CBT-I is a nonpharmacological treatment that rapidly improves sleep quality by strengthening circadian rhythms (i.e., propensity to remain alert during the day and sleepy during night over a 24-h cycle), increasing the homeostatic sleep drive (i.e., increasing propensity for sleep through sustained and planned wakefulness), and alleviating insomnia-related anxiety. Ĭognitive behavioral therapy for insomnia (CBT-I) is recommended as the first-line treatment for insomnia by the American College of Physicians, the Veterans Affairs/Department of Defense (VA/DoD) insomnia treatment guidelines, and the American Academy of Sleep Medicine. Identifying and treating insomnia is especially crucial in vulnerable subgroups at greater risk for sleep disturbance, including older adults, patients with physical and mental health comorbidities, and veterans. Sleep is crucial for physical and mental functioning, and extended periods of sleep disturbance have harmful downstream consequences, including increased risk for inflammation and chronic pain, higher rates of suicide, and dementia. Insomnia is a debilitating, chronic condition that affects up to one third of the general population and involves difficulty falling or staying asleep and associated daytime dysfunction. Formal implementation trials are needed to systematically determine the real-world impact of strategies such as enlisting CBT-I champions, informing opinion leaders about CBT-I services, and promoting network weaving among primary care, mental health, and sleep clinics. These findings suggest promising opportunities to improve implementation of CBT-I, especially at facilities with less well-established CBT-I programs. Resultsįindings suggested implementation barriers and facilitators related to the CFIR constructs of intervention characteristic (e.g., providers unfamiliar with primary evidence of CBT-I effectiveness), inner setting (e.g., sleep as a low relative priority in primary care), and outer setting (e.g., lack of external incentives for increasing CBT-I use), as well as several successful strategies, including use of local champions and supportive opinion leaders. ![]() Data were concurrently collected and analyzed with rapid assessment process (RAP) techniques. We used a thematic analysis approach in which common ideas were identified across interviews and then grouped into larger conceptual themes. ![]() Semi-structured interviews, using the Consolidated Framework for Implementation Research (CFIR) as a guide, were conducted with 17 providers from five Veterans Affairs (VA) facilities (8 primary care physicians, 4 primary care psychologists, and 5 CBT-I coordinators). This work identifies barriers and successful strategies used to overcome these barriers to guide future implementation efforts promoting evidence-based sleep care. The goal of this study was to obtain a broad range of perspectives on CBT-I implementation from providers who commonly utilize and deliver CBT-I. This is particularly concerning for vulnerable populations, like older adults, who may be at increased risk of harms from medications. Despite increased access, most patients with insomnia receive sleeping medications instead of CBT-I. Over the last 10 years, the Veterans Health Administration (VHA) evidence-based psychotherapy training program has trained nearly 1000 providers to deliver CBT-I in hospitals and clinics nationwide. ![]() Up to one third of the general population struggles with chronic insomnia, greatly increasing the risk for chronic pain and inflammation, depression and suicide, and cognitive decline. Insomnia is a prevalent and debilitating public health concern. Cognitive behavioral therapy for insomnia (CBT-I) is a highly effective nonpharmacological intervention that is widely considered the gold standard for insomnia treatment.
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