mechanisms of change in cognitive behavioral therapy for insomnia (cbti)

Conditions: Sleep Initiation and Maintenance Disorders

Summary: the purpose of this study is to investigate the mechanisms of change in cognitive behavioral therapy for insomnia (cbti) in a sample of adults aged 50-65. this study aims to evaluate the pre-post treatment change in sleep, circadian rhythms, biomarkers, cognitive performance, and structural and functional magnetic resonance imaging scans (mri).

baseline part 1: * online demographic and contact information * schedule baseline part 2 with the investigators via online link * 1 week of daily sleep diaries baseline part 2: * internet-based interview with the investigators to confirm study eligibility requirements * online self-report questionnaires * 2 weeks of daily sleep diaries * 2 weeks of sleep/wake assessment wearing a watch-like activity monitor (actiwatch) objective baseline: * single-night, diagnostic in-home sleep study, including and the following equipment: * adhesive patch which will adhere to the arm * sensor belts worn around the chest, fitted with nasal canula, pulse oximeter, and 3 electrodes which will adhere to the back of the neck and behind each ear * next-day appointment: * neuropsychological assessment * structural and functional magnetic resonance imaging scan (mri) * non-invasive blood pressure readings * low-volume blood draw (used to obtain genetic biomarkers) * removal of adhesive patch * next-day evening (2-nights): * consumable capsule * sensor belt worn around the chest/abdomen random assignment: if it is determined the participant is eligible for the study, participants will be randomly assigned to one of the treatment groups (in-person, telehealth or internet delivered) or asked to wait to start treatment. treatment phase i: * participants will complete up to 12 weeks of insomnia treatment or wait for treatment ("waitlist") 12-week post-treatment part 1: * complete 2 weeks of an online daily sleep diary and actigraphy * complete online self-report questionnaires objective 12-week post-treatment: • repeat "objective baseline" outlined above treatment phase ii (wlc): * treatment will start for participants who had been assigned to the waitlist condition 3-month follow-up: * complete online self-report questionnaires

Eligibility criteria:
inclusion criteria: * aged 50-65 * normal hearing with or without hearing aids * ability to speak and read english and ability to give informed consent * possession of a computer with video and audio capabilities * meets dsm-5 criteria for insomnia disorder * internet speed sufficient for participating in teletherapy (e.g., zoom health) or shuti (for icbti group) * moca scores ≥24 will be deemed normal cognitive status and considered eligible for study participation and/or assessed by the ability to comprehend the baseline screening questionnaires * willing to refrain from new external behavioral health or medication treatment for issues pertaining to sleep during participation in the study * indication that the individual plans to be in the area for the 6 months following the first baseline assessment exclusion criteria: * failure to meet the above "inclusion criteria" * current circadian rhythm disorder, sleep deprivation, or hypersomnia and related sleep disorders (assessed with clinical interview and/or self-report) as cbti has not been validated in these populations. verified by self-report and/or clinical interview (scisd-r) * untreated sleep disordered breathing (e.g., obstructive sleep apnea) assessed by self-report, clinical interview, and/or diagnostic sleep study (i.e., baseline sleep study psg) * failing to meet criteria for mri scan (e.g., having metallic implants); see pre-screen mri checklist for full list of exclusions for mri scans. * fear/phobia of needles (conflict with blood draw) and/or small spaces (conflict with mri scanner) * current suicide risk meriting crisis intervention as assessed by the patient health questionnaire (phq-9) and/or disclosure of serious suicidal ideation * pregnancy (self-report, proposed instruments and treatments have not been validated in this population) * sleep efficiency \> 85%, assessed by the sleep diary * serious mental health diagnosis (e.g., bipolar disorder or psychosis) assessed by structured interview (m.i.n.i.) * currently engaged in evidence-based psychotherapy for insomnia (i.e., cognitive behavioral therapy) by self-report * failure to follow protocol (e.g., consistent "no show" for appointments, answering questionnaires dishonestly, refusal to complete more than 2 assessments \[e.g., fmri and neuropsych\])

Keywords: insomnia insomnia disorder cognitive behavioral therapy