0318 Early Sleep Intervention Mitigates Poor Sleep and Improves Mood in the COVID-19 Pandemic

Abstract

Introduction Rates of sleep disturbance and depressed mood increased during the COVID-19 pandemic. Acute symptoms of sleep disturbance may develop into chronic insomnia if left untreated and constitute a risk for depression. However, the impact of early treatment of insomnia symptoms on the development of chronic insomnia and depressive symptoms remains unknown. Here we present the primary outcome results from a pre-registered, 2-arm randomized controlled feasibility trial launched early in the pandemic, investigating whether a brief telehealth insomnia intervention targeting acute insomnia symptoms prevents the subsequent deterioration of insomnia and depression. Methods Forty-nine participants with pandemic-onset insomnia symptoms were randomized to receive four telehealth sessions of Cognitive Behavioral Therapy for Insomnia (CBT-I) over five weeks or to a waitlist control. Primary outcome measures included the Insomnia Severity Index and the Patient Health Questionnaire-9 excluding the sleep item collected at weeks 0, 6, 12, and 28. Linear mixed-effects models tested the hypotheses that early insomnia intervention improves the 28-week trajectory of insomnia and depressive symptoms relative to the control group. The MacArthur framework tested if improvement of insomnia mediates subsequent improvement in depression. Results The two linear mixed-effects models revealed significant time-by-intervention interactions, indicating improved trajectories of insomnia and depressive symptoms across the 28-weeks in the CBT-I group compared to the control group (Insomnia: B=-1.03, p<.001; Depression: B=-0.52, p=0.009). The rate of improvement in insomnia during treatment (0-5 weeks) mediated the subsequent improvement in depressive symptoms following treatment (6-weeks; B=2.31, p=0.005), but not at 12- or 28-weeks (all B’s <=1.44, all p’s>0.203). In contrast, depression symptom improvement during treatment was not associated with insomnia symptoms (all timepoint p's>=0.132). The percentage of participants with insomnia diagnosis was lower in the CBT-I vs control group at both timepoints (short-term: 21.7% vs. 50%; long-term: 22.7% vs. 50%). Conclusion These are the first findings establishing that brief telehealth CBT-I significantly improved both acute pandemic-onset insomnia symptoms and subsequent trajectory of insomnia and depression. Although the sample size was small and pandemic conditions may never fully be replicated, these results support treatment of acute sleep disturbance in the context of stressors for improved long-term sleep and mood symptoms. Support (if any)