online cognitive behavioural therapy for sleep and mental health for older adults with insomnia and subjective cognitive complaints

Conditions: Insomnia

Summary: the goal of this randomized controlled clinical trial is to assess a novel cognitive-behavioral program for sleep and mental health using a multidomain web platform (ecbti+) in participants with insomnia and subjective cognitive complaint. the main questions it aims to answer are: * whether the ecbti+ intervention improves sleep (subjective: insomnia severity index \[isi\], objective: eeg-based sleep efficiency) sleep and mental health (geriatric anxiety index \[gai\] and geriatric depression scale \[gds\]) compared to the control intervention * whether the ecbti+ intervention improves cognitive abilities (subjective: cognitive failure questionnaire \[cfq\], objective: cantab executive functions composite score) compared to the control intervention

participants with insomnia disorder will complete: * a phone interview * two video conferences (assessment of eligibility and tutorial to set up sleep monitoring devices) * 9 nights of at-home polysomnography with an eeg headband (3 times x 3 nights) * 42 sleep diaries (3 times x 14 days) * 42 days wearing an actigraphy device (3 times x 14 days) * online questionnaires * phone call for a check-in with a psychologist * 3 cognitive testing sessions * 10 modules of online information on health, over the course of 10 weeks * in mri subgroup: 2 in-person testing good sleeper participants will complete: * a phone interview * two video conferences (assessment of eligibility and tutorial to set up sleep monitoring devices) * 3 nights of at-home polysomnography with an eeg headband * 14 sleep diaries * 14 days wearing an actigraphy device * online questionnaires * 1 cognitive testing session * 1 in person session for mri. in addition, researchers will compare outcomes from participants with insomnia and subjective cognitive complaint to a group of good sleepers to have normative values for imaging data.

Eligibility criteria:
inclusion * age 60 years or older at the time of enrolment * sleep condition indicator, sci ≤ 16 and/or meeting dsm-v criteria based on the symptoms assessed by the sci * subjective cognitive complaints (self-report version of everyday cognition scale (ecog), score ≥ 2 on any item) * ability to read and understand french or english * ability to use a smartphone or tablet, and access to home internet connection * if on hypnotic or psychotropic medication (including cannabis), being on stable dosage for at least 2 months prior to study entry * score on the stop-bang questionnaire \< 3 corresponding to participants with low risk of obstructive sleep apnea exclusion * located outside of québec or ontario * current hospitalization or planned major surgery * uncorrected severe hearing or vision impairment * reported diagnosis of major neurocognitive disorder or mild cognitive impairment (mci) * performance suggestive of major neurocognitive disorder or mci on t-moca \< 17 * reported diagnosis of schizophrenia or bipolar disorder * reported diagnosis or positive screen on the mini for psychotic or bipolar disorders * high suicidal risk, as assessed by the modified columbia-suicide severity rating scale * reported diagnosis or positive screening (apnea-hypopnea index \>30 on a level 3 home sleep apnea test) for another untreated sleep disorder (e.g., sleep disordered breathing (osa), rem sleep behavior disorder (rbd), restless legs syndrome (rls); individuals with treated and controlled osa (residual apnea-hypopnea index \<30 and good therapeutic compliance) or rls will not be excluded * current shift work * currently receiving cbt, having received cbti in the past * frequent alcohol consumption having an impact on functionning (\>10 glasses/week and having a significant impact on functionning) * illicit drugs use (more than once a month) additional exclusion criteria for neuroimaging * psychotropic (including hypnotic) medication in the past 2 weeks * contraindications for mri (e.g., pacemaker, metallic implant, claustrophobia) * unable or unwilling to come to one of the participating mri centers (montreal, ottawa) * medical conditions likely to affect sleep; in particular: * current neurological disorder (e.g., epilepsy with any seizure in the past year, concussion in the past 3 months, multiple sclerosis, parkinson's disease) * past history of brain lesion (e.g., brain hemorrhage, brain tumor, any condition having required brain surgery) * major surgery (i.e., requiring general anesthesia) in the past 3 months * untreated thyroid disorder * chronic pain syndrome self-reported as interfering with sleep (e.g., migraine, fibromyalgia, rheumatoid arthritis) * recent and severe infection in the past 3 months (e.g., pneumonia, kidney infection) * active cancer or treated cancer with post-cancer treatment for less than 2 years inclusion/exclusion criteria for good sleepers twenty-five good sleepers without cognitive complaint will be recruited as controls for the mri session following the same criteria described above, except that sci ≥ 17, not meeting the diagnostic criteria for chronic insomnia as assessed by the insomnia module of the scid and no subjective cognitive complaint.

Keywords: insomnia cognition mental health subjective cognitive complaint sleep online cbt older adults anxiety depression executive functions electroencephalography magnetic resonance imaging