Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2023 Jul 1;19(7):1211-1217.
doi: 10.5664/jcsm.10540.

In-person and telehealth treatment of veterans with insomnia disorder using cognitive behavioral therapy for insomnia during the COVID-19 pandemic

Jennifer L Martin  1   2 , Jason DeViva  3   4 , Elissa McCarthy  5 , Philip Gehrman  6   7 , Karen Josephson  1 , Michael Mitchell  1 , Christopher de Beer  8 , Jennifer Runnals  8   9
Affiliations
Observational Study

In-person and telehealth treatment of veterans with insomnia disorder using cognitive behavioral therapy for insomnia during the COVID-19 pandemic

Jennifer L Martin et al. J Clin Sleep Med. .

Abstract

Study objectives: Cognitive behavioral therapy for insomnia (CBT-I) is the recommended first-line treatment for insomnia disorder. The goal of this study was to evaluate clinical benefits of CBT-I to veterans with insomnia disorder during the early months of the COVID-19 pandemic using an uncontrolled observational design.

Methods: A cohort of 63 Veterans Affairs (VA) mental health providers delivered CBT-I to 180 veterans as part of an evidence-based psychotherapy training program and captured de-identified treatment outcome data through a data portal. The main patient outcomes were change in the Insomnia Severity Index (ISI) total score from the initial clinical assessment session to the last treatment session, response rate (% with ISI change > 7 from assessment to last session), and remission rate (% with ISI < 8 at the last session). We tested the noninferiority of telehealth only compared with at least 1 in-person session.

Results: Fifty-six percent of veterans seen for an evaluation completed CBT-I treatment during the structured training program phase and completed an initial and final ISI. Among these veterans, ISI scores decreased by an average of 9.9 points from before to after treatment (P < .001), 66% experienced a clinically meaningful treatment response, and 43% experienced insomnia symptom remission. Benefits were similar whether the veteran received some in-person care or received CBT-I entirely via telehealth.

Conclusions: Findings suggest, regardless of treatment modality, CBT-I remained highly effective during the early months of the pandemic, which was a challenging time for both clinical providers and veterans in need of insomnia treatment.

Citation: Martin JL, DeViva J, McCarthy E, et al. In-person and telehealth treatment of veterans with insomnia disorder using cognitive behavioral therapy for insomnia during the COVID-19 pandemic. J Clin Sleep Med. 2023;19(7):1211-1217.

Keywords: COVID-19; cognitive behavioral therapy for insomnia; insomnia; telehealth; veterans.

PubMed Disclaimer

Conflict of interest statement

All authors have seen and approved the submitted manuscript. Work for this study was performed at the Department of Veterans Affairs, Durham Healthcare System (data collection and processing), and Department of Veterans Affairs, Greater Los Angeles Healthcare System (data analysis). Jennifer L. Martin reports research funding from VA Greater Los Angeles Healthcare System, Geriatric Research, Education, and Clinical Center and a VA Health Services Research and Development Service (HSR&D) Research Career Scientist Award (RCS 20-191). Christopher de Beer reports research funding from the Department of Veterans Affairs Office of Mental Health and Suicide Prevention (OMHSP). Jennifer Runnals reports research funding from the Department of Veterans Affairs OMHSP. Philip Gehrman reports research funding from Merck, Inc.; is a paid consultant of Idorsia; and is on the scientific advisory board of Eight Sleep. The views in this article represent those of the authors and not the Department of Veterans Affairs or the federal government. The other authors report no conflicts of interest.

Figures

Figure 1
Figure 1. Evaluation and provision of CBT-I to veterans who received care from providers in the training cohort.
*Analytic sample excludes 13 individuals with missing data on their final ISI score, even though they completed CBT-I (defined as a documented clinical evaluation session plus 5 CBT-I treatment sessions or documentation of a treatment termination session). CBT-I = cognitive behavioral therapy for insomnia, ISI = Insomnia Severity Index.
Figure 2
Figure 2. Graphs showing noninferiority margins with observed differences and 90% confidence intervals.
ISI score change (A) and remission rates (C) were noninferior for telehealth alone as compared with some in-person CBT-I sessions, although treatment response rates did not meet the noninferiority threshold (B). CBT-I = cognitive behavioral therapy for insomnia, ISI = Insomnia Severity Index.
See this image and copyright information in PMC

References

    1. Alexander M , Ray MA , Hebert JR , et al. . The National Veteran Sleep Disorder Study: descriptive epidemiology and secular trends, 2000–2010 . Sleep. 2016. ; 39 ( 7 ): 1399 – 1410 . - PMC - PubMed
    1. Ryden AM , Martin JL , Matsuwaka S , et al. . Insomnia disorder among older veterans: results of a postal survey . J Clin Sleep Med. 2019. ; 15 ( 4 ): 543 – 551 . - PMC - PubMed
    1. Martin JL , Schweizer A , Hughes JM , et al. . Estimated rate of insomnia among women veterans: results of a postal survey . Womens Health Issues. 2017. ; 27 ( 3 ): 366 – 373 . - PMC - PubMed
    1. Colvonen PJ , Almklov E , Tripp JC , Ulmer CS , Pittman JOE , Afari N . Prevalence rates and correlates of insomnia disorder in post-9/11 veterans enrolling in VA healthcare . Sleep. 2020. ; 43 ( 12 ): zsaa119 . - PMC - PubMed
    1. Mysliwiec V , Martin JL , Ulmer CS , et al. . The Management of chronic insomnia disorder and obstructive sleep apnea: synopsis of the 2019 U.S. Department of Veterans Affairs and U.S. Department of Defense Clinical Practice Guidelines . Ann Intern Med. 2020. ; 172 ( 5 ): 325 – 336 . - PubMed

Publication types