0423 Insomnia Management Program in Primary Care Can Improve Subjective Sleep Quality and Insomnia Severity Index (ISI)

Abstract Introduction Insomnia is the most common sleep disorder affecting up to 30% of the US population with Chronic Insomnia at 10%. Cognitive behavioral therapy for insomnia (CBT-I) has been recommended as the first line treatment and standard of care by the American College of Physicians and American Academy of Sleep Medicine. The goal of CBT-I is to help remedy symptoms and improve sleep quality with the aim of eliminating the reliance on prescription medications. Nonetheless, the use of CBT-I is limited while the use of sleep medications remains high, up to 8% of the US population. The aim of this pilot was to test the use of self-guided CBT-I using mobile app (CBT-I Coach) to reduce chronic insomnia and decrease the need for new sleep aide prescriptions. Methods The one-arm pilot was conducted in a diverse, large university-based family medicine practice. Family medicine providers (n=11) received education on insomnia and recommended primary management with CBT-I. Patient recruitment was completed in 8 weeks and included both referrals and from chart reviews (ICD 10 codes for insomnia). Participants received sleep education including sleep hygiene education and insomnia management with a CBT-I mobile app. Results The 23 participants, aged 25 to 64, reported significant improvement in ISI from moderate to sub-threshold insomnia (baseline M=19.26, SD=3.60 to final M= 14.04, SD=7.0, paired t-test=4.47, df=22, p.001, Cohen’s d=.93). In response to the intervention, 54.5% assessed their insomnia as “improved”, 36.4% as “stable”, and only 9.1% as "worse.” 71.4% of those taking prescribed medications rated their insomnia as “stable”, 66.7% of those taking Melatonin rated their insomnia as “improved” and 66.7% of those taking nothing at all rated their insomnia as “improved.” Notably, for those taking any sleep aide or medication, there was neither an increase in dosage nor a new prescription during this study. Conclusion Primary care implementation of a self-guided insomnia management program delivered through the app CBT-I Coach can improve sleep quality and insomnia severity. This intervention can especially be beneficial for those taking nonprescription sleep aide (melatonin) or no medication at all. Support (if any)