- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT05490550
Comparing Insomnia Care As Usual to Digital Augmentation (CICADA)
March 19, 2024 updated by: Anne Germain, Noctem, LLC
Comparing Insomnia Care As Usual to Digital Augmentation
The purpose of this pragmatic non-inferiority randomized clinical trial is to evaluate whether Cognitive Behavioral Treatment of Insomnia (CBTI) delivered through a clinical decision support digital platform is non-inferior to insomnia care delivered as usual at three military treatment facilities for treatment of insomnia, symptoms of depression and anxiety, and treatment satisfaction.
Study Overview
Status
Recruiting
Conditions
Intervention / Treatment
Detailed Description
Chronic insomnia is pervasive among service members and adversely affects health and readiness.
Insomnia rarely remits spontaneously, and sleep-focused treatments are required to reduce or eliminate insomnia.
Cognitive Behavioral Treatment of Insomnia (CBTI) is the first line treatment for insomnia.
CBTI remains underutilized and is often unavailable in care settings where service members receive sleep healthcare.
Digital health technology is one of the strategic components identified by the DHA to support behavioral health, including sleep health.
NOCTEM® has developed and validated its Clinician Operated Assistive Sleep Technology (COAST™) platform to scale delivery and access to CBTI.
This non-inferiority trial will evaluate and compare the changes in insomnia severity following COAST-enhanced CBTI or insomnia care as usual (ICAU) pre- to post-treatment and at the 3-month follow up.
Secondary outcomes of interest include changes in depression and anxiety over time, and patient satisfaction with insomnia care following COAST-enhanced CBTI or ICAU.
Study Type
Interventional
Enrollment (Estimated)
188
Phase
- 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
- Name: Anne Germain, PhD
- Phone Number: (412) 897-3183
- Email: anne@noctemhealth.com
Study Contact Backup
- Name: Megan Wolfson, LCSW
- Phone Number: (412) 360-4878
- Email: megan@noctemhealth.com
Study Locations
-
-
Washington
-
Lakewood, Washington, United States, 98431
- Recruiting
- Madigan Army Medical Center
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Contact:
- Brian O'Reilly
-
-
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
Ages Eligible for Study
18 years and older (Adult, Older Adult)
Accepts Healthy Volunteers
No
Description
Inclusion Criteria:
- Active duty service members, men and women, diagnosed with chronic insomnia and deemed eligible for CBTI by their treating clinician.
- Age 18 or older.
- Absence of, or stable, psychiatric, or medical comorbidity(ies), such that they do not compromise safety when completing study procedures.
- If using prescribed sleep medication(s), have received the medication(s) at a stable dosage for at least 4 weeks, with no scheduled change in medication or dosage over the acute intervention phase (up to 12 weeks)
- Owning or ability to use a smartphone (iPhone or Android) that is no older than 5 years old (e.g., iPhone 6, and Android phone with Lollipop 5.0 mobile operating system)
Exclusion Criteria:
- Presence of an untreated or under-treated comorbid sleep disorder that requires independent treatment or that may be exacerbated by sleep restriction or stimuli control, e.g., obstructive sleep apnea (OSA) or rapid-eye-movement (REM) behavior disorder or sleep walking with a history of injury to self or others.
- Acute psychiatric distress associated with marked impairments in functioning or that limits engagement in CBTI, adversely impacts the risk/benefit ratio of participating in the study, or requires immediate attention, as indicated by, but not limited to, the examples listed below. Please note that each referring clinician will determine whether a patient is eligible for the study.
- Having planned or attempted suicide or the harming of others in the past 6 months.
- Seeking and/or receiving treatment at psychiatric clinic facility at a level that requires inpatient or partial hospitalization level of psychiatric care.
- Currently requiring the support of an assigned case manager for services such as coordination of medications, appointments, transportation, and/or for completing activities of daily living.
- Active substance use disorder.
- Past or current psychotic or bipolar disorder or sub-threshold symptoms of psychotic or bipolar disorders.
- Currently pregnant, breastfeeding, or being the parent of a newborn < 3 months old.
- Untreated seizure disorder.
- Suspected, diagnosed, or inadequately treated sleep apnea (less than 4 hours of CPAP use per night).
- Anticipates relocating/moving out of state in the next 3 months
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: Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Active Comparator: COAST-enhanced CBTI
Patients randomized to COAST will receive CBTI via the COAST platform, with the assistance of a licensed clinician via NOCTEM's digital sleep hub.
Participants will utilize the COAST patient app on their smartphone for engagement in insomnia treatment and receipt of clinician's recommendations.
COAST clinicians will utilize the COAST web-based portal for adherence monitoring, progress review, and for providing personalized insomnia treatment recommendations.
|
Participants will receive CBTI delivered through the COAST platform by one of NOCTEM's certified and licensed COAST clinician.
Communication between the participant and licensed clinician will occur primarily through COAST's HIPAA-compliant text messaging, but clinicians and patients may elect to connect via telephone calls or HIPAA-compliant secure videoconference if needed.
|
Active Comparator: Military Treatment Facility Insomnia Care As Usual
Patients randomized to the ICAU arm will receive insomnia care as usual by a certified clinician at their respective site, according to current referral and treatment practices.
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Participants will receive the insomnia care offered at their site following current delivery practices (i.e., face-to-face or virtual; individual or group format).
During the treatment phase, participants randomized to ICAU will be instructed to communicate with their clinicians as needed, according to standard procedures in place.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Insomnia Severity
Time Frame: baseline
|
Insomnia Severity Index (ISI)
|
baseline
|
Insomnia Severity
Time Frame: 6-8 week check-in
|
Insomnia Severity Index (ISI)
|
6-8 week check-in
|
Insomnia Severity
Time Frame: 3-month follow up
|
Insomnia Severity Index (ISI)
|
3-month follow up
|
Symptoms of Depression
Time Frame: baseline
|
Patient Health Questionnaire-2 (PHQ-2)
|
baseline
|
Symptoms of Depression
Time Frame: 6-8 week check-in
|
Patient Health Questionnaire-2 (PHQ-2)
|
6-8 week check-in
|
Symptoms of Depression
Time Frame: 3-month follow up
|
Patient Health Questionnaire-2 (PHQ-2)
|
3-month follow up
|
Symptoms of Anxiety
Time Frame: baseline
|
Generalized Anxiety Disorder 2-item (GAD-2)
|
baseline
|
Symptoms of Anxiety
Time Frame: 6-8 week check-in
|
Generalized Anxiety Disorder 2-item (GAD-2)
|
6-8 week check-in
|
Symptoms of Anxiety
Time Frame: 3-month follow up
|
Generalized Anxiety Disorder 2-item (GAD-2)
|
3-month follow up
|
Acceptability of Insomnia Care
Time Frame: 6-8 week check-in
|
An adapted version of the Insomnia Treatment Acceptability Scale (ITAS) with ratings of perceived acceptability and treatment preference for both COAST-enhanced CBTI and insomnia care as usual (ICAU).
|
6-8 week check-in
|
Satisfaction with Insomnia Care
Time Frame: 6-8 week check in
|
Client Satisfaction Questionnaire assessing perceived quality of care, services, and clinicians encountered during treatment.
|
6-8 week check in
|
Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Sponsor
Investigators
- Principal Investigator: Anne Germain, Noctem, LLC
Publications and helpful links
The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.
General Publications
- Edinger JD, Arnedt JT, Bertisch SM, Carney CE, Harrington JJ, Lichstein KL, Sateia MJ, Troxel WM, Zhou ES, Kazmi U, Heald JL, Martin JL. Behavioral and psychological treatments for chronic insomnia disorder in adults: an American Academy of Sleep Medicine clinical practice guideline. J Clin Sleep Med. 2021 Feb 1;17(2):255-262. doi: 10.5664/jcsm.8986.
- Pulantara IW, Parmanto B, Germain A. Clinical Feasibility of a Just-in-Time Adaptive Intervention App (iREST) as a Behavioral Sleep Treatment in a Military Population: Feasibility Comparative Effectiveness Study. J Med Internet Res. 2018 Dec 7;20(12):e10124. doi: 10.2196/10124.
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)
August 16, 2023
Primary Completion (Estimated)
December 1, 2024
Study Completion (Estimated)
March 1, 2025
Study Registration Dates
First Submitted
July 30, 2022
First Submitted That Met QC Criteria
August 4, 2022
First Posted (Actual)
August 5, 2022
Study Record Updates
Last Update Posted (Actual)
March 21, 2024
Last Update Submitted That Met QC Criteria
March 19, 2024
Last Verified
March 1, 2024
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
- JW210372
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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