Abstract Introduction Use of telemedicine platforms for conducting CBTI has the potential to reach more patients than in person treatment alone. While CBTI has been shown to be effective in older adults, questions about proficiency with technology and preference for treatment modality have not been addressed. Methods Baseline data from participants in the RCT of the Effectiveness of Stepped-Care Sleep Therapy In General Practice (RESTING) study were used. Analyses compared CBTI treatment modality preference (in person, online [video platform], no preference) across the following variables: insomnia severity (Insomnia Severity Index; ISI), depression (Geriatric Depression Scale; GDS), cognitive functioning (telephone-based cognitive screen) and internet proficiency (IP; assessing comfort with and frequency of internet use). Data collected prior to the pandemic-shut down (March 2020) were utilized for the primary analysis of treatment preference; n=71, mean age = 62.5 (SD = 8.1); 64.8% female; treatment preferences: in person (33.8%), no preference (25.4%), online (40.8%). A secondary analysis compared IP data from participants with baseline data from pre-pandemic (Nov 2019-Feb 2020, n=71), early pandemic (March-June 2020, n=28), and late pandemic (the most recent four months of enrollment, July 2020-Nov 2020, n=40) periods. Results Pre-pandemic, age was not significantly associated with treatment modality preference, nor any baseline clinical characteristics or demographic variables (p’s >.01). Only ‘comfort’ and ‘comfort+frequency’ scores from the internet proficiency measure differed significantly between treatment preference groups (p’s<.002). Post-hoc analyses revealed the online group had significantly higher comfort and comfort+frequency scores than the in person group (p’s<. 003). Comparing data from pre-pandemic, early pandemic, and late pandemic, frequency of internet use and comfort+frequency with internet use differed across groups (p’s <.004). Post-hoc comparisons revealed frequency of internet use scores were higher in the late pandemic compared to pre-pandemic (p=.003). Conclusion These findings suggest that comfort using technology, but not age or clinical characteristics, is associated with treatment modality preference for patients with insomnia who are enrolled in a technology-based clinical trial of CBTI. As proficiency in use of technology increases, for example, during and following the pandemic, one can expect that telemedicine will be an increasingly viable approach to providing CBTI among older adults. Support (if any) 1R01AG057500
Abstract Introduction Prevalence of insomnia and prescription of sleep medications increases in older adults and is associated with heightened risk of falls, cognitive and psychomotor detriments, and exacerbation of pre-existing conditions. The present study aimed to characterize beliefs about sleep and sleep medications, hypnotic self-efficacy, and hypnotic dependence in a sample of older adults with insomnia disorder. Methods Adults 50 years and older (N = 141) who met DSM-5 criteria for insomnia disorder were enrolled in the RCT of the Effectiveness of Stepped-Care Sleep Therapy In General Practice (RESTING) study. At baseline, participants completed the Beliefs about Medications Questionnaire (BMQ; subscales assess the belief that hypnotics are necessary and concern regarding consequences of use), Insomnia Severity Index (ISI), Dysfunctional Beliefs and Attitudes about Sleep Scale (DBAS), Pre-Sleep Arousal Scale (PSAS), and the Patient Health Questionnaire-4 (PHQ-4). Participants taking prescription sleep medications (n = 54) also reported if they had sedative hypnotic reduction goals and completed the Sleep Medications Dependency Scale and Hypnotic Self-Efficacy Scale. Results Those taking prescription sleep medications reported greater belief in the necessity of sedative hypnotics (p < .001, d = 1.69) and greater anxiety and depression (p = .005, d = .57) than those not taking prescription medications; groups did not differ significantly on the BMQ concern subscale, ISI, DBAS, or PSAS. 70.4% of participants using prescription sleep medications endorsed decrease in sedative hypnotic use as a treatment goal. Dependency on sleep medications, but not hypnotic self-efficacy, was greater in those with this goal (p = .003, d = .94). Higher levels of hypnotic dependence were associated with both greater concern (r = .40, p = .003) and belief in the necessity of sleep medications (r = .48, p < .001). Conclusion Our findings indicate that many treatment-seeking older adults with insomnia disorder take prescription sleep medications. They tend to believe in the necessity of sleep medications for controlling sleep disruption, but also identify medication reduction as a treatment goal, even if endorsing dependence on hypnotics. This highlights the importance of disseminating non-medication treatments that address both insomnia and reduction of sedative hypnotic use. Support (if any) 1R01AG057500
Insomnia and pain have been shown to increase risk for development of depression and substance use disorders. Depression, substance use, stress, and pain are also strongly correlated with sleep impairment. No studies have examined associations between insomnia, pain, stress, substance use, and depression in a sample of nurses, who may experience these disturbances due to stressful work environments, intense physical demands, and rotating work schedules. Therefore, the present study examined if insomnia symptoms, pain symptoms, and perceived stress were associated with alcohol use and depressive symptoms in nurses, and if insomnia diagnosis moderated these associations. Participants were 400 nurses (92% female; 78% white, mean age = 39.51 ± 11.13) recruited from two hospitals for a parent study, “Sleep and Vaccine Response in Nurses (SAV-RN)” (R01AI128359-01, PIs: Taylor & Kelly). Participants completed measures of depression, pain, insomnia, and stress. Linear regression was used to assess the associations between insomnia symptoms, stress, and pain with depressive symptoms and substance use. Insomnia diagnosis (based on diagnostic cutoffs from questionnaire data) was examined as a moderator of the associations between pain, stress, depressive symptoms, and substance use. Greater insomnia symptoms were associated with consuming fewer drinks per week (p = .04), and greater perceived stress was associated with consuming more drinks per week (p = .01). Greater insomnia symptoms, perceived stress, and pain were each associated with greater depressive symptoms (ps < .001). Insomnia diagnosis moderated the association between perceived stress and depressive symptoms (β = 0.11, p = .05), such that nurses with insomnia disorder had a stronger positive relationship between perceived stress and depressive symptoms. Results suggest insomnia symptoms, stress, and pain were associated with greater mood disturbance. Greater stress was associated with greater substance use, which may reflect coping attempts. Nurses with insomnia may be particularly susceptible to increases in depressive symptoms under times of stress. Given that nurses are the first-line of care in hospital settings, it is essential to address these problems proactively and comprehensively. NIAID R01AI128359-01
Abstract Introduction Prior research has demonstrated a relationship between screen time and sleep health, but more work is needed to understand the potential impact of reason for screen time and timing (i.e., weekend vs. weekday). This study aimed to determine whether screen time, and reason for use, was associated with insomnia symptoms in a sample of university students during the school term. Further, we sought to determine whether effects differed by weekend/weekday. Methods Participants were 767 enrolled students from two universities (age x̄=20.94 [SD=5.25]; 74% women). Insomnia symptoms were assessed with the Insomnia Severity Index (ISI); screen time was a self-report of average daily screen time for a variety of purposes (productivity, social media, streaming media, browsing the internet, or video games) on weekdays/workdays and weekends/off days. Results A total of 16.4% of the sample had insomnia symptoms in the clinical range (ISI x̄=9.1 [SD=5.3]). Participants reported 10.0 hours (SD=4.5) of screen time per day on weekdays and 10.8 hours (SD=5.2) per day on weekends. During the week, the most screen time (44%; x̄=4.4 [SD=2.6] hours/day) was spent on productivity (work or school). On weekends, the most screen time (30%; x̄=3.3 [SD=2.1] hours/day) was spent on streaming media. More screen time on the weekends was associated with greater insomnia symptoms (r=.10, p=.004), but not during the week (r=.05, p=.185). Regression analyses indicated weekend screen time accounted for 2% of the variance in insomnia symptoms, and this relationship was driven by screen time for productivity (beta=.09, p=.017) and video games (beta=.09, p=.019). Conclusion Among university students, self-reported screen time during the week was not associated with elevated insomnia symptoms. Weekend screen time, particularly for the purpose of productivity and video games, was associated with elevated insomnia symptoms though the effect was small. Although screen time is often highlighted as a key contributor to poor sleep health, this impact was minimal in the current study. Future work should continue to examine whether different motivations for screen time is associated with various facets of sleep health, and delineate these associations by weekend vs. weekday. Support (If Any) None
Abstract Introduction Digital CBTI programs are effective at treating symptoms of insomnia. They also have the potential to increase treatment reach, convenience, and affordability for patients, and to reduce long wait times for behavioral sleep medicine providers. The COVID-19 pandemic has instigated an increased reliance on the use of technology for many. Thus, this study evaluates middle aged and older adults before and during the COVID-19 pandemic to assess: (1) differences in treatment modality preference (digital vs. therapist-led CBTI) and (2) sleep-related predictors of treatment modality preference. Methods Participants were older adults (N=229, 74% female, mean age=63.14) who were enrolled in the RCT of the Effectiveness of Stepped-Care Sleep Therapy in General Practice (RESTING) study. At baseline, participants rated if they would prefer to access CBTI digitally or with a CBTI therapist, either in person or via telemedicine. After March 2020, in person was no longer listed as an option. Participants completed the Insomnia Severity Index (ISI) and a two-week sleep diary that allowed for an assessment of total sleep time (TST), sleep onset latency (SOL), and wake after sleep onset (WASO). Analyses compared responses to these items from participants completing assessments before March 2020 (Pre-Covid; n=74, 65% female, mean age=62.52) and after March 2020 (During-Covid; n=155, 78% female, mean age=63.44). Results Pre-Covid, 26% of participants preferred digital treatment, 47% of participants preferred a therapist-led intervention, and 27% did not express a preference. During-Covid, 35% of participants preferred digital treatment, 32% of participants preferred a therapist-led intervention, and 32% did not express a preference. This difference was statistically significant (c2=4.24, p=0.04). Responses were not significantly different between the first six months and the most recent six months of the pandemic (p=0.60). None of the sleep measures (ISI, TST, SOL, WASO) were associated with treatment modality preference in the full sample, Pre-Covid, or During-Covid. Conclusion The COVID-19 pandemic was associated with increased preference for digital CBTI among patients who are 50 and older, regardless of insomnia severity. Findings suggest that digital CBTI may be an acceptable treatment to many individuals with insomnia, thus increasing its dissemination potential. Support (If Any) R01AG057500 and T32MH019938
Technology has the potential to increase access to evidence-based insomnia treatment. Patient preferences/perceptions of automated digital cognitive behavior therapy for insomnia (CBTI) and telehealth-delivered CBTI remain largely unexplored among middle-aged and older adults. Using a qualitative approach, the current study describes patients' reasons for participating in the clinical trial, preferences for digital CBTI (dCBTI) versus therapist-led CBTI, patient attitudes toward dCBTI, and patient attitudes toward telehealth-delivered therapist-led CBTI.
