Mobile Sleep Intervention for OEF, OIF and OND Veterans
Condition: Chronic Insomnia
MeSH terms: Sleep Initiation and Maintenance Disorders
Study type: Interventional

Summary: 
      Many Veterans of the recent wars in Iraq and Afghanistan struggle with chronic insomnia
      (trouble falling or staying asleep). Most current interventions for insomnia are
      time-consuming, making it difficult for this younger, working group of Veterans to use and
      benefit from these interventions. The investigators will assess whether Veterans find it
      helpful to use two health information technology tools, one for measuring participant sleep
      (the WatchPAT) and one for managing participant sleep (the CBTI Coach). The WatchPAT will
      measure physiological sleep in the Veteran participant's home. The CBTI Coach is a mobile
      health application used on the Veteran's mobile phone or tablet to teach skills that can
      reduce insomnia. The investigators will combine use of the WatchPAT with the CBTI Coach so
      Veterans can self-manage insomnia at home. Participants will record their physiological sleep
      and self-report on their sleep at home during a 6 week self-management program. The
      investigators will measure if Veterans find the tools helpful and easy to use, and which
      Veterans find the tools most helpful.
    

Detailed description: 
      Sleep disturbance in the form of chronic insomnia (difficulty in falling or staying asleep)
      is a major health care problem for Operation Enduring Freedom (OEF), Operation Iraqi Freedom
      (OIF), and Operation New Dawn (OND) Veterans. Chronic insomnia is often co-morbid with mental
      and behavioral health issues such as posttraumatic stress disorder (PTSD) and mild traumatic
      brain injury (mTBI), which are common in these Veterans. Current behavioral interventions
      like cognitive behavioral therapy for insomnia (CBTI) that are used to treat chronic insomnia
      are effective, but time-consuming. As a result, this largely younger, working cohort of
      Veterans does not use and benefit from these interventions as much as they could. The
      investigators will assess the usability and feasibility of two health information technology
      (HIT) tools for measuring objective and subjective sleep, and for self-managing chronic
      insomnia. An existing mobile sleep monitoring device used by some VA sleep clinics, the
      WatchPAT, will be used to measure objective sleep parameters in the Veteran's home. A benefit
      of this tool is that it can detect probable sleep apnea, which will permit referral of these
      Veterans for sleep apnea treatment instead of insomnia self-management. An existing VA mobile
      health application (or app), the CBTI Coach, can be used on a mobile device to teach skills
      to reduce insomnia based on the elements of manualized CBTI. The goal is to combine the
      WatchPAT and the CBTI Coach along with self-management guidance to help Veterans with chronic
      insomnia learn how to improve their sleep. As part of a 6-week pre-post intervention pilot
      usability and feasibility trial, patients will record their objective and subjective sleep at
      home at the beginning of the 6-week self-management trial and again at the end. Subjective
      sleep reports in the form of sleep diaries will be measured throughout the program as part of
      using the CBTI Coach app. The objective and subjective sleep reports will be combined and
      accessible from the mobile device and can be used to help guide sleep self-management by the
      participant. Self-management will be aided by self-management worksheets and features of the
      CBTI Coach App. Usability of the two HIT tools will be assessed within the conceptual
      framework of an Integrated Technology Acceptance Model via survey items about each of the HIT
      tools. Feasibility will be assessed using measures of the number of times that elements of
      the CBTI Coach were accessed during the 6-week program, and from a semi-structured
      qualitative interview conducted at the end of the program. In the interview, the
      investigators will obtain information about the barriers to and facilitators of use of the
      WatchPAT and CBTI Coach. If there is high use of these tools for insomnia self-management,
      then the pilot study will have provided important incremental value to the new VA CBTI Coach
      app. The investigators also will collect data about the user factors that impact use of the
      tools (e.g., depression, mild traumatic brain injury, age), and thereby either be able to
      target the tools toward those most likely to use them, or suggest further developments to
      increase use by potential users. The pilot sample will provide preliminary data on sleep
      outcomes. The proposed work is responsive to multiple priority areas for HSR&D including
      Healthcare Informatics, Healthcare Access, Mental and Behavioral Health, and Post-deployment
      Health. By partnering with the VA Office of Connected Health (Web and Mobile Solutions), the
      VA's eHealth QUERI, and the developers of the VA CBTI Coach App, the investigators will
      ensure that these findings are maximally useful for future versions of the CBTI Coach app.
      The investigators also will be able to determine the usefulness of an integrated mobile sleep
      assessment and self-management program that can be used by Veterans anywhere.
    

Intervention name(s): WatchPAT sleep monitor; CBT-i Coach mobile app
Intervention type(s): Device; Behavioral
Intervention description(s): Self-management of insomnia using a mobile sleep device; Self-management of insomnia using a mobile app based on Cognitive Behavioral Therapy for Insomnia
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: chronic insomnia; Veterans Health