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Abstract Introduction Treatment adherence has been a proposed barrier to the success of digital CBT-I (dCBT-I). Adherence to sleep restriction may be particularly important for treatment gains. One model of improving treatment adherence is to enhance dCBT-I with a nurse coach. This study compared adherence to sleep restriction between those with and without access to a nurse coach. Methods 288 individuals with insomnia (DSM-5 diagnostic criteria) were randomized into two conditions: enhanced dCBT-I (access to a nurse coach: n=148) and control (online program only: n=140). Those in the coaching model had an initial consult with the nurse coach focused on motivational enhancement, and then received feedback via email after each session based on sleep diary reports. Those who miss two consecutive sessions were stepped-up to telehealth coaching focused on implementing sleep restriction. All participants included in this preliminary analysis completed at least 3 sleep diary entries per week throughout the study. Sleep restriction was measured with sleep diary data, operationalized as the change in standard deviation of time in bed and wake time before and after the introduction of sleep restriction. Results Results indicate that those in the coaching group showed a greater mean reduction in the standard deviation of time in bed (coaching group: -53.3 min, control reduction: -35.9 min; Cohen’s d = 0.23). Similarly mean changes in standard deviations of wake time was greater in the coaching group compared to the control group (coaching group: -19.0 min, control reduction: 1.2 min; Cohen’s d = 0.22). Conclusion Results provide preliminary support that enhancing dCBT-I with nurse coaching may produce better adherence to sleep restriction. Future research should include sensitivity analyses, and examine the relationship between adherence to sleep restriction and improvements in symptoms. Support (if any) Support for this study was provided from the National Heart Lung and Blood Institute R01HL159180 awarded to Dr. Philip Cheng.
Bayoneto et al. (Sat,) studied this question.