An innovative hybrid cognitive behavioral therapy for insomnia approach to insomnia treatment: a retrospective chart review study.

BACKGROUND

Insomnia is a common and significant concern within family medicine; however, there is limited access to qualified sleep specialists trained in the first-line treatment: cognitive behavioral treatment for insomnia (CBT-I). Technology advancements allowed for "app delivery" of CBT-I, but platforms do not customize treatment. To our knowledge, DrLullaby was the first to offer a hybrid approach, to improve behavioral sleep medicine access, through "tech-enabled services," including telehealth sessions alongside our sleep data portal. We hypothesized that this approach would yield improved sleep outcomes.

METHOD: A retrospective chart review of patients who engaged in hybrid CBT-I treatment (n = 155) was performed. The sample was split into two groups based on treatment protocol: (G1) hybrid CBT-I, non-sleep medication tapering (n = 113) and (G2) sleep medication tapering (n = 42). CBT-I-trained clinicians provided virtual insomnia treatment and assigned lessons in the sleep data portal for support between sessions. Self-reported sleep log and medication tapering (for G2) data were analyzed pre-and-post treatment using one-way repeated-measures ANOVA.

RESULTS

Sleep metrics significantly improved from baseline to posttreatment for the hybrid CBT-I group, including total sleep time, sleep onset latency, wake after sleep onset, and sleep efficiency (Ps < 0.001). Almost 67% of patients in the sleep medication tapering group completely discontinued their sleep medication(s).

CONCLUSIONS

DrLullaby's hybrid approach resulted in a significant reduction of insomnia symptoms and sleep medication dosage. Virtual delivery of tech-enabled CBT-I, alongside sleep medication tapering, may be a viable referral option for family medicine clinicians who otherwise lack access to the first-line insomnia treatment.