Internet-Based Cognitive-Behavioral Therapy for Insomnia in Adults With Asthma: A Pilot Study

ABSTRACT

Background/Objective: Insomnia is common among adults with asthma and is associated with worse asthma control. Cognitive-behavioral therapy for insomnia (CBT-I) is an effective treatment for insomnia with medical comorbidities, but it has not been tested in asthma. The purpose of this study was to assess the feasibility and acceptability of an Internet-based CBT-I intervention, called Sleep Healthy Using the Internet (SHUTi), among adults with asthma and comorbid insomnia, and to gather preliminary efficacy data on changes in insomnia severity, sleep quality, asthma control, and asthma-related quality of life. Methods: A single-group, pretest–posttest design was employed, where all participants completed the SHUTi program. Online questionnaires were completed pre- and postintervention. Individual telephone interviews were conducted after posttreatment data collection to obtain participants’ experiences with SHUTi and suggestions for improvement. Results: The sample (N = 23) comprised men and women aged 18–75 years with moderate to severe, not well-controlled asthma, and comorbid insomnia. Nineteen (83%) completed postintervention assessments. Improvements on the Insomnia Severity Index, Pittsburgh Sleep Quality Index, Asthma Control Test, and Asthma Quality of Life Questionnair–Marks were observed at postintervention. Data from the telephone interviews suggest that most participants had a positive experience with SHUTi. Participants suggested incorporating asthma-specific content into future versions of the intervention. Conclusions: Internet-based CBT-I is a potential treatment option for adults with asthma and comorbid insomnia.

Acknowledgments

We would like to thank Miranda Kuzman, Grace Pinto, Mariana De Alba, and Chloe Minahan for their contributions.

Conflicts of Interest Disclosures

This was not an industry-funded study. F.S.L and S.M.S. have indicated no financial conflicts of interest. L.M.R. has equity ownership in BeHealth Solutions, LLC, a company developing and making available products related to the research reported in this publication. Specifically, BeHealth Solutions, LLC, has licensed the SHUTi program and the software platform on which it was built from the University of Virginia. The terms of this arrangement have been reviewed and approved by the University of Virginia in accordance with its conflict of interest policy. D.J.B. reports receiving consultation fees from Bayer HealthCare, BeHealth Solutions, Ebb Therapeutics, CME Institute, and Emmi Solutions. In addition, D.J.B. receives licensing fees (royalties) for the Pittsburgh Sleep Quality Index (PSQI), which is copyrighted by the University of Pittsburgh. S.E.W. reports grants and personal fees from AstraZeneca, grants from GSK, grants from Boehringer-Ingelheim, grants and personal fees from Sanofi Regeneron, grants from Novartis, grants from Merck, outside the submitted work. P.J.S. reports grants from Inspire Medical Systems and Jazz Pharmaceuticals, outside the submitted work, and receiving consultation fees from Inspire Medical Systems, Jazz Pharmaceuticals, Itamar Medical, National Football League, and Emmi Solutions.

Additional information

Funding

This study was supported by grants R03HL135213 and UL1TR001857 from the National Institutes of Health.