Optimization of Insomnia Treatment in Primary Care

April 5, 2022 updated by: Charles M. Morin, Laval University

Stepped Care Treatment for Insomnia Delivered in Primary Care Clinics: A Pragmatic Clinical Trial

The primary objective of this pragmatic clinical trial is to evaluate the efficacy, feasibility, and adaptability of pharmacological and non-pharmacological treatments for insomnia disorder, delivered in primary care clinics. The second objective is to evaluate the efficacy of a sequential (stepped care) approach for persistent insomnia.

Study Overview

Status

Status

Indicates the current recruitment status or the expanded access status.
Recruiting

Conditions

Conditions

The disease, disorder, syndrome, illness, or injury that is being studied. On ClinicalTrials.gov, conditions may also include other health-related issues, such as lifespan, quality of life, and health risks.

Intervention / Treatment

Intervention / Treatment

A process or action that is the focus of a clinical study. Interventions include drugs, medical devices, procedures, vaccines, and other products that are either investigational or already available. Interventions can also include noninvasive approaches, such as education or modifying diet and exercise.

Study Type

Study Type

Describes the nature of a clinical study. Study types include interventional studies (also called clinical trials), observational studies (including patient registries), and expanded access.
Interventional

Enrollment (Anticipated)

Enrollment

The number of participants in a clinical study. The "anticipated" enrollment is the target number of participants that the researchers need for the study.
300

Phase

Phase

The stage of a clinical trial studying a drug or biological product, based on definitions developed by the U.S. Food and Drug Administration (FDA). The phase is based on the study's objective, the number of participants, and other characteristics. There are five phases: Early Phase 1 (formerly listed as Phase 0), Phase 1, Phase 2, Phase 3, and Phase 4. Not Applicable is used to describe trials without FDA-defined phases, including trials of devices or behavioral interventions.
  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Contact

Study Contact

The name and contact information for the person who can answer enrollment questions for a clinical study. Each location where the study is being conducted may also have a specific contact, who may be better able to answer those questions.

Study Locations

  • Canada
    • Quebec
      • Quebec City, Quebec, Canada, G1K 0A6
        • Recruiting
        • Laval University
        • Contact:
        • Principal Investigator:
          • Charles M Morin, PhD

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Eligibility Criteria

The key requirements that people who want to participate in a clinical study must meet or the characteristics they must have. Eligibility criteria consist of both inclusion criteria (which are required for a person to participate in the study) and exclusion criteria (which prevent a person from participating). Types of eligibility criteria include whether a study accepts healthy volunteers, has age or age group requirements, or is limited by sex.

Ages Eligible for Study

18 years and older (Adult, Older Adult)

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Description

Inclusion Criteria:

  • Aged 18 years or over
  • Meeting criteria for insomnia disorder
  • Registered patient at one of the primary care clinics participating in the study
  • Fluent in French
  • Computer and internet access

Exclusion Criteria:

  • Unstable or untreated psychiatric disorder
  • Lifetime psychotic or bipolar disorder
  • Current suicide risk
  • Progressive or unstable medical disorder
  • Untreated sleep disorder other than insomnia
  • Use of medication altering sleep
  • Irregular or atypical sleep-wake schedule
  • Current or planned pregnancy

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: Non-Randomized
  • Interventional Model: Sequential Assignment
  • Masking: None (Open Label)

Arms and Interventions

Participant Group / Arm

Participant Group / Arm

A group or subgroup of participants in a clinical trial that receives a specific intervention/treatment, or no intervention, according to the trial's protocol.
Intervention / Treatment

Intervention / Treatment

A process or action that is the focus of a clinical study. Interventions include drugs, medical devices, procedures, vaccines, and other products that are either investigational or already available. Interventions can also include noninvasive approaches, such as education or modifying diet and exercise.
Active Comparator: Treatment as usual
Hypnotics - Medication used 1 to 7 nights/week for 6 to 8 weeks
Drug: Hypnotics
Medication used 1 to 7 nights/week for 6 to 8 weeks.
Experimental: Online cognitive behavior therapy
Online CBT- Internet self-help program for insomnia with 6 cores
Behavioral: Online CBT
Internet self-help program for insomnia with 6 cores.
Experimental: Treatment as usual + Online CBT
Hypnotics - Medication used 1 to 7 nights/week for 6 to 8 weeks Online CBT- Internet self-help program for insomnia with 6 cores
Drug: Hypnotics
Medication used 1 to 7 nights/week for 6 to 8 weeks.
Behavioral: Online CBT
Internet self-help program for insomnia with 6 cores.
Experimental: Medication
Hypnotics - Medication used 1 to 7 nights/week for 6 to 8 weeks (arms 1, 3, 4)
Drug: Hypnotics
Medication used 1 to 7 nights/week for 6 to 8 weeks.
Experimental: In-person cognitive behavior therapy
Face-to-face CBT- Face-to-face therapy with 3 to 4 individual sessions in a period of 6 to 8 weeks.
Behavioral: Face-to-face CBT
Face-to-face therapy with 3 to 4 individual sessions in a period of 6 to 8 weeks.
No Intervention: No additional treatment

What is the study measuring?

Primary Outcome Measures

Primary Outcome Measures

In a clinical study's protocol, the planned outcome measure that is the most important for evaluating the effect of an intervention/treatment. Most clinical studies have one primary outcome measure, but some have more than one.
Outcome Measure
Measure Description
Time Frame
Remission of insomnia
Time Frame: Post-1 (after 6-week treatment phase 1)
Insomnia Severity Index score (average of two consecutive weeks < 8, with none > 10)
Post-1 (after 6-week treatment phase 1)
Remission of insomnia
Time Frame: Post-2 (after 6-week treatment phase 2)
Insomnia Severity Index score (average of two consecutive weeks < 8, with none > 10)
Post-2 (after 6-week treatment phase 2)

Secondary Outcome Measures

Secondary Outcome Measures

In a clinical study's protocol, a planned outcome measure that is not as important as the primary outcome measure for evaluating the effect of an intervention but is still of interest. Most clinical studies have more than one secondary outcome measure.
Outcome Measure
Measure Description
Time Frame
Total sleep time from sleep diary
Time Frame: Post-1 (after 6-week treatment phase 1)
Mean total sleep time per night in minutes from sleep diary
Post-1 (after 6-week treatment phase 1)
Total sleep time from sleep diary
Time Frame: Post-2 (after 6-week treatment phase 2)
Mean total sleep time per night in minutes from sleep diary
Post-2 (after 6-week treatment phase 2)
Total wake time from sleep diary
Time Frame: Post-1 (after 6-week treatment phase 1)
Mean total wake time (combining sleep onset latency, wake after sleep onset, and duration of early morning awakening) in minutes from sleep diary
Post-1 (after 6-week treatment phase 1)
Total wake time from sleep diary
Time Frame: Post-2 (after 6-week treatment phase 2)
Mean total wake time (combining sleep onset latency, wake after sleep onset, and duration of early morning awakening) in minutes from sleep diary
Post-2 (after 6-week treatment phase 2)
Sleep efficiency from sleep diary
Time Frame: Post-1 (after 6-week treatment phase 1)
Mean sleep efficiency in percentage (total sleep time divided by time spent in bed, multiplied by 100) from sleep diary
Post-1 (after 6-week treatment phase 1)
Sleep efficiency from sleep diary
Time Frame: Post-2 (after 6-week treatment phase 2)
Mean sleep efficiency in percentage (total sleep time divided by time spent in bed, multiplied by 100) from sleep diary
Post-2 (after 6-week treatment phase 2)
Total sleep time from actigraphy
Time Frame: Post-1 (after 6-week treatment phase 1)
Mean total sleep time per night in minutes from actigraphy
Post-1 (after 6-week treatment phase 1)
Total sleep time from actigraphy
Time Frame: Post-2 (after 6-week treatment phase 2)
Mean total sleep time per night in minutes from actigraphy
Post-2 (after 6-week treatment phase 2)
Total wake time from actigraphy
Time Frame: Post-1 (after 6-week treatment phase 1)
Mean total wake time (combining sleep onset latency, wake after sleep onset, and duration of early morning awakening) in minutes from actigraphy
Post-1 (after 6-week treatment phase 1)
Total wake time from actigraphy
Time Frame: Post-2 (after 6-week treatment phase 2)
Mean total wake time (combining sleep onset latency, wake after sleep onset, and duration of early morning awakening) in minutes from actigraphy
Post-2 (after 6-week treatment phase 2)
Sleep efficiency from actigraphy
Time Frame: Post-1 (after 6-week treatment phase 1)
Mean sleep efficiency in percentage (total sleep time divided by time spent in bed, multiplied by 100) from actigraphy
Post-1 (after 6-week treatment phase 1)
Sleep efficiency from actigraphy
Time Frame: Post-2 (after 6-week treatment phase 2)
Mean sleep efficiency in percentage (total sleep time divided by time spent in bed, multiplied by 100) from actigraphy
Post-2 (after 6-week treatment phase 2)
Fatigue
Time Frame: Post-1 (after 6-week treatment phase 1)
Flinders Fatigue Scale (7-item self-report scale measuring fatigue over the past two weeks; total score ranges from 0 to 31, higher scores indicating greater fatigue)
Post-1 (after 6-week treatment phase 1)
Fatigue
Time Frame: Post-2 (after 6-week treatment phase 2)
Flinders Fatigue Scale (7-item self-report scale measuring fatigue over the past two weeks; total score ranges from 0 to 31, higher scores indicating greater fatigue)
Post-2 (after 6-week treatment phase 2)
Depression
Time Frame: Post-1 (after 6-week treatment phase 1)
Patient Health Questionnaire (PHQ-9)
Post-1 (after 6-week treatment phase 1)
Depression
Time Frame: Post-2 (after 6-week treatment phase 2)
Patient Health Questionnaire (PHQ-9)
Post-2 (after 6-week treatment phase 2)
Anxiety
Time Frame: Post-1 (after 6-week treatment phase 1)
Generalized Anxiety Disorder 7-item (GAD-7)
Post-1 (after 6-week treatment phase 1)
Anxiety
Time Frame: Post-2 (after 6-week treatment phase 2)
Generalized Anxiety Disorder 7-item (GAD-7)
Post-2 (after 6-week treatment phase 2)
Disability
Time Frame: Post-1 (after 6-week treatment phase 1)
Work and Social Adjustment Scale (5-item scale scale assessing functional impact of insomnia; total score ranging from 0 to 40, higher scores indicating greater disability)
Post-1 (after 6-week treatment phase 1)
Disability
Time Frame: Post-2 (after 6-week treatment phase 2)
Work and Social Adjustment Scale (5-item scale scale assessing functional impact of insomnia; total score ranging from 0 to 40, higher scores indicating greater disability)
Post-2 (after 6-week treatment phase 2)
Medication use
Time Frame: Post-1 (after 6-week treatment phase 1)
Frequency of use (number of nights/week)
Post-1 (after 6-week treatment phase 1)
Medication use
Time Frame: Post-2 (after 6-week treatment phase 2)
Frequency of use (number of nights/week)
Post-2 (after 6-week treatment phase 2)

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Sponsor

The organization or person who initiates the study and who has authority and control over the study.
Laval University

Collaborators

Collaborators

An organization other than the sponsor that provides support for a clinical study. This support may include activities related to funding, design, implementation, data analysis, or reporting.
Canadian Institutes of Health Research (CIHR)

Investigators

Investigators

A researcher involved in a clinical study. Related terms include site principal investigator, site sub-investigator, study chair, study director, and study principal investigator.
  • Principal Investigator: Charles Morin, PhD, Université Laval Centre d'étude des troubles du sommeil

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

Study Start

The actual date on which the first participant was enrolled in a clinical study. The "anticipated" study start date is the date that the researchers think will be the study start date.
September 1, 2018

Primary Completion (Anticipated)

Primary Completion

The date on which the last participant in a clinical study was examined or received an intervention to collect final data for the primary outcome measure. Whether the clinical study ended according to the protocol or was terminated does not affect this date. For clinical studies with more than one primary outcome measure with different completion dates, this term refers to the date on which data collection is completed for all the primary outcome measures. The "anticipated" primary completion date is the date that the researchers think will be the primary completion date for the study.
December 1, 2023

Study Completion (Anticipated)

Study Completion

The date on which the last participant in a clinical study was examined or received an intervention/treatment to collect final data for the primary outcome measures, secondary outcome measures, and adverse events (that is, the last participant's last visit). The "anticipated" study completion date is the date that the researchers think will be the study completion date.
December 1, 2023

Study Registration Dates

First Submitted

First Submitted

The date on which the study sponsor or investigator first submitted a study record to ClinicalTrials.gov. There is typically a delay of a few days between the first submitted date and the record's availability on ClinicalTrials.gov (the first posted date).
July 17, 2018

First Submitted That Met QC Criteria

First Submitted That Met QC Criteria

The date on which the study sponsor or investigator first submits a study record that is consistent with National Library of Medicine (NLM) quality control (QC) review criteria. The sponsor or investigator may need to revise and submit a study record one or more times before NLM's QC review criteria are met. It is the responsibility of the sponsor or investigator to ensure that the study record is consistent with the NLM QC review criteria.
August 13, 2018

First Posted (Actual)

First Posted

The date on which the study record was first available on ClinicalTrials.gov after National Library of Medicine (NLM) quality control (QC) review has concluded. There is typically a delay of a few days between the date the study sponsor or investigator submitted the study record and the first posted date.
August 16, 2018

Study Record Updates

Last Update Posted (Actual)

Last Update Posted

The most recent date on which changes to a study record were made available on ClinicalTrials.gov. There may be a delay between when the changes were submitted to ClinicalTrials.gov by the study's sponsor or investigator (the last update submitted date) and the last update posted date.
April 6, 2022

Last Update Submitted That Met QC Criteria

Last Update Submitted That Met QC Criteria

The most recent date on which the study sponsor or investigator submitted changes to a study record that are consistent with National Library of Medicine (NLM) quality control (QC) review criteria. It is the responsibility of the sponsor or investigator to ensure that the study record is consistent with the NLM QC review criteria.
April 5, 2022

Last Verified

Last Verified

The most recent date on which the study sponsor or investigator confirmed the information about a clinical study on ClinicalTrials.gov as accurate and current. If a study with a recruitment status of recruiting; not yet recruiting; or active, not recruiting has not been confirmed within the past 2 years, the study's recruitment status is shown as unknown.
April 1, 2022

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

Other Study ID Numbers

Identifiers or ID numbers other than the NCT number that are assigned to a clinical study by the study's sponsor, funders, or others. These numbers may include unique identifiers from other trial registries and National Institutes of Health grant numbers.
  • CIHR0083000212

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

No

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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