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Rowan AB, Magnante AT, Urh N, Figueroa L. Cognitive Behavioral Therapy for Insomnia Self-Management Mobile Apps: A Review of Efficacy and Quality. J Clin Psychol Med Settings 2024:10.1007/s10880-023-09992-y. [PMID: 38281307 DOI: 10.1007/s10880-023-09992-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/04/2023] [Indexed: 01/30/2024]
Abstract
Cognitive behavioral therapy for insomnia (CBT-I) is the recommended treatment for insomnia, yet multiple barriers limit utilization. Digital CBT-I may present a solution, though related reviews have focused on Internet-based delivery rather than app use. The high utilization of health apps and prevalence of sleep apps indicate the need to equip clinicians with app-specific research. Toward this end, we reviewed efficacy and quality data on self-management CBT-I smartphone apps, revealing efficacy research on eleven apps, five of which were publicly available. While preliminary, these efficacy studies showed consistent positive findings. When examining quantitative quality indicators for the five publicly available apps, two had consistent data. Overall, two apps, CBTi Coach and Insomnia Coach, had positive, empirical findings across all efficacy and quality assessment approaches. We provide recommendations to guide clinician decision making regarding CBT-I self-management apps based on the literature and publicly available methods of app evaluations.
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Affiliation(s)
- Anderson B Rowan
- College of Health and Behavioral Sciences, Regent University, 1000 Regent University Drive, Virginia Beach, VA, 23464, USA.
| | - Anna T Magnante
- W. G. (Bill) Hefner VA Healthcare System, Salisbury, NC, USA
- VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, NC, USA
- Department of Neurology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Nicole Urh
- College of Health and Behavioral Sciences, Regent University, 1000 Regent University Drive, Virginia Beach, VA, 23464, USA
| | - Lynette Figueroa
- College of Health and Behavioral Sciences, Regent University, 1000 Regent University Drive, Virginia Beach, VA, 23464, USA
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2
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Lee Y, Kim I, Lee S, Yu S. Information and Communication Technology-Based Application for Cognitive Behavioral Therapy among Community-Dwelling Older Adults with Insomnia: Development and Validation Study. Healthcare (Basel) 2024; 12:106. [PMID: 38201011 PMCID: PMC10778576 DOI: 10.3390/healthcare12010106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 12/21/2023] [Accepted: 12/27/2023] [Indexed: 01/12/2024] Open
Abstract
This study developed an information and communication technology-based mobile application to administer cognitive behavioral therapy to community-dwelling older adults with insomnia. First, the content of the application was determined through a systematic review and preference survey. Preference data on the perception, needs, and preference for non-face-to-face service content were collected from 15 July 2021 to 31 August 2021 from 100 community-dwelling older adults aged 65 years and older. In the design stage, the structure and function of the application were determined, and an interface was designed. The application was developed in conjunction with design experts and programmers using Android Studio software (Android 9). Usability tests were conducted during the implementation stage, followed by an evaluation stage. The evaluation revealed that the application's structure and functions should comprise sleep information, sleep-habit improvement, sleep assistance, video, real-time counseling, and exercise services. These elements were finalized after receiving the results of a preference analysis and advice from an advisory panel of experts in different fields. The developed application was rated with a score of four or higher in all areas. This study successfully developed, implemented, and evaluated a new mobile application called Smart Sleep for community-dwelling older adults with insomnia.
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Affiliation(s)
- Yeonhee Lee
- Department of Nursing Science, College of Nursing, Gachon University, Incheon 21936, Republic of Korea;
| | - Inseong Kim
- Health Insurance Review & Assessment Service, Wonju-si 26465, Republic of Korea;
| | - Seonheui Lee
- Department of Nursing Science, College of Nursing, Gachon University, Incheon 21936, Republic of Korea;
| | - Soyoung Yu
- College of Nursing, CHA University, Pocheon 11160, Republic of Korea
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3
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Thorshov TC, Øverby CT, Hansen DD, Bong WK, Skifjeld K, Hurlen P, Dammen T, Moen A, Hrubos-Strøm H. Experience with the use of a digital sleep diary in symptom management by individuals with insomnia -a pilot mixed method study. Sleep Med X 2023; 6:100093. [PMID: 38162592 PMCID: PMC10757200 DOI: 10.1016/j.sleepx.2023.100093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 11/01/2023] [Accepted: 11/08/2023] [Indexed: 01/03/2024] Open
Abstract
Background Insomnia is the most common sleep disorder. The recommended treatment is cognitive behavioural therapy for insomnia (CBTi). A sleep diary is a core tool in CBTi. We have developed a digital sleep diary with a standardised feedback function. Aim To study feasibility of the digital sleep diary in participants of the Akershus Sleep Apnea (ASAP) cohorts with difficulties falling asleep or maintaining sleep. To describe sleep diary engagement and explore experiences with the digital sleep diary with potential influences in insomnia symptom management. Material and methods Twenty participants were recruited from the ASAP. All filled out a digital sleep diary up to 12 weeks. Treatment options provided were a self-help book (N = 11) or electroencephalography neurofeedback (N = 9) in addition to the sleep diary standardised feedback function. We collected quantitative data from the sleep diary reports and we sub-divided insomnia by sleep onset insomnia and non-sleep onset insomnia. Finally, we performed qualitative interviews. Results The median number of entries to the sleep diary was 81 (25th quartile: 26, 75th quartile 84). In the qualitative analysis, we identified two main themes; "structure and overview" and "usability and digital features". Conclusion The sleep diary was found to be feasible when distributed in combination with a self-help book or electroencephalography neurofeedback. The qualitative results emphasised the importance of a timely graphical overview and visualisations of self-recorded sleep.
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Affiliation(s)
- Thea Christine Thorshov
- Division of Surgery, Department of Otorhinolaryngology, Akershus University Hospital, Lørenskog, Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Norway
| | - Caroline Tonje Øverby
- Division of Surgery, Department of Otorhinolaryngology, Akershus University Hospital, Lørenskog, Norway
- Faculty of Medicine, Institute of Clinical Medicine, Campus Ahus, University of Oslo, Norway
| | - Diana Dobran Hansen
- Division of Surgery, Department of Otorhinolaryngology, Akershus University Hospital, Lørenskog, Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Norway
| | - Way Kiat Bong
- Faculty of Technology, Art and Design, Department of Computer Science, Human-Computer Interaction and Universal Design of ICT, Oslo Metropolitan University, Oslo, Norway
| | | | - Petter Hurlen
- Division of Clinical Informatics, Department of Diagnostics and Technology, Akershus University Hospital, Lørenskog, Norway
| | - Toril Dammen
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Norway
- Department of Research and Innovation, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Anne Moen
- Faculty of Medicine, Institute of Health and Society, Department of Nursing Science, University of Oslo, Norway
| | - Harald Hrubos-Strøm
- Division of Surgery, Department of Otorhinolaryngology, Akershus University Hospital, Lørenskog, Norway
- Faculty of Medicine, Institute of Clinical Medicine, Campus Ahus, University of Oslo, Norway
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Nazem S, Barnes SM, Forster JE, Hostetter TA, Monteith LL, Kramer EB, Gaeddert LA, Brenner LA. Efficacy of an Internet-Delivered Intervention for Improving Insomnia Severity and Functioning in Veterans: Randomized Controlled Trial. JMIR Ment Health 2023; 10:e50516. [PMID: 37999953 DOI: 10.2196/50516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 09/26/2023] [Accepted: 10/06/2023] [Indexed: 11/25/2023] Open
Abstract
BACKGROUND Despite a growing evidence base that internet-delivered cognitive behavioral therapy for insomnia (iCBT-I) is associated with decreased insomnia severity, its efficacy has been minimally examined in veterans. OBJECTIVE The objective of this study was to evaluate the efficacy of an unguided iCBT-I (Sleep Healthy Using the Internet [SHUTi]) among veterans. METHODS We conducted a single-blind, randomized controlled trial in Operation Enduring Freedom, Operation Iraqi Freedom, and Operation New Dawn veterans eligible for Veterans Health Administration care. Participants were randomly assigned (1:1) to receive SHUTi (a self-guided and interactive program) or an Insomnia Education Website (IEW) that provided nontailored and fixed insomnia information. Web-based assessments were administered at baseline, postintervention, 6 months postintervention, and 1 year postintervention. The primary outcome was self-reported insomnia severity (Insomnia Severity Index [ISI]). Secondary outcomes were self-reported mental and physical health functioning (Veterans RAND 36-item Health Survey). Exploratory outcomes comprised sleep diary parameters. RESULTS Of the 231 randomized participants (mean age 39.3, SD 7.8 years; 170/231, 73.5% male sex; 26/231, 11.3% Black; 172/231, 74.5% White; 10/231, 4.3% multiracial; and 17/231, 7.4% other; 36/231, 15.6% Hispanic) randomized between April 2018 and January 2019, a total of 116 (50.2%) were randomly assigned to SHUTi and 115 (49.8%) to the IEW. In intent-to-treat analyses, SHUTi participants experienced significantly larger ISI decreases compared with IEW participants at all time points (generalized η2 values of 0.13, 0.12, and 0.10, respectively; all P<.0001). These corresponded to estimated larger differences in changes of -3.47 (95% CI -4.78 to -2.16), -3.80 (95% CI -5.34 to -2.27), and -3.42 (95% CI -4.97 to 1.88) points on the ISI for the SHUTi group. SHUTi participants experienced significant improvements in physical (6-month generalized η2=0.04; P=.004) and mental health functioning (6-month and 1-year generalized η2=0.04; P=.009 and P=.005, respectively). Significant sleep parameter improvements were noted for SHUTi (all P<.05), though the pattern and magnitude of these reductions varied by parameter. No adverse events were reported. CONCLUSIONS Self-administered iCBT-I was associated with immediate and long-term improvements in insomnia severity. Findings suggest that leveraging technology to meet insomnia treatment demands among veterans may be a promising approach. TRIAL REGISTRATION ClinicalTrials.gov NCT03366870; https://clinicaltrials.gov/ct2/show/NCT03366870.
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Affiliation(s)
- Sarra Nazem
- Dissemination & Training Division, National Center for Posttraumatic Stress Disorder, Menlo Park, CA, United States
- Veterans Affairs Rocky Mountain Mental Illness Research, Education and Clinical Center, Aurora, CO, United States
| | - Sean M Barnes
- Veterans Affairs Rocky Mountain Mental Illness Research, Education and Clinical Center, Aurora, CO, United States
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Jeri E Forster
- Veterans Affairs Rocky Mountain Mental Illness Research, Education and Clinical Center, Aurora, CO, United States
- Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Trisha A Hostetter
- Veterans Affairs Rocky Mountain Mental Illness Research, Education and Clinical Center, Aurora, CO, United States
| | - Lindsey L Monteith
- Veterans Affairs Rocky Mountain Mental Illness Research, Education and Clinical Center, Aurora, CO, United States
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
- Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Emily B Kramer
- Veterans Affairs Rocky Mountain Mental Illness Research, Education and Clinical Center, Aurora, CO, United States
| | - Laurel A Gaeddert
- Veterans Affairs Rocky Mountain Mental Illness Research, Education and Clinical Center, Aurora, CO, United States
| | - Lisa A Brenner
- Veterans Affairs Rocky Mountain Mental Illness Research, Education and Clinical Center, Aurora, CO, United States
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
- Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
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5
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Wickwire EM, Collen J, Capaldi VF, Williams SG, Assefa SZ, Adornetti JP, Huang K, Venezia JM, Jones RL, Johnston CW, Thomas C, Thomas MA, Mounts C, Drake CL, Businelle MS, Grandner MA, Manber R, Albrecht JS. Patient Engagement and Provider Effectiveness of a Novel Sleep Telehealth Platform and Remote Monitoring Assessment in the US Military: Pilot Study Providing Evidence-Based Sleep Treatment Recommendations. JMIR Form Res 2023; 7:e47356. [PMID: 37971788 PMCID: PMC10690521 DOI: 10.2196/47356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 09/07/2023] [Accepted: 09/11/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Sleep problems are common and costly in the US military. Yet, within the military health system, there is a gross shortage of trained specialist providers to address sleep problems. As a result, demand for sleep medicine care far exceeds the available supply. Telehealth including telemedicine, mobile health, and wearables represents promising approaches to increase access to high-quality and cost-effective care. OBJECTIVE The purpose of this study was to evaluate patient engagement and provider perceived effectiveness of a novel sleep telehealth platform and remote monitoring assessment in the US military. The platform includes a desktop web portal, native mobile app, and integrated wearable sensors (ie, a commercial off-the-shelf sleep tracker [Fitbit]). The goal of the remote monitoring assessment was to provide evidence-based sleep treatment recommendations to patients and providers. METHODS Patients with sleep problems were recruited from the Internal Medicine clinic at Walter Reed National Military Medical Center. Patients completed intensive remote monitoring assessments over 10 days (including a baseline intake questionnaire, daily sleep diaries, and 2 daily symptom surveys), and wore a Fitbit sleep tracker. Following the remote monitoring period, patients received assessment results and personalized sleep education in the mobile app. In parallel, providers received a provisional patient assessment report in an editable electronic document format. Patient engagement was assessed via behavioral adherence metrics that were determined a priori. Patients also completed a brief survey regarding ease of completion. Provider effectiveness was assessed via an anonymous survey. RESULTS In total, 35 patients with sleep problems participated in the study. There were no dropouts. Results indicated a high level of engagement with the sleep telehealth platform, with all participants having completed the baseline remote assessment, reviewed their personalized sleep assessment report, and completed the satisfaction survey. Patients completed 95.1% of sleep diaries and 95.3% of symptom surveys over 10 days. Patients reported high levels of satisfaction with most aspects of the remote monitoring assessment. In total, 24 primary care providers also participated and completed the anonymous survey. The results indicate high levels of perceived effectiveness and identified important potential benefits from adopting a sleep telehealth approach throughout the US military health care system. CONCLUSIONS Military patients with sleep problems and military primary care providers demonstrated high levels of engagement and satisfaction with a novel sleep telehealth platform and remote monitoring assessment. Sleep telehealth approaches represent a potential pathway to increase access to evidence-based sleep medicine care in the US military. Further evaluation is warranted.
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Affiliation(s)
- Emerson M Wickwire
- Sleep Disorders Center, Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Jacob Collen
- Sleep Disorders Center, Walter Reed National Military Medical Center, Bethesda, MD, United States
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, United States
| | - Vincent F Capaldi
- Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, MD, United States
| | - Scott G Williams
- Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, MD, United States
| | - Samson Z Assefa
- Sleep Disorders Center, Fort Belvoir Community Hospital, Fort Belvoir, VA, United States
| | - Julianna P Adornetti
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Kathleen Huang
- Center for Military Psychiatry and Neuroscience, Behavioral Biology Branch, Walter Reed Army Institute of Research, Silver Spring, MD, United States
| | - Janet M Venezia
- Center for Military Psychiatry and Neuroscience, Behavioral Biology Branch, Walter Reed Army Institute of Research, Silver Spring, MD, United States
| | - Rachell L Jones
- Center for Military Psychiatry and Neuroscience, Behavioral Biology Branch, Walter Reed Army Institute of Research, Silver Spring, MD, United States
| | - Christine W Johnston
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Connie Thomas
- Center for Military Psychiatry and Neuroscience, Behavioral Biology Branch, Walter Reed Army Institute of Research, Silver Spring, MD, United States
| | - Mary Ann Thomas
- Sleep Disorders Center, Walter Reed National Military Medical Center, Bethesda, MD, United States
| | - Charles Mounts
- Sleep Disorders Center, Walter Reed National Military Medical Center, Bethesda, MD, United States
| | | | - Michael S Businelle
- TSET Health Promotion Research Center, Stephenson Cancer Center, Oklahoma City, OK, United States
| | - Michael A Grandner
- Department of Psychiatry, University of Arizona College of Medicine, Tucson, AZ, United States
| | - Rachel Manber
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Stanford University, Palo Alto, CA, United States
| | - Jennifer S Albrecht
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, United States
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6
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Kramer EB, Gaeddert LA, Jackson CL, Hostetter TA, Forster JE, Nazem S. The association among insomnia symptom severity, comorbid symptoms, and suicidal ideation in two veteran cohorts meeting diagnostic criteria for insomnia disorder. J Clin Psychol 2023; 79:1420-1433. [PMID: 36696685 DOI: 10.1002/jclp.23488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 12/15/2022] [Accepted: 01/10/2023] [Indexed: 01/26/2023]
Abstract
OBJECTIVE Examine the association between insomnia symptom severity and suicidal ideation (SI), after adjusting for clinical comorbidity in veterans meeting diagnostic criteria for insomnia disorder. METHODS Secondary data analyses of psychometrically validated baseline assessments of depression, posttraumatic stress disorder (PTSD), and anxiety symptoms from two online insomnia intervention randomized clinical trials (n = 232; n = 80) were conducted. Multiple linear regression was used to determine the association between insomnia symptom severity and SI, after controlling for clinical comorbidity and demographics. RESULTS Insomnia symptom severity was significantly correlated with comorbid depression, PTSD, and anxiety symptoms in both cohorts and significantly correlated with SI in one. After controlling for demographics and clinical comorbidity, insomnia symptom severity was not significantly associated with SI in linear regression models. CONCLUSION Findings extend insomnia-suicide research by providing evidence that insomnia symptom severity may not confer a unique risk for SI above comorbid mental health symptoms in veterans meeting diagnostic criteria for insomnia disorder.
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Affiliation(s)
- Emily B Kramer
- U.S. Department of Veterans Affairs, Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC), Aurora, Colorado, USA
| | - Laurel A Gaeddert
- U.S. Department of Veterans Affairs, Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC), Aurora, Colorado, USA
| | - Christine L Jackson
- U.S. Department of Veterans Affairs, Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC), Aurora, Colorado, USA
| | - Trisha A Hostetter
- U.S. Department of Veterans Affairs, Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC), Aurora, Colorado, USA
| | - Jeri E Forster
- U.S. Department of Veterans Affairs, Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC), Aurora, Colorado, USA.,Department of Physical Medicine and Rehabilitation, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Sarra Nazem
- U.S. Department of Veterans Affairs, Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC), Aurora, Colorado, USA.,U.S. Department of Veterans Affairs, National Center for PTSD, Dissemination & Training Division, Menlo Park, California, USA
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Nuo M, Fang H, Wang T, Liang J, He Y, Han H, Lei J. Understanding the research on tracking, diagnosing, and intervening in sleep disorders using mHealth apps: Bibliometric analysis and systematic reviews. Digit Health 2023; 9:20552076231165967. [PMID: 37051563 PMCID: PMC10084565 DOI: 10.1177/20552076231165967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 03/09/2023] [Indexed: 04/14/2023] Open
Abstract
Objectives In solving the global challenge of sleep disorders, Mobile Health app is one of the important means to monitor, diagnose, and intervene in sleep disorders. This study aims to (1) summarize the status and trends of research in this field; (2) assess the production and usage of sleep mHealth apps; (3) calculate the conversion rate of grants that the proportion of newly developed apps from being funded and developed to published on application stores. Methods Using bibliometric and content analysis methods, based on "Research Paper-Product Output-Product Application" chain and considering the "Research Grants" of articles, we conducted a systematic review of eight databases, to identify relevant studies over the last decade. Results Over the past decade, 1399 authors published 313 papers in 182 journals and conferences. The number of publications increased with an average annual growth of 41.6%. The current focus area is research using cognitive behavioral therapy to intervene in sleep. Sleep-staging tracking is a shortcoming of this field. A total 368 sleep mHealth apps (233 newly developed and 135 existing) were examined in 313 papers; 323 grants supported 178 articles (56.9%). Only 12 of the newly developed apps are used in the real world, resulting in a 9% grant conversion rate. Conclusions In the last decade, the field of tracking, diagnosing, and intervening in sleep disorders using mHealth apps has shown a trend of rapid development. However, the conversion rate of products from being funded and developed for use by end-users is low.
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Affiliation(s)
- Mingfu Nuo
- Institute of Medical Technology, Health Science Center, Peking University, Beijing, China
| | - Hongjuan Fang
- Department of Endocrinology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Tong Wang
- Department of Medical Informatics, School of Public Health, Jilin University, Changchun, China
| | - Jun Liang
- IT Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- School of Public Health, Zhejiang University, Hangzhou, China
- Key Laboratory of Cancer Prevention and Intervention, China National Ministry of Education, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yunfan He
- School of Public Health, Zhejiang University, Hangzhou, China
| | - Hongbin Han
- Institute of Medical Technology, Health Science Center, Peking University, Beijing, China
- Department of Radiology, Peking University Third Hospital, Health Science Center, Peking University, Beijing, China
| | - Jianbo Lei
- Institute of Medical Technology, Health Science Center, Peking University, Beijing, China
- Center for Medical Informatics, Health Science Center, Peking University, Beijing, China
- School of Medical Informatics and Engineering, Southwest Medical University, Luzhou, China
- Jianbo Lei, Institute of Medical Technology, Health Science Center, Peking University, 38 Xueyuan Rd, Haidian District, Beijing, China.
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8
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Yamamoto M, Lim CT, Huang H, Spottswood M, Huang H. Insomnia in primary care: Considerations for screening, assessment, and management. THE JOURNAL OF MEDICINE ACCESS 2023; 7:27550834231156727. [PMID: 36938324 PMCID: PMC10021100 DOI: 10.1177/27550834231156727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 01/25/2023] [Indexed: 03/17/2023]
Abstract
Insomnia, including insomnia disorder, is a common but often overlooked complaint in primary care settings. It is a risk factor for various medical and psychiatric diagnoses and is associated with substantial health care costs. While cognitive behavioral therapy for insomnia (CBT-I) is the first-line treatment for insomnia disorder, access to CBT-I is limited. This article provides a pragmatic approach to screening, assessment, and treatment of insomnia in the primary care setting, promoting a population health approach. The authors review the role of CBT-I, treatment of comorbid conditions, and pharmacologic recommendations in working with primary care patients with insomnia. In addition, the authors highlight the potential utility of technology in improving access to insomnia care.
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Affiliation(s)
- Mari Yamamoto
- Department of Family Medicine,
University of Washington School of Medicine, Seattle, WA, USA
- Mari Yamamoto, Department of Family
Medicine, University of Washington School of Medicine, Seattle, WA 98125, USA.
| | - Christopher T Lim
- Department of Psychiatry, Boston
Medical Center, Boston University School of Medicine, Boston, MA, USA
| | - Heather Huang
- Departments of Internal Medicine and
Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison,
WI, USA
| | - Margaret Spottswood
- Department of Psychiatry, University of
Vermont College of Medicine, Burlington, VT, USA
- Community Health Centers of Burlington,
Burlington, VT, USA
| | - Hsiang Huang
- Department of Psychiatry, Cambridge
Health Alliance, Cambridge, MA, USA
- Harvard Medical School, Boston, MA,
USA
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9
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Kaitz J, Robinson SA, Petrakis BA, Reilly ED, Chamberlin ES, Wiener RS, Quigley KS. Veteran Acceptance of Sleep Health Information Technology: a Mixed-Method Study. JOURNAL OF TECHNOLOGY IN BEHAVIORAL SCIENCE 2022; 8:57-68. [PMID: 36530383 PMCID: PMC9745770 DOI: 10.1007/s41347-022-00287-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 10/07/2022] [Accepted: 10/27/2022] [Indexed: 12/14/2022]
Abstract
Sleep disturbances, including chronic insomnia and sleep apnea, are major concerns for US veterans, with rising rates and detrimental effects on physical, mental, and social well-being. Sleep disturbances in veterans are also underdiagnosed and undertreated for reasons that include limited sleep clinician availability, long wait times, and the time commitment for treatment. Greater use of sleep health information technologies could improve access to assessment and treatment of sleep disturbances. However, the assessment of acceptance of these technologies among veterans is still ongoing. This mixed-method study combines data from two separate but similar randomized controlled trials to assess acceptance of sleep health information technologies for veterans with chronic insomnia. Sleep health information technologies included in these trials were the following: (1) a WatchPAT sleep monitor for home-based sleep assessment, including detection of sleep apnea, and (2) the VA mobile app Cognitive Behavioral Therapy for Insomnia (CBT-i Coach), which supports self-management of insomnia. The combined sample of 37 veterans receiving care within one New England VA medical center completed a six-week trial using both health information technology tools. Participants completed a survey and interview at the end of the 6 weeks. Overall, participants found the tools acceptable, easy to use, and useful and reported they would use them in the future. Thus, these sleep health information technologies appear to provide an acceptable remote option for assessing and managing sleep issues for veterans. ClinicalTrials.gov NCT02392000; http://clinicaltrials.gov/ct2/show/NCT02392000 and ClinicalTrials.gov NCT03305354; https://clinicaltrials.gov/ct2/show/NCT03305354.
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Affiliation(s)
- Jenesse Kaitz
- CHOIR/Bedford VA Center for Healthcare Organization and Implementation Research (CHOIR), Bedford Healthcare System, Bedford, MA USA
| | - Stephanie A. Robinson
- CHOIR/Bedford VA Center for Healthcare Organization and Implementation Research (CHOIR), Bedford Healthcare System, Bedford, MA USA
- The Pulmonary Center, Boston University School of Medicine, Boston, MA USA
| | - Beth Ann Petrakis
- CHOIR/Bedford VA Center for Healthcare Organization and Implementation Research (CHOIR), Bedford Healthcare System, Bedford, MA USA
| | - Erin D. Reilly
- Mental Illness Research, Education, and Clinical Center (MIRECC), Bedford Healthcare System, Bedford, USA
- University of Massachusetts Medical School, Worcester, MA USA
| | - Elizabeth S. Chamberlin
- Geriatric Research Education and Clinical Center (GRECC), Bedford Healthcare System, Bedford, MA USA
| | - Renda Soylemez Wiener
- The Pulmonary Center, Boston University School of Medicine, Boston, MA USA
- Center for Healthcare Organization & Implementation Research and Medical Service, Boston Healthcare System, Boston, MA USA
| | - Karen S. Quigley
- Department of Psychology, Northeastern University, Boston, MA USA
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10
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Morgenthaler TI, Kolla BP, Anderson SE, Wahl A, Clark P, Smith JM, Luedke TC, McColley S, Phillips SA, Harper SB, Boudreau NB, Monson AJ. Development and acceptability of a mobile health application integrated with the electronic heath record for treatment of chronic insomnia disorder. J Clin Sleep Med 2022; 18:2785-2792. [PMID: 35959953 PMCID: PMC9713915 DOI: 10.5664/jcsm.10218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 07/19/2022] [Accepted: 07/20/2022] [Indexed: 12/14/2022]
Abstract
STUDY OBJECTIVES To describe the development and feasibility of a cognitive behavioral therapy for insomnia (CBT-I) program delivered via personal digital devices and fully integrated with the electronic health record (EHR). METHODS A multidisciplinary team of clinicians and members of our Center for Digital Health collaborated to develop a Chronic Insomnia Interactive Care Plan (ChI-ICP), an application that provides personalized and just in time education and promotes self-management using CBT-I concepts, and is activated from and fully integrated into the EHR. Following development, we evaluated patient engagement and workflows, assessed changes to provider workload, and examined outcomes on measures of insomnia during a pilot deployment of the application. RESULTS A total of 222 patients were enrolled and 179 engaged with the plan during the 3-month pilot program. Enrolled patients generated an average of 3.9 ± 2.3 In Basket messages, most being automated notifications related to noncompletion of assigned tasks, while only a few were related to patients requesting additional training or help with insomnia. Sleep efficiency improved from baseline until the completion of the program from 74.5% ± 16.7% to 87.6% ± 10.8% (P = .001), and the Insomnia Severity Index improved from 14.9 ± 5.22 to 11.6 ± 4.80 (P = .006). CONCLUSIONS In this pilot implementation of an integrated ChI-ICP, patient engagement was favorable, workflows and workload were not significantly burdensome for the care teams, and initial evaluation of efficacy was favorable. This provides evidence for an application that is a scalable method to assist patients with chronic insomnia and future work should assess its efficacy in controlled trials. CITATION Morgenthaler TI, Kolla BP, Anderson SE, et al. Development and acceptability of a mobile health application integrated with the electronic heath record for treatment of chronic insomnia disorder. J Clin Sleep Med. 2022;18(12):2785-2792.
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Affiliation(s)
- Timothy I. Morgenthaler
- Center for Sleep Medicine, Mayo Clinic, Rochester, Minnesota
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota
| | - Bhanu Prakash Kolla
- Center for Sleep Medicine, Mayo Clinic, Rochester, Minnesota
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota
| | - Sandra E. Anderson
- Center for Sleep Medicine, Mayo Clinic, Rochester, Minnesota
- Department of Nursing, Mayo Clinic, Rochester, Minnesota
| | - Adam Wahl
- Center for Sleep Medicine, Mayo Clinic, Rochester, Minnesota
- Department of Nursing, Mayo Clinic, Rochester, Minnesota
| | - Patrick Clark
- Center for Sleep Medicine, Mayo Clinic, Rochester, Minnesota
- Department of Nursing, Mayo Clinic, Rochester, Minnesota
| | - Justin M. Smith
- Department of Nursing, Mayo Clinic, Rochester, Minnesota
- Center for Digital Health, Mayo Clinic, Rochester, Minnesota
| | | | - Samantha McColley
- Clinical Informatics and Practice Support, Mayo Clinic, Rochester, Minnesota
| | | | - Sarah B. Harper
- Center for Digital Health, Mayo Clinic, Rochester, Minnesota
| | - Nancy B. Boudreau
- Health Education and Content Services, Mayo Clinic, Rochester, Minnesota
| | - Amanda J. Monson
- Center for Sleep Medicine, Mayo Clinic, Rochester, Minnesota
- Department of Nursing, Mayo Clinic, Rochester, Minnesota
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11
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Knouse LE, Hu X, Sachs G, Isaacs S. Usability and feasibility of a cognitive-behavioral mobile app for ADHD in adults. PLOS DIGITAL HEALTH 2022; 1:e0000083. [PMID: 36812621 PMCID: PMC9931323 DOI: 10.1371/journal.pdig.0000083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 06/29/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Cognitive-behavioral therapy (CBT) has growing evidence of efficacy for Attention-Deficit/Hyperactivity Disorder (ADHD) in adults. Mobile health apps are promising tools for delivering scalable CBT. In a 7-week open study of Inflow, a CBT-based mobile app, we assessed usability and feasibility to prepare for a randomized controlled trial (RCT). METHOD 240 adults recruited online completed baseline and usability assessments at 2 (n = 114), 4 (n = 97) and after 7 weeks (n = 95) of Inflow use. 93 participants self-reported ADHD symptoms and impairment at baseline and 7 weeks. RESULTS Participants rated Inflow's usability favorably, used the app a median of 3.86 times per week, and a majority of those using the app for 7 weeks self-reported decreases in ADHD symptoms and impairment. CONCLUSION Inflow demonstrated usability and feasibility among users. An RCT will determine whether Inflow is associated with improvement among more rigorously assessed users and beyond non-specific factors.
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Affiliation(s)
- Laura E. Knouse
- Department of Psychology, University of Richmond, Richmond, Virginia, United States of America
- * E-mail:
| | - Xiaodi Hu
- Department of Psychology, University of Richmond, Richmond, Virginia, United States of America
- Master of Science in Human-Computer Interaction Program, College of Information Studies, University of Maryland, College Park, Maryland, United States of America
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12
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Kuhn E, Miller KE, Puran D, Wielgosz J, YorkWilliams SL, Owen JE, Jaworski BK, Hallenbeck HW, McCaslin SE, Taylor KL. A Pilot Randomized Controlled Trial of the Insomnia Coach Mobile App to Assess Its Feasibility, Acceptability, and Potential Efficacy. Behav Ther 2022; 53:440-457. [PMID: 35473648 DOI: 10.1016/j.beth.2021.11.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 11/09/2021] [Accepted: 11/11/2021] [Indexed: 11/19/2022]
Abstract
Insomnia is highly prevalent among military veterans but access to cognitive-behavioral therapy for insomnia (CBT-I) is limited. Thus, this study examined the feasibility, acceptability, and potential efficacy of Insomnia Coach, a CBT-I-based, free, self-management mobile app. Fifty U.S. veterans, who were mostly male (58%) and mean age 44.5 (range = 28-55) years with moderate insomnia symptoms were randomized to Insomnia Coach (n = 25) or a wait-list control condition (n = 25) for 6 weeks. Participants completed self-report measures and sleep diaries at baseline, posttreatment, and follow-up (12 weeks postrandomization), and app participants (n = 15) completed a qualitative interview at posttreatment. Findings suggest that Insomnia Coach is feasible to use, with three quarters of participants using the app through 6 weeks and engaging with active elements. For acceptability, perceptions of Insomnia Coach were very favorable based on both self-report and qualitative interview responses. Finally, for potential efficacy, at posttreatment, a larger proportion of Insomnia Coach (28%) than wait-list control participants (4%) achieved clinically significant improvement (p = .049) and there was a significant treatment effect on daytime sleep-related impairment (d = -0.6, p = .044). Additional treatment effects emerged at follow-up for insomnia severity (d = -1.1, p = .001), sleep onset latency (d = -0.6, p = .021), global sleep quality (d = -0.9, p = .002), and depression symptoms (d = -0.8, p = .012). These findings provide preliminary evidence that among veterans with moderate insomnia symptoms, a CBT-I-based self-management app is feasible, acceptable, and promising for improving insomnia severity and other sleep-related outcomes. Given the vast unmet need for insomnia treatment in the population, Insomnia Coach may provide an easily accessible, convenient public health intervention for individuals not receiving care.
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Affiliation(s)
- Eric Kuhn
- National Center for PTSD, VA Palo Alto Health Care System; Stanford University, School of Medicine.
| | - Katherine E Miller
- Mental Illness Research, Education and Clinical Center, Corporal Michael J. Crescenz Veterans Affairs Medical Center
| | - Deloras Puran
- National Center for PTSD, VA Palo Alto Health Care System
| | - Joseph Wielgosz
- National Center for PTSD, VA Palo Alto Health Care System; Stanford University, School of Medicine; Sierra Pacific Mental Illness Research, Education and Clinical Center, VA Palo Alto Health Care System
| | - Sophie L YorkWilliams
- National Center for PTSD, VA Palo Alto Health Care System; University of Colorado Boulder
| | - Jason E Owen
- National Center for PTSD, VA Palo Alto Health Care System
| | | | - Haijing Wu Hallenbeck
- National Center for PTSD, VA Palo Alto Health Care System; Stanford University School of Medicine
| | - Shannon E McCaslin
- National Center for PTSD, VA Palo Alto Health Care System; Stanford University School of Medicine
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13
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Arroyo AC, Zawadzki MJ. The Implementation of Behavior Change Techniques in mHealth Apps for Sleep: Systematic Review. JMIR Mhealth Uhealth 2022; 10:e33527. [PMID: 35377327 PMCID: PMC9132368 DOI: 10.2196/33527] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 12/21/2021] [Accepted: 01/07/2022] [Indexed: 01/19/2023] Open
Abstract
Background Mobile health (mHealth) apps targeting health behaviors using behavior change techniques (BCTs) have been successful in promoting healthy behaviors; however, their efficacy with sleep is unclear. Some work has shown success in promoting sleep through mHealth, whereas there have been reports that sleep apps can be adverse and lead to unhealthy obsessions with achieving perfect sleep. Objective This study aims to report and describe the use of BCTs in mHealth apps for sleep with the following research questions: How many BCTs are used on average in sleep apps, and does this relate to their effectiveness on sleep outcomes? Are there specific BCTs used more or less often in sleep apps, and does this relate to their effectiveness on sleep outcomes? Does the effect of mHealth app interventions on sleep change when distinguishing between dimension and measurement of sleep? Methods We conducted a systematic review following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines to review articles on mHealth app interventions for sleep published between 2010 and 2020. Results A total of 12 studies met the eligibility criteria. Most studies reported positive sleep outcomes, and there were no negative effects reported. Sleep quality was the most common dimension of sleep targeted. Subjective measures of sleep were used across all apps, whereas objective measures were often assessed but rarely reported as part of results. The average number of BCTs used was 7.67 (SD 2.32; range 3-11) of 16. Of the 12 studies, the most commonly used BCTs were feedback and monitoring (n=11, 92%), shaping knowledge (n=11, 92%), goals and planning (n=10, 83%), and antecedents (n=10, 83%), whereas the least common were scheduled consequences (n=0, 0%), self-belief (n=0, 0%), and covert learning (n=0, 0%). Most apps used a similar set of BCTs that unfortunately did not allow us to distinguish which BCTs were present when studies reported more positive outcomes. Conclusions Our study describes the peer-reviewed literature on sleep apps and provides a foundation for further examination and optimization of BCTs used in mHealth apps for sleep. We found strong evidence that mHealth apps are effective in improving sleep, and the potential reasons for the lack of adverse sleep outcome reporting are discussed. We found evidence that the type of BCTs used in mHealth apps for sleep differed from other health outcomes, although more research is needed to understand how BCTs can be implemented effectively to improve sleep using mHealth and the mechanisms of action through which they are effective (eg, self-efficacy, social norms, and attitudes).
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Affiliation(s)
- Amber Carmen Arroyo
- Department of Psychological Sciences, University of California, Merced, CA, United States
| | - Matthew J Zawadzki
- Department of Psychological Sciences, University of California, Merced, CA, United States
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14
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Al Mahmud A, Wu J, Mubin O. A scoping review of mobile apps for sleep management: User needs and design considerations. Front Psychiatry 2022; 13:1037927. [PMID: 36329917 PMCID: PMC9624283 DOI: 10.3389/fpsyt.2022.1037927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 09/28/2022] [Indexed: 11/17/2022] Open
Abstract
Sleep disorders are prevalent nowadays, leading to anxiety, depression, high blood pressure, and other health problems. Due to the proliferation of mobile devices and the development of communication technologies, mobile apps have become a popular way to deliver sleep disorder therapy or manage sleep. This scoping review aims to conduct a systematic investigation of mobile apps and technologies supporting sleep, including the essential functions of sleep apps, how they are used to improve sleep and the facilitators of and barriers to using apps among patients and other stakeholders. We searched articles (2010 to 2022) from Scopus, Web of Science, Science Direct, PubMed, and IEEE Xplore using the keyword sleep apps. In total, 1,650 peer-reviewed articles were screened, and 51 were selected for inclusion. The most frequently provided functions by the apps are sleep monitoring, measuring sleep, providing alarms, and recording sleep using a sleep diary. Several wearable devices have been used with mobile apps to record sleep duration and sleep problems. Facilitators and barriers to using apps were identified, along with the evidence-based design guidelines. Existing studies have proved the initial validation and efficiency of delivering sleep treatment by mobile apps; however, more research is needed to improve the performance of sleep apps and devise a way to utilize them as a therapy tool.
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Affiliation(s)
- Abdullah Al Mahmud
- Centre for Design Innovation, Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Jiahuan Wu
- School of Computer, Data and Mathematical Sciences, Western Sydney University, Penrith, NSW, Australia
| | - Omar Mubin
- School of Computer, Data and Mathematical Sciences, Western Sydney University, Penrith, NSW, Australia
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15
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Reilly ED, Robinson SA, Petrakis BA, Gardner MM, Wiener RS, Castaneda-Sceppa C, Quigley KS. Mobile Intervention to Improve Sleep and Functional Health of Veterans With Insomnia: Randomized Controlled Trial. JMIR Form Res 2021; 5:e29573. [PMID: 34889746 PMCID: PMC8704109 DOI: 10.2196/29573] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 10/22/2021] [Accepted: 10/28/2021] [Indexed: 01/14/2023] Open
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
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Affiliation(s)
- Erin Dawna Reilly
- Mental Illness Research, Education, and Clinical Center, VA Bedford Healthcare System, Bedford, MA, United States.,Social and Community Reintegration Research, VA Bedford Healthcare System, Bedford, MA, United States.,University of Massachusetts Medical School, Worcester, MA, United States
| | - Stephanie A Robinson
- Center for Healthcare Outcomes and Implementation Research, VA Bedford Healthcare System, Bedford, MA, United States.,Pulmonary Division, Boston University School of Medicine, Boston, MA, United States
| | - Beth Ann Petrakis
- Center for Healthcare Outcomes and Implementation Research, VA Bedford Healthcare System, Bedford, MA, United States
| | | | - Renda Soylemez Wiener
- Center for Healthcare Outcomes and Implementation Research, VA Bedford Healthcare System, Bedford, MA, United States.,Pulmonary Division, Boston University School of Medicine, Boston, MA, United States
| | | | - Karen S Quigley
- Social and Community Reintegration Research, VA Bedford Healthcare System, Bedford, MA, United States.,Center for Healthcare Outcomes and Implementation Research, VA Bedford Healthcare System, Bedford, MA, United States.,Northeastern University, Boston, MA, United States
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16
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Sun J, McPhillips MV, Chen KC, Zang Y, Li J, Oehlke J, Brewster GS, Gooneratne NS. Primary care provider evaluation and management of insomnia. J Clin Sleep Med 2021; 17:1083-1091. [PMID: 33576737 DOI: 10.5664/jcsm.9154] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES To evaluate the type and extent of information collected from patients with insomnia during their first office encounter for insomnia and the prescribing therapies of primary care providers during this initial encounter. METHODS This study was a retrospective chart review of randomly selected patients who had a primary care provider office visit at any clinic affiliated with a university medical system between March 1, 2013, and March 1, 2016. Demographic and clinical information was abstracted for analysis. RESULTS Our sample (n = 200) was primarily female (63.5%), White (69%), middle-aged (ages 44.6 ± 15.1 years) adults. Most (68.5%) encounter notes did not have significant information related to insomnia risk factors and symptoms (< 50% of the notes). When examining comorbidities, we found that younger patients (<45 years old) were more likely to have anxiety linked to insomnia (P = .025), whereas older patients (≥45) were less likely to have any identified comorbidities associated with insomnia (P = .009). Only 5.0% of patients with insomnia were referred for cognitive-behavioral therapy for insomnia, whereas 51.5% of patients were prescribed sleep medications. The younger cohort was statistically more likely to receive sleep hygiene or cognitive-behavioral therapy for insomnia as a treatment option in comparison to the older cohort (P = .01 and P = .04, respectively). CONCLUSIONS Progress notes from primary care providers tend to have a paucity of information on insomnia symptoms and related comorbidities. Medications are often prescribed as the first-line treatment for insomnia. Cognitive-behavioral therapy for insomnia remains underutilized despite robust evidence suggesting that cognitive-behavioral therapy for insomnia is a safe and effective treatment for insomnia.
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Affiliation(s)
- Joy Sun
- Division of Geriatric Medicine, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Miranda V McPhillips
- Center for Sleep and Respiratory Neurobiology and Division of Sleep Medicine, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.,School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ker-Cheng Chen
- Division of Geriatric Medicine, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Yinyin Zang
- Center for Clinical Epidemiology and Biostatistics and the Department of Biostatistics and Epidemiology, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Junxin Li
- School of Nursing, John Hopkins University, Baltimore, Maryland
| | - Jessica Oehlke
- Division of Sleep Medicine, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Glenna S Brewster
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia
| | - Nalaka S Gooneratne
- Division of Geriatric Medicine, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.,Center for Sleep and Respiratory Neurobiology and Division of Sleep Medicine, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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17
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Maguen S, Gloria R, Huggins J, Goldstein LA, Kanady JC, Straus LD, Metzler TJ, Lujan C, Neylan TC. Brief behavioral treatment for insomnia improves psychosocial functioning in veterans: results from a randomized controlled trial. Sleep 2021; 44:5918478. [PMID: 33022048 DOI: 10.1093/sleep/zsaa205] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 07/28/2020] [Indexed: 11/13/2022] Open
Abstract
STUDY OBJECTIVES Our goal was to compare brief behavioral treatment for insomnia (BBTI) to a progressive muscle relaxation training (PMRT) control condition among veterans with insomnia, examining psychosocial functioning as a primary outcome and sleep-related outcomes, mood, cognition, and pain as secondary outcomes. METHODS Veterans were randomly assigned to either BBTI or PMRT (N = 91; 24-74 years; M = 49 years). BBTI consisted of two in-person (60-min and 30-min sessions) and two telephone sessions (20-min each), and the PMRT control condition was matched to BBTI for session duration and type. Veterans were assessed through clinical interview at baseline and self-report measures at pre-, mid-, and posttreatment, as well as 6-month follow-up for the BBTI condition to assess sustained response. Measures also included continuous sleep monitoring with sleep diary. RESULTS Intent-to-treat analyses demonstrated that individuals who completed BBTI versus PMRT reported greater improvements in work, home, social and cognitive functioning, insomnia symptom severity, mood, and energy. Improvements in psychosocial functioning, insomnia symptoms, and mood were maintained 6-months following BBTI treatment completion. CONCLUSIONS Veterans who received BBTI improved and maintained gains in psychosocial functioning, insomnia, and mood. BBTI is a treatment that can be implemented in primary care, mental health, or integrated care settings and provide symptom relief and improved functioning among those with insomnia, one of the most commonly reported mental health problems among veterans. CLINICAL TRIAL REGISTRATION NCT02571452.
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Affiliation(s)
- Shira Maguen
- San Francisco Veterans Affairs Health Care System, San Francisco, CA.,Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA.,Sierra Pacific Mental Illness Research Education, and Clinical Center, San Francisco, CA
| | - Rebecca Gloria
- San Francisco Veterans Affairs Health Care System, San Francisco, CA
| | - Joy Huggins
- San Francisco Veterans Affairs Health Care System, San Francisco, CA
| | - Lizabeth A Goldstein
- San Francisco Veterans Affairs Health Care System, San Francisco, CA.,Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA.,Sierra Pacific Mental Illness Research Education, and Clinical Center, San Francisco, CA
| | - Jennifer C Kanady
- San Francisco Veterans Affairs Health Care System, San Francisco, CA.,Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA.,Sierra Pacific Mental Illness Research Education, and Clinical Center, San Francisco, CA
| | - Laura D Straus
- San Francisco Veterans Affairs Health Care System, San Francisco, CA.,Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA.,Sierra Pacific Mental Illness Research Education, and Clinical Center, San Francisco, CA
| | - Thomas J Metzler
- San Francisco Veterans Affairs Health Care System, San Francisco, CA.,Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA.,Sierra Pacific Mental Illness Research Education, and Clinical Center, San Francisco, CA
| | - Callan Lujan
- San Francisco Veterans Affairs Health Care System, San Francisco, CA.,Department of Psychology, Washington State University, Pullman, WA
| | - Thomas C Neylan
- San Francisco Veterans Affairs Health Care System, San Francisco, CA.,Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA.,Sierra Pacific Mental Illness Research Education, and Clinical Center, San Francisco, CA
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18
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Erten Uyumaz B, Feijs L, Hu J. A Review of Digital Cognitive Behavioral Therapy for Insomnia (CBT-I Apps): Are They Designed for Engagement? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18062929. [PMID: 33809308 PMCID: PMC7999422 DOI: 10.3390/ijerph18062929] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 03/01/2021] [Accepted: 03/03/2021] [Indexed: 11/23/2022]
Abstract
There are different ways to deliver Cognitive Behavioral Therapy for Insomnia (CBT-I), of which in-person (face to face) is the traditional delivery method. However, the scalability of in-person therapy is low. Digital Cognitive Behavioral Therapy for Insomnia (dCBT-I) is an alternative and there are tools on the market that are validated in clinical studies. In this paper, we provide a review of the existing evidence-based CBT-I apps and a summary of the published usability-oriented studies of these apps. The goal is to explore the range of interaction methods commonly applied in dCBT-I platforms, the potential impact for the users, and the design elements applied to achieve engagement. Six commercially available CBT-I apps tested by scientifically valid methods were accessed and reviewed. Commonalities were identified and categorized into interactive elements, CBT-I-related components, managerial features, and supportive motivational features. The dCBT-I apps were effectively assisting the users, and the type of interactions promoted engagement. The apps’ features were based on design principles from interactive product design, experience design, online social media, and serious gaming. This study contributes to the field by providing a critical summary of the existing dCBT-I apps that could guide future developers in the field to achieve a high engagement.
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19
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Aji M, Gordon C, Stratton E, Calvo RA, Bartlett D, Grunstein R, Glozier N. Framework for the Design Engineering and Clinical Implementation and Evaluation of mHealth Apps for Sleep Disturbance: Systematic Review. J Med Internet Res 2021; 23:e24607. [PMID: 33595441 PMCID: PMC7929739 DOI: 10.2196/24607] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 10/12/2020] [Accepted: 01/15/2021] [Indexed: 01/16/2023] Open
Abstract
Background Mobile health (mHealth) apps offer a scalable option for treating sleep disturbances at a population level. However, there is a lack of clarity about the development and evaluation of evidence-based mHealth apps. Objective The aim of this systematic review was to provide evidence for the design engineering and clinical implementation and evaluation of mHealth apps for sleep disturbance. Methods A systematic search of studies published from the inception of databases through February 2020 was conducted using 5 databases (MEDLINE, Embase, Cochrane Library, PsycINFO, and CINAHL). Results A total of 6015 papers were identified using the search strategy. After screening, 15 papers were identified that examined the design engineering and clinical implementation and evaluation of 8 different mHealth apps for sleep disturbance. Most of these apps delivered cognitive behavioral therapy for insomnia (CBT-I, n=4) or modified CBT-I (n=2). Half of the apps (n=4) identified adopting user-centered design or multidisciplinary teams in their design approach. Only 3 papers described user and data privacy. End-user acceptability and engagement were the most frequently assessed implementation metrics. Only 1 app had available evidence assessing all 4 implementation metrics (ie, acceptability, engagement, usability, and adherence). Most apps were prototype versions (n=5), with few matured apps. A total of 6 apps had supporting papers that provided a quantitative evaluation of clinical outcomes, but only 1 app had a supporting, adequately powered randomized controlled trial. Conclusions This is the first systematic review to synthesize and examine evidence for the design engineering and clinical implementation and evaluation of mHealth apps for sleep disturbance. The minimal number of apps with published evidence for design engineering and clinical implementation and evaluation contrasts starkly with the number of commercial sleep apps available. Moreover, there appears to be no standardization and consistency in the use of best practice design approaches and implementation assessments, along with very few rigorous efficacy evaluations. To facilitate the development of successful and evidence-based apps for sleep disturbance, we developed a high-level framework to guide researchers and app developers in the end-to-end process of app development and evaluation.
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Affiliation(s)
- Melissa Aji
- Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Christopher Gordon
- CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Glebe, Australia.,Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Elizabeth Stratton
- Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Rafael A Calvo
- Dyson School of Design Engineering, Imperial College London, London, United Kingdom
| | - Delwyn Bartlett
- Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.,CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Glebe, Australia
| | - Ronald Grunstein
- CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Glebe, Australia.,Charles Perkins Centre - RPA Clinic, Royal Prince Alfred Hospital, Sydney, Australia
| | - Nick Glozier
- Brain and Mind Center, The University of Sydney, Camperdown, Australia
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20
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Chung K, Kim S, Lee E, Park JY. Mobile App Use for Insomnia Self-Management in Urban Community-Dwelling Older Korean Adults: Retrospective Intervention Study. JMIR Mhealth Uhealth 2020; 8:e17755. [PMID: 32831177 PMCID: PMC7477668 DOI: 10.2196/17755] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 03/30/2020] [Accepted: 04/15/2020] [Indexed: 01/20/2023] Open
Abstract
Background As an evidence-based psychotherapy for treating insomnia, cognitive behavioral therapy for insomnia (CBT-I), which helps people with sleep problems to change their unhelpful sleep-related beliefs and habits, has been well-established in older adults. Recently, the utilization of mobile CBT-I apps has been getting attention from mental health professionals and researchers; however, whether mobile CBT-I apps are usable among older users has yet to be determined. Objective The aims of this study were to explore the relationships between subjective sleep quality and subjective memory complaints and depressive symptoms; to explore the relationship between perceived difficulty in mobile app use and usability of the mobile phone–based self-help CBT-I app, named MIND MORE, in urban community-dwelling Korean older adults; to compare changes in subjective sleep quality from pre-intervention to post-intervention, during which they used the mobile app over a 1-week intervention period; and evaluate adherence to the app. Methods During the 2-hour training program delivered on 1 day titled “Overcoming insomnia without medication: How to use the ‘MIND MORE’ mobile app for systematic self-management of insomnia” (pre-intervention), 41 attendants were asked to gain hands-on experience with the app facilitated by therapists and volunteer workers. They were then asked to complete questionnaires on sociodemographic characteristics, subjective evaluation of mental health status (ie, depression, memory loss and impairment, and sleep problems), and app usability. For the 1-week home-based self-help CBT-I using the app (post-intervention), 9 of the 41 program attendants, who had already signed up for the pre-intervention, were guided to complete the given questionnaires on subjective evaluation of sleep quality after the 1-week intervention, specifically 8 days after the training program ended. Results Due to missing data, 40 of 41 attendants were included in the data analysis. The main findings of this study were as follows. First, poor subjective sleep quality was associated with higher ratings of depressive symptoms (40/40; ρ=.60, P<.001) and memory complaints (40/40; ρ=.46, P=.003) at baseline. Second, significant improvements in subjective sleep quality from pre-intervention to post-intervention were observed in the older adults who used the MIND MORE app only for the 1-week intervention period (9/9; t8=3.74, P=.006). Third, apart from the program attendants who did not have a smartphone (2/40) or withdrew from their MIND MORE membership (3/40), those who attended the 1-day sleep education program adhered to the app from at least 2 weeks (13/35, 37%) to 8 weeks (2/35, 6%) without any further contact. Conclusions This study provides empirical evidence that the newly developed MIND MORE app not only is usable among older users but also could improve subjective sleep quality after a 1-week self-help intervention period.
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Affiliation(s)
- Kyungmi Chung
- Department of Psychiatry, Yonsei University College of Medicine, Yongin Severance Hospital, Yonsei University Health System, Yongin, Republic of Korea.,Center for Digital Health, Yongin Severance Hospital, Yonsei University Health System, Yongin, Republic of Korea.,Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Republic of Korea
| | - Seoyoung Kim
- Nowon Eulji Medical Center, Eulji University, Seoul, Republic of Korea
| | - Eun Lee
- Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Republic of Korea.,Department of Psychiatry, Yonsei University College of Medicine, Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea
| | - Jin Young Park
- Department of Psychiatry, Yonsei University College of Medicine, Yongin Severance Hospital, Yonsei University Health System, Yongin, Republic of Korea.,Center for Digital Health, Yongin Severance Hospital, Yonsei University Health System, Yongin, Republic of Korea.,Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Republic of Korea
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21
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Pruiksma KE, Hale WJ, Mintz J, Peterson AL, Young-McCaughan S, Wilkerson A, Nicholson K, Dondanville KA, Fina BA, Borah EV, Roache JD, Litz BT, Bryan CJ, Taylor DJ. Predictors of Cognitive Behavioral Therapy for Insomnia (CBTi) Outcomes in Active-Duty U.S. Army Personnel. Behav Ther 2020; 51:522-534. [PMID: 32586427 DOI: 10.1016/j.beth.2020.02.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 02/10/2020] [Accepted: 02/10/2020] [Indexed: 10/25/2022]
Abstract
Cognitive behavioral therapy for insomnia (CBTi) is well established as the first-line treatment for the management of chronic insomnia. Identifying predictors of response to CBTi should enable the field to efficiently utilize resources to treat those who are likely to respond and to personalize treatment approaches to optimize outcomes for those who are less likely to respond to traditional CBTi. Although a range of studies have been conducted, no clear pattern of predictors of response to CBTi has emerged. The purpose of this study was to examine the impact and relative importance of a comprehensive group of pretreatment predictors of insomnia outcomes in 99 active-duty service members who received in-person CBTi in a randomized clinical trial. Results indicated that higher levels of baseline insomnia severity and total sleep time predicted greater improvements on the Insomnia Severity Index (ISI) following treatment. Higher depression symptoms and a history of head injury predicted a worse response to treatment (i.e., smaller improvements on the ISI). Clinically meaningful improvements, as measured by the reliable change index (RCI), were found in 59% of the sample. Over and above baseline insomnia severity, only depressive symptoms predicted this outcome. Future studies should examine if modifications to CBTi based on these predictors of response can improve outcomes.
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Affiliation(s)
| | - Willie J Hale
- University of Texas Health Science Center at San Antonio; University of Texas at San Antonio
| | - Jim Mintz
- University of Texas Health Science Center at San Antonio
| | - Alan L Peterson
- University of Texas Health Science Center at San Antonio; South Texas Veterans Health Care System, San Antonio; University of Texas at San Antonio
| | | | | | | | | | - Brooke A Fina
- University of Texas Health Science Center at San Antonio
| | - Elisa V Borah
- University of Texas Health Science Center at San Antonio
| | - John D Roache
- University of Texas Health Science Center at San Antonio
| | | | - Craig J Bryan
- National Center for Veterans Studies, Salt Lake City, UT; University of Utah
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Yang L, Kang Y, Zhang W, Zhang B. [Application and research progress of internet-based cognitive behavioral therapy for insomnia disorder]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2020; 40:142-146. [PMID: 32376547 DOI: 10.12122/j.issn.1673-4254.2020.01.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Insomnia disorder is one of the most common sleep disorders with an increasing incidence to cause substantial economic losses and social burden. The therapy for insomnia disorder mainly includes medication treatment and cognitive behavioral therapy. Medications are associated with various adverse effects and can be easily addictive. Cognitive behavioral therapy has been proposed as the first-line treatment for insomnia disorder. But due to the disadvantages of face-to-face cognitive behavioral therapy including a high cost and the lack of standardization, internet-based cognitive behavioral therapy has emerged as an alternative with an almost equivalent efficacy to face-to-face cognitive behavioral therapy and better effects than medication. This review summarizes the basic principles of cognitive behavioral therapy for insomnia and discusses the development, forms, effects as well as the advantages and disadvantages of internet-based cognitive behavioral therapy.
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Affiliation(s)
- Lulu Yang
- Department of Psychiatry, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Yinzhi Kang
- Department of Psychiatry, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Wanling Zhang
- Shenzhen Mental Health Center/Shenzhen Kangning Hospital, Shenzhen 518118, China
| | - Bin Zhang
- Department of Psychiatry, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
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