Telehealth-Delivered Cognitive Behavioral Therapy for Insomnia in Individuals with Multiple Sclerosis: A Pilot Study

Abstract

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.

Cognitive Behavioral Therapy for Insomnia Improves Sleep Outcomes in Individuals With Concussion: A Preliminary Randomized Wait-List Control Study

“…Our results indicate that CBT-I improved insomnia symptoms and sleep quality in people with concussion and align with other studies demonstrating a treatment effect using CBT-I in neurologic populations. [11][12][13] Individuals with multiple sclerosis experienced a reduction in insomnia symptoms and improvement in sleep quality, depression, and anxiety after completing a digital, telehealth, or in-person CBT-I intervention 11,12,36 ; individuals with Parkinson's disease experienced improvement in insomnia symptoms following a digital CBT-I program. 13 In addition, the high rate of clinically meaningful change provides further support that CBT-I is an effective intervention to improve insomnia severity, sleep quality, and postconcussion symptoms in individuals with postconcussion insomnia.…”

“…CBT-I is effective in treating insomnia in the general population8–10 as well as people with neurological conditions including multiple sclerosis11,12 and Parkinson’s disease,13 yet evidence is limited in individuals with concussion. A recent scoping review indicates CBT is beneficial for individuals with a traumatic brain injury (including concussion) and has potential to reduce concomitant symptoms 14.…”

The Role of Sleep in Multiple Sclerosis

“…Cognitive Behavioural Therapy for Insomnia (CBT-I) promotes healthy habits on sleep-related behaviours and suggests strategies to improve psychological processes and cognitive distortions that may contribute to persistent insomnia. There is well established evidence that has shown the effectiveness of CBT-I in cases of insomnia [263][264][265][266][267]. Recent data suggest that this approach is also useful in MS patients who also experience psychological comorbidities, such as, for example, depressive states [268].…”