We know CBT-I works, now what?

Muench, Alexandria; Vargas, Iván; Grandner, Michael; Ellis, Jason; Posner, Donn; Bastien, Célyne; Drummond, S; Perlis, Michael L.

doi:10.12703/r/11-4

Cited by 48 publications

(25 citation statements)

References 142 publications

(155 reference statements)

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“…Cognitive Behavioral Therapy for insomnia (CBT-I) is generally considered the first line therapy for primary and comorbid insomnia. 6 Of relevance to the current study, a handful of publications report the use of various types of acoustic stimulation in clinical trials for insomnia. This includes music, 44 white noise, 45 and vibroacoustic stimulation.…”

Section: Discussionmentioning

confidence: 99%

Cereset Research Standard Operating Procedures for Insomnia: A Randomized, Controlled Clinical Trial

Tegeler

Clary

Shaltout

et al. 2023

Global Advances in Integrative Medicine and Health

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Background Interventions for insomnia that also address autonomic dysfunction are needed. Objective We evaluate Cereset Research™ Standard Operating Procedures (CR-SOP) in a pilot randomized, controlled trial. CR-SOP is a less operator-dependent, more generalizable innovation of HIRREM®, a noninvasive, closed-loop, allostatic, acoustic stimulation neurotechnology demonstrated to improve insomnia and autonomic function. Methods Adults with Insomnia Severity Index (ISI) scores of ≥8 were randomized to receive ten sessions of CR-SOP, with tones linked to brainwaves (LB, intervention), or a sham condition of random tones not linked to brainwaves (NL, control). Measures were collected at enrollment and 0-14 days and 4-6 weeks post-allocated intervention. The primary outcome was differential change in ISI from baseline to 4-6 weeks post-intervention. Secondary self-report measures assessed sleep quality65 and behavioral outcomes. Ten-minute recordings of heart rate and blood pressure were collected to analyze autonomic function (heart rate variability [HRV] and baroreflex sensitivity). Results Of 22 randomized, 20 participants completed the allocated condition. Intention to treat analysis of change from baseline to the 4-6 week outcome demonstrated mean ISI score reduction of 4.69 points among controls (SE 1.40). In the intervention group, there was an additional 2.58 point reduction in ISI score (SE 2.13; total reduction of 7.27, P = .24). Sleep quality and some measures of autonomic function improved significantly among the intervention group compared to control. Conclusions This pilot study compared use of a standardized, allostatic, acoustic neurotechnology intervention with a sham, active control condition. The magnitude of change in insomnia severity was clinically relevant and similar to the findings in a prior, fully powered trial, but the differential improvement observed was not statistically significant. Significant improvements were demonstrated in sleep quality and some autonomic function measures.

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Section: Discussionmentioning

confidence: 99%

Cereset Research Standard Operating Procedures for Insomnia: A Randomized, Controlled Clinical Trial

Tegeler

Clary

Shaltout

et al. 2023

Global Advances in Integrative Medicine and Health

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“…Given their reliance on easily understandable sleep-related variables derived from ISI and PSQI responses and frequently reported in outcome studies [ 63 , 64 ], our subtypes might be an aid to tailor the delivery of evidence-based treatments such as cognitive behavioral therapy for insomnia (CBT-I) [ 65 , 66 , 67 ] consistently with the stepped-care approach proposed by Rybarczyk and Mack [ 68 ]. For example, those in the SI profile might require full, multicomponent CBT-I with particular emphasis on the cognitive therapy component to manage sleep-related distress and worry, and possible psychological comorbidity should be evaluated and addressed with these patients.…”

Section: Discussionmentioning

confidence: 99%

Sleep Quality and Insomnia Severity among Italian University Students: A Latent Profile Analysis

Carpi

Marques

Milanese

et al. 2022

JCM

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Insomnia is a widespread sleep disorder associated with physical and mental health conditions. Although the heterogeneity of insomnia presentations has been acknowledged, research investigating clinically meaningful insomnia subtypes is still ongoing. This study aimed at exploring insomnia subtypes according to widely-used measures of symptoms severity and sleep quality among Italian university students using a latent profile analysis. Data were collected from 490 students reporting relevant insomnia symptoms through an online cross-sectional survey comprising the Insomnia Severity Index, the Pittsburgh Sleep Quality Index, the 21-item Depression Anxiety Stress Scale, and the Short Form-12. Latent profile analysis identified five insomnia subtypes. The severe insomnia (8.8%) group showed the highest insomnia severity, with diverse complaints concerning sleep quality and daytime functioning. Moderate insomnia with sleep duration complaints (8.4%) and moderate insomnia with medication use (15.9%) subgroups were characterized by middle range insomnia severity, with problems of sleep continuity and sleep medication use, respectively. Subthreshold insomnia with sleep latency complaints (20.4%) and subthreshold insomnia (46.5%) groups showed attenuated insomnia symptoms. Higher psychological complaints and worse quality of life were associated with greater sleep complaints. Overall, these findings highlight the relevance of sleep quality domains in identifying insomnia subtypes and might help optimize insomnia treatments.

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“…10,11 Muench and colleagues offer a review of the efficacy and treatment changes, including treatment effects of about 50% reduction in symptoms severity in a variety of settings and in various demographic groups. 12 In fact, a preference for CBT-I or other behavioral therapies over medication as initial therapy has been endorsed in the following clinical practice guidelines: The American Academy of Sleep Medicine, 13 The British Association for Psychopharmacology, 14 The American College of Physicians, 15,16 and The European Sleep Research Society. 17 Despite the recommendations and evidence for CBT-I as a first line treatment for insomnia, many barriers exist to getting this treatment to patients.…”

Section: Evidence and Accessmentioning

confidence: 99%

“…Treatment has proven effective in a variety of settings and effects are still present at 3-month follow-up. 12 Additionally, referring clinicians themselves may be a barrier due to a lack of training in CBT-I techniques, as well as their biases that patients would be reluctant to engage in CBT-I and would prefer medication. 19 For these and other reasons, insomnia is most often treated in primary care clinics by medical providers using pharmacologic interventions.…”

Section: Cognitive Behavioral Therapy For Insomniamentioning

confidence: 99%

Cognitive-behavioral therapy for insomnia for primary care: Review of components and application for residents in primary care

Traupman

Dixon

2022

Int J Psychiatry Med

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Healthy sleep patterns are a significant component of good physical and mental health. Quality sleep can be affected by such things as stress, age, pregnancy, physical health problems, and shift work. Behaviors related to sleep problems can be one of three types: predisposing, precipitating, and perpetuating. Additionally, cognitive processes related to sleep quality tend to be predominated by sleep thinking or insomnia thinking. Multiple medical organizations promote Cognitive Behavioral Therapy for Insomnia as a best practice for clinical management of sleep problems and disorders. Cognitive Behavioral Therapy for Insomnia consists of five components aimed at addressing both the behavioral and cognitive impediments to high quality sleep. These components are sleep hygiene, relaxation, sleep restriction, stimulus control, and cognitive therapy. This paper will address each component, as well as provide a patient education pattern well suited for primary care settings.

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We know CBT-I works, now what?

Cited by 48 publications

References 142 publications

Cereset Research Standard Operating Procedures for Insomnia: A Randomized, Controlled Clinical Trial

Cereset Research Standard Operating Procedures for Insomnia: A Randomized, Controlled Clinical Trial

Sleep Quality and Insomnia Severity among Italian University Students: A Latent Profile Analysis

Cognitive-behavioral therapy for insomnia for primary care: Review of components and application for residents in primary care

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