November, 2008
Telephone Intervention for Chronic Insomnia in Primary Care
U-M Depression Center member, Dr. Todd Arnedt was recently awarded a grant for his new research project studying chronic insomnia sufferers and the use of telephone-delivered intervention and therapy. Funding for this grant was provided by the University of Michigan Department of Psychiatry, the Department of Internal Medicine-Geriatrics, the Department of Family Medicine, and the Michigan Institute for Clinical and Health Research (MICHR).
Insomnia, a chronic nighttime problem for more than 50 million adults, impairs quality of life, exacerbates chronic medical conditions, and increases psychiatric illness risk. Total healthcare costs of insomnia are as high as $108 billion annually. Most insomnia sufferers present in primary care, where hypnotics are first-line treatments. Limitations of pharmacotherapy include adverse side effects, limited long-term efficacy data, and safety concerns with certain patients. Cognitive-behavioral therapy for insomnia (CBTI) yields equivalent short-term efficacy and superior long-term durability to hypnotics, yet several barriers have limited its integration into primary care. Telephone-delivered interventions are efficacious for promoting other health behaviors and are well-suited to busy, space-limited primary care practices.
The primary aims of this project are to (1) compare the efficacy of a telephone-delivered cognitive-behavioral therapy for insomnia – primary care (CBTI-PC) intervention to a healthy sleep information pamphlet (HSIP) for improving self-reported sleep quality; and (2) determine the efficacy of CBTI-PC for improving self-reported daytime functioning and quality of life. Secondary aims will focus on the feasibility of developing and implementing CBTI-PC. Thirty UMHS primary care patients with DSM-IV primary insomnia will be randomized to CBTI-PC or HSIP. CBTI-PC will be delivered by a CBTI-experienced interventionist in up to eight treatment sessions, depending on treatment progress; HSIP participants will be instructed to follow recommendations in a healthy sleep pamphlet.
Outcome measures focused on self-reported sleep quality and daytime impairment will be administered at pre-treatment, post-treatment, and at 12-week follow-up. An efficacious, time-limited, cost-effective, widely available nonpharmacological insomnia treatment has the greatest potential of being implemented in primary care, curtailing healthcare costs, and improving public health. This Type II Collaborative Grant application proposes an innovative bedside to practice project that will be used to justify R01 funding to compare the efficacy and cost-effectiveness of CBTI-PC to other nonpharmacological and pharmacological insomnia treatments.
