Internet-Based Cognitive Behavioral Therapy for Insomnia in Appalachian Women: A Pilot Study

ABSTRACT

Objective/Background

Appalachian women are disproportionately affected by insufficient sleep but live in a healthcare shortage area with prevalent prescription drug abuse. A self-administered, non-pharmacologic intervention such as Internet-based cognitive behavioral therapy for insomnia (CBT-I) may be ideal in this population, but psycho-social characteristics (e.g., high depression rates) and cultural norms (e.g., suspicion of technology) necessitate a pilot study. We evaluated the effectiveness of Sleep Healthy Using the Internet (SHUTi) on insomnia severity, sleep quality, perceived stress, depression symptoms, and sleep aid use in Appalachian women ages 45 +.

Participants

Forty-six women enrolled; 38 completed the six-week intervention in 2018 (mean age 55 years).

Methods

We employed a single group, pre/post-test, mixed-methods design. Participants completed an online survey and a qualitative interview pre- and post-intervention. Quantitative data were analyzed using one-way repeated measures ANOVA or generalized estimating equations. Interviews were qualitatively analyzed using a multi-stage coding process.

Results

Positive and statistically significant (p < .01) improvements were observed on mean scores for the Insomnia Severity Index (15.1 to 6.5), the Pittsburgh Sleep Quality Index (12.1 to 8.5), the Perceived Stress Scale (20 to 14.6), and the Center for Epidemiologic Studies Depression Scale Revised (9.8 to 5.2). The odds of reporting sleep medication use post-intervention were significantly lower than pre-intervention (OR 0.28 [95% CI 0.11–0.74]). Interviews highlighted most and least helpful intervention components and suggested that participants benefitted from SHUTi.

Conclusions

Internet-based CBT-I may be a useful, non-pharmacologic treatment that reduces insomnia severity, perceived stress, depression symptoms, and sleep aid use in middle-aged Appalachian women.

Disclosure statement

No potential conflict of interest was reported by the authors.

Notes

¹ Due to geographic location, underserved rural status, and higher rates of disease, death, and suffering, compared to the general population, Appalachian women fit the NIH criteria for a health disparities population. https://www.nimhd.nih.gov/about/overview/.

Additional information

Funding

This work was supported by the Building Interdisciplinary Research Careers in Women’s Health Program under NIDA Grant K12DA035150, pilot funding from the Igniting Research Collaborations Grant (University of Kentucky College of Pharmacy) and the University of Kentucky Center for Clinical and Translational Sciences under Grant UL1TROO1998;National Institute on Drug Abuse [K12DA035150];University of Kentucky College of Pharmacy [Igniting Research Collaborations Grant];Center for Clinical and Translational Science, University of Kentucky [UL1TROO1998].