The Feasibility of Home-Based Estimation of Circadian Timing in Veterans With Insomnia and Past Traumatic Brain Injury.

OBJECTIVE

To evaluate the feasibility and acceptability (eg, user experience) of 2 methods for home-based estimation of circadian timing among veterans with insomnia and a history of traumatic brain injury (TBI).

SETTING

An outpatient setting at a Department of Veterans Affairs medical center.

PARTICIPANTS

Veterans between the ages of 18 and 64 years with current insomnia and a history of mild-to-severe TBI.

DESIGN

A prospective observational study evaluating the feasibility of 2 home-based methods for estimating circadian timing, that is, dim light melatonin onset (DLMO): (1) indirect prediction of DLMO using activity and light-exposure data collected through actigraphy (ie, pDLMO); and (2) estimation of DLMO via direct measurement of melatonin in self-collected salivary samples (ie, salivary DLMO). Participants wore an actigraphy device and completed sleep diaries for one week. They then spent one evening self-collecting 7 saliva samples under dim light conditions. Finally, participants completed a brief qualitative interview on their experiences.

MAIN MEASURES: Primary outcomes were the success rates for estimation of each home-based DLMO method. Feasibility was set as 70% successful estimation for a given measure, for those who completed the respective procedures.

RESULTS

pDLMO could be estimated for 27 of 29 participants (93.1%) who completed actigraphy data collection, meeting the feasibility goal. Salivary DLMO could only be estimated for 7 of 28 participants (25%) who completed saliva collection. Participants broadly expressed acceptance of both home-based DLMO methods and a willingness to use them again. Several barriers related to each method were identified that can inform future implementation efforts with this patient population.

CONCLUSION

pDLMO is feasible and acceptable for estimating circadian timing in veterans with insomnia and past TBI. Using pDLMO could help identify circadian-sleep misalignment after TBI, helping personalize insomnia treatments based on patient-specific needs and interrupting the bidirectional cycle of insomnia and circadian dysregulation.