A pilot trial for veterans with alcohol use disorder (AUD) who report symptoms of insomnia will test the feasibility and acceptability of cognitive behavioral therapy for insomnia (CBT-I). The protocol for this study was published in BMJ Open.
Symptoms of insomnia have been reported by 74% of veterans seeking treatment for AUD, the treatment of which has been found to be negatively affected by sleep disturbances. CBT-I has been shown to effectively treat chronic insomnia among veteran populations.
This study was designed to test for the feasibility of incorporating CBT-I in the AUD care setting among veterans with the objective of enhancing alcohol treatment. On the basis of published studies, the authors anticipate moderate to large effects on insomnia severity and small effects on drinking frequency and quantity.
The study will recruit 80 veterans enrolled in the Addictions Treatment Programme at the Harry S Truman Memorial Veterans’ Hospital in Missouri between 2019 and 2021. Eligible individuals will have met the criteria for moderate to severe AUD, for acute to chronic insomnia disorder, and have used substances during the past 2 months.
In this study, insomnia will be defined as difficulty falling asleep or staying asleep at least 3 nights per week for at least 1 month; additionally, this must be accompanied by daytime impairment.
The study participants will be randomly assigned to receive 5 CBT-I sessions or 1 session of sleep hygiene education in addition to the AUD treatment. Participants will complete assessments at baseline, after treatment, and 6 weeks.
The study was designed to be conducted in person but was switched to remote interventions via the telephone or the Department of Veterans Affairs’ Video Connect service due to the remote location of the study site.
The CBT-I intervention will follow the established protocols published in the 2014 CBT-I in Veterans manual. Participants will be instructed to limit naps, avoid caffeine, tobacco, alcohol, and rich foods before bedtime, to exercise, and establish a bedtime routine.
Each week the percentage of time spent in bed will be titrated based on sleep efficiency. Stimulus in the bedroom will be addressed to limit arousal. Veterans will be guided through relaxation exercises and will undergo CBT, identifying thoughts which interfere with sleep.
The sleep hygiene session will involve reviewing a 1-page handout about sleep hygiene with a therapist for 15 to 30 minutes.
At the study conclusion participants will respond to the 8-item Client Satisfaction Questionnaire, 7-item Insomnia Severity Index, and will undergo a Timeline Followback interview in order to assess feasibility and acceptability of the CBT-I intervention among veterans in AUD treatment.
Miller MB, Metrik J, McGeary JE, et al. Protocol for the Project SAVE randomised controlled trial examining CBT for insomnia among veterans in treatment for alcohol use disorder. BMJ Open. 2021;11(6):e045667. doi:10.1136/bmjopen-2020-045667