans With Insomnia: Randomized Controlled Trial

Abstract

Background Insomnia is a prevalent and debilitating disorder among veterans. Cognitive behavioral therapy for insomnia (CBTI) can be effective for treating insomnia, although many cannot access this care. Technology-based solutions and lifestyle changes, such as physical activity (PA), offer affordable and accessible self-management alternatives to in-person CBTI. Objective This study aims to extend and replicate prior pilot work to examine whether the use of a mobile app for CBTI (cognitive behavioral therapy for insomnia coach app [CBT-i Coach]) improves subjective and objective sleep outcomes. This study also aims to investigate whether the use of the CBT-i Coach app with adjunctive PA improves sleep outcomes more than CBT-i Coach alone. Methods A total of 33 veterans (mean age 37.61 years, SD 9.35 years) reporting chronic insomnia were randomized to use either the CBT-i Coach app alone or the CBT-i Coach app with a PA intervention over 6 weeks, with outcome measures of objective and subjective sleep at pre- and posttreatment. Results Although the PA manipulation was unsuccessful, both groups of veterans using the CBT-i Coach app showed significant improvement from baseline to postintervention on insomnia (P<.001), sleep quality (P<.001), and functional sleep outcomes (P=.002). Improvements in subjective sleep outcomes were similar in those with and without posttraumatic stress disorder and mild-to-moderate sleep apnea. We also observed a significant but modest increase in objective sleep efficiency (P=.02). Conclusions These findings suggest that the use of a mobile app–delivered CBTI is feasible and beneficial for improving sleep outcomes in veterans with insomnia, including those with comorbid conditions such as posttraumatic stress disorder or mild-to-moderate sleep apnea. Trial Registration ClinicalTrials.gov NCT03305354; https://clinicaltrials.gov/ct2/show/NCT03305354

Understanding the research on tracking, diagnosing, and intervening in sleep disorders using mHealth apps: Bibliometric analysis and systematic reviews

“…Additionally, approximately 50% of the studies did not provide names, and the remaining articles studied 185 sleep mHealth apps that provided names, as shown in Figure 13 . The CBT-I Coach 37 – 42 is the most popular app, followed by SnoreLab and Calm.…”

Veteran Acceptance of Sleep Health Information Technology: a Mixed-Method Study

“…Sample 1 examined sleep outcomes from pre- to post-intervention of sleep HITs (Reilly et al, 2019 ). Sample 2 extended the work of Sample 1 and added a physical activity intervention (Reilly et al, 2021 ). Similarities and differences between the two are described in greater detail below.…”

“…In Sample 1, 50 veterans were assessed, 38 were enrolled, 18 were withdrawn due to sleep apnea, and 11 completed the full study (8 with mild sleep apnea; Reilly et al, 2019 ). In Sample 2, 48 veterans were assessed, 33 enrolled, 2 were withdrawn due to severe sleep apnea, and 26 completed (16 with mild or moderate sleep apnea; Reilly et al, 2021 ). Full information on participant inclusion and attrition has been previously published for each sample (Reilly et al, 2019 , 2021 ).…”

“…In Sample 2, 48 veterans were assessed, 33 enrolled, 2 were withdrawn due to severe sleep apnea, and 26 completed (16 with mild or moderate sleep apnea; Reilly et al, 2021 ). Full information on participant inclusion and attrition has been previously published for each sample (Reilly et al, 2019 , 2021 ). For both studies, participants were compensated $15 for each of the first two visits and $40 for the final visit for a total of $70 for study completion.…”

“…Participants in this study were not instructed to use the Fitbit to track sleep. Methods and primary clinical outcomes of Sample 1 and Sample 2 are reported respectively in Reilly et al ( 2019 , 2021 ). Both studies were approved by the Institutional Review Board of the VA Bedford Healthcare System.…”