This approach involves collecting detailed data on resources utilized and the unit costs of those resources, thereby revealing actual resource use and economic costs for each treatment arm. Micro-costing was used to itemize and abstract costs of the two interventions: a mindfulness-based intervention known as mindful awareness practices for insomnia (MAP-I) and CBT-I. The present report examines estimated intervention costs in this ongoing trial. An ongoing randomized non-inferiority clinical trial, the Caregiver Sleep Research study, is evaluating whether mindfulness meditation is non-inferior to cognitive behavioral therapy for insomnia (CBT-I) in the treatment of insomnia in AD caregivers. Research on insomnia treatment efficacy in AD caregivers is limited. Trial Registration ClinicalTrials.Among the over 5 million informal caregivers for patients with Alzheimer’s disease (AD) in the United States (US), over 60% experience insomnia. CBT-I should be considered a first-line treatment for insomnia, regardless of abstinence. No group differences emerged for abstinence or heavy-drinking frequency.Ĭonclusions and Relevance In this randomized clinical trial, CBT-I outperformed sleep hygiene in reducing insomnia symptoms and alcohol-related problems over time but had no effect on frequency of heavy drinking. ![]() They also reported greater decreases in alcohol problems at follow-up (group × time interaction: −0.84 95% CI, −1.66 to −0.02), and this effect was mediated by posttreatment change in insomnia severity. ![]() Relative to sleep hygiene, CBT-I participants reported greater decreases in insomnia severity at posttreatment (group × time interaction: −3.70 95% CI, −6.79 to −0.61) and follow-up (−3.34 95% CI, −6.46 to −0.23) and greater improvements in sleep efficiency (posttreatment, 8.31 95% CI, 1.35 to 15.26 follow-up, 18.03 95% CI, 10.46 to 25.60). Of those randomized, 59 (88%) provided posttreatment or follow-up data (31 CBT-I, 28 sleep hygiene). The CBT-I group included 32 participants, and the sleep hygiene control group 35 participants. Results The study cohort included 67 veterans with a mean (SD) age of 46.3 years (11.8) 61 (91%) were male and 6 (9%) female. Posttreatment insomnia severity was tested as a mediator of CBT-I effects on alcohol use outcomes at the 6-week follow-up. Main Outcomes and Measures Primary outcomes included posttreatment insomnia severity (assessed using the Insomnia Severity Index) and follow-up frequency of any drinking and heavy drinking (4 drinks for women, ≥5 drinks for men number of days via Timeline Followback) and alcohol-related problems (Short Inventory of Problems). Participants were asked to complete sleep diaries for 7 days at each assessment. ![]() Interventions Participants were randomly assigned to receive 5 weekly sessions of CBT-I or a single session about sleep hygiene (control). Follow-up visits occurred posttreatment and at 6 weeks. Patients in treatment for AUD were eligible if they met criteria for insomnia disorder and reported alcohol use in the past 2 months at baseline. Objective To test the feasibility, acceptability, and preliminary efficacy of CBT-I among veterans early in their AUD treatment and to examine improvement in insomnia as a mechanism for improvement in alcohol use outcomes.ĭesign, Setting, and Participants For this randomized clinical trial, participants were recruited through the Addictions Treatment Program at a Veterans Health Administration hospital between 20. Yet the first-line treatment for insomnia (cognitive behavioral therapy for insomnia, CBT-I) is often delayed until abstinence is established. Importance Three of 4 adults in treatment for alcohol use disorder (AUD) report symptoms of insomnia.
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