A Pilot Randomized Controlled Trial to Assess Feasibility and Treatment Effect of a Web-Based Delivered Cognitive Behavioral Therapy for Insomnia Program in Individuals with Multiple Sclerosis

Abstract

Background: At least 40% of individuals with multiple sclerosis (MS) experience chronic insomnia. Recent studies indicate that cognitive behavioral therapy for insomnia (CBT-I) is an effective treatment for insomnia symptoms in individuals with MS. CBT-I delivered using web-based applications has been shown to be effective and may increase access to CBT-I for individuals with MS who have mobility difficulties, fatigue, or live in rural areas. Therefore, the purpose of this study was to assess the feasibility and treatment effect of CBT-I delivered using a web-based application with or without biweekly phone calls to improve sleep quality and fatigue in individuals with MS and symptoms of insomnia. Methods: Forty-one individuals with MS and symptoms of insomnia were randomized into either a group that participated in a 6-week web-based CBT-I program (wCBT-I) or a group that participated in a web-based CBT-I program and received biweekly support phone calls (wCBT-I+PC). Participants completed surveys online to assess insomnia severity, sleep quality, fatigue, sleep self-efficacy, depression, anxiety, and motivation to change their sleep behavior. Results: The overall retention rate was 48.8%, and the adherence rate was 96.34%. Both groups had a significant improvement in insomnia severity, sleep quality, anxiety, and sleep self-efficacy. Only the wCBT-I group had a significant improvement in depression and fatigue. Conclusions: Web-delivered CBT-I is feasible and effective in improving sleep outcomes and concomitant symptoms in individuals with MS. Web-based CBT-I may increase the accessibility of CBT-I treatment and provide a stepped-care approach to treating chronic insomnia in individuals with MS.

Telehealth-Delivered Cognitive Behavioral Therapy for Insomnia in Individuals with Multiple Sclerosis: A Pilot Study

“…The results that tele-CBTi improves sleep outcomes support recent studies that have shown that the principles of F2F-CBTi have been delivered effectively through different modalities, such as web-based and tele-CBTi [ 15 , 17 , 37 ]. The results of our study are also consistent with previous studies that found that CBT-I improves comorbid symptoms including fatigue, depression, and quality of life in people with MS specifically, as well as within the general population [ 15 , 18 , 20 , 38 – 41 ].…”

“…Furthermore, individuals with MS may have additional barriers to attending in-person CBT-I such as mobility restrictions and other comorbidities [ 10 ]. Another recently published study found a web-based CBT-I program tailored specifically for individuals with MS resulted in improvements in insomnia severity, sleep quality, sleep self-efficacy, and anxiety [ 20 ]. However, web-delivered CBT-I is an automated program that cannot be tailored to the specific needs of the individual.…”

“…However, web-delivered CBT-I is an automated program that cannot be tailored to the specific needs of the individual. Also, the web-based CBT-I study in people with MS had an attrition rate of 50%, suggesting that acceptability of a web-delivered program is limited [ 20 ]. Tele-CBTi would allow greater accessibility of care while also including tailored treatment with a practitioner.…”

The Impact of Cognitive Behavioral Therapy for Insomnia on Sleep Log and Actigraphy Outcomes in People with Multiple Sclerosis: A Secondary Analysis

“…Recent studies have suggested CBT-I improves self-report sleep outcomes in people with multiple sclerosis (MS). [24][25][26][27] A case series studying CBT-I in 11 individuals with MS showed that most participants reported a decrease in overall insomnia (6 of 7), depression (5 of 10), and fatigue (6 of 10), and an increase of TST (8 of 11). 24 Siengsukon et al recently found individuals with MS exhibited significant improvements in insomnia symptoms, sleep quality, fatigue, self-efficacy, and depression symptoms after traditional in-person CBT-I, 27 as well as after webbased CBT-I intervention.…”

“…24 Siengsukon et al recently found individuals with MS exhibited significant improvements in insomnia symptoms, sleep quality, fatigue, self-efficacy, and depression symptoms after traditional in-person CBT-I, 27 as well as after webbased CBT-I intervention. 26 However, it remains unclear if individuals with MS have an improvement in sleep log outcomes or objectively assessed sleep outcomes following CBT-I. Also, it is unknown if CBT-I improves sleep variability in people with MS.…”