Mobile Intervention to Improve Sleep and Functional Health of Veterans With Insomnia: Randomized Controlled Trial

Erin Dawna Reilly, Stephanie A Robinson, Beth Ann Petrakis, Melissa M Gardner, Renda Soylemez Wiener, Carmen Castaneda-Sceppa, Karen S Quigley, Erin Dawna Reilly, Stephanie A Robinson, Beth Ann Petrakis, Melissa M Gardner, Renda Soylemez Wiener, Carmen Castaneda-Sceppa, Karen S Quigley

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://ichgcp.net/clinical-trials-registry/NCT03305354.

Keywords: cognitive behavioral therapy; insomnia; mobile app; physical activity.

Conflict of interest statement

Conflicts of Interest: None declared.

©Erin Dawna Reilly, Stephanie A Robinson, Beth Ann Petrakis, Melissa M Gardner, Renda Soylemez Wiener, Carmen Castaneda-Sceppa, Karen S Quigley. Originally published in JMIR Formative Research (https://formative.jmir.org), 09.12.2021.

Figures

Figure 1
Figure 1
CONSORT diagram of participant inclusion and attrition. CBT-i: cognitive behavioral therapy for insomnia; ISI: insomnia severity index; OEF: Operation Enduring Freedom; OIF: Operation Iraqi Freedom; PA: physical activity.

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