Journal article
Cognitive behavioral therapy for insomnia among heavy-drinking veterans: a randomized pilot trial
Sleep advances, Vol.6(2), zpaf037
04/2025
DOI: 10.1093/sleepadvances/zpaf037
PMCID: PMC12199704
PMID: 40575624
Abstract
Study Objectives
Two in five Veterans report symptoms of insomnia, with higher rates among those who drink heavily. Although Cognitive Behavioral Therapy for Insomnia (CBT-I) has demonstrated efficacy among those with Alcohol Use Disorder, abstinence is often considered a prerequisite for treatment, leaving its impact unclear among those who are actively drinking. This trial tested the efficacy of CBT-I among heavy-drinking Veterans with insomnia (#NCT03804788).
Methods
Veterans from across the United States were randomly assigned to CBT-I or sleep hygiene control. Participants completed retrospective surveys and 14 sleep diaries at baseline, post-treatment, and 3-month follow-up. Primary outcomes were feasibility and insomnia severity. All other outcomes are secondary/exploratory. Intent-to-treat analyses were conducted using multilevel models.
Results
Recruitment spanned June 2019 to March 2023 (N = 71, 80% male, M = 38 years). On average, we recruited 4 participants per month, with retention of 86% at post-treatment and 90% at follow-up. Of 38 CBT-I participants, 33 (87%) completed all 5 treatment sessions, and most responded to treatment (based on change in outcome scores; 22/38 at post, 27/38 at follow-up). Relative to control (n = 33), CBT-I participants reported large improvements in insomnia severity, both post-treatment [d = 1.26 (95% CI: 0.74, 1.76)] and at 3-month follow-up [d = 1.33 (95% CI: 0.81, 1.84)]. At follow-up, results for use of alcohol as a sleep aid [d = 0.66 (95% CI: 0.18, 1.14)] and sleep medication [d = 0.44 (95% CI: −0.03, 0.91)] also favored CBT-I.
Conclusions
CBT-I is feasible among heavy-drinking Veterans and has large effects on insomnia severity. Studies testing mechanistic effects on alcohol outcomes are warranted.
Details
- Title: Subtitle
- Cognitive behavioral therapy for insomnia among heavy-drinking veterans: a randomized pilot trial
- Creators
- Mary Beth Miller - University of MissouriRyan W Carpenter - University of Notre DameSydney D Shoemaker - University of MissouriKatie R Moskal - University of MissouriBrian Borsari - San Francisco VA Health Care SystemEric R Pedersen - University of Southern CaliforniaBruce D Bartholow - University of IowaDouglas Steinley - University of MissouriChristina S McCrae - University of South Florida
- Resource Type
- Journal article
- Publication Details
- Sleep advances, Vol.6(2), zpaf037
- DOI
- 10.1093/sleepadvances/zpaf037
- PMID
- 40575624
- PMCID
- PMC12199704
- NLM abbreviation
- Sleep Adv
- ISSN
- 2632-5012
- eISSN
- 2632-5012
- Publisher
- Oxford University Press
- Grant note
- American Academy of Sleep Medicine FoundationNational Institute on Alcohol Abuse and Alcoholism: K23AA026895, K23AA029729 NIH
This work was supported by funding from the American Academy of Sleep Medicine Foundation and the National Institute on Alcohol Abuse and Alcoholism (grant number K23AA026895). Investigator effort was also supported by K23AA029729. NIH had no role in study design; data collection, analysis, or interpretation; manuscript preparation; or the decision to submit the paper for publication. The content is solely the responsibility of the authors and does not necessarily represent the official views of NIH, the Department of Veterans Affairs or the United States Government. The authors have no conflicts of interest to report.
- Language
- English
- Date published
- 04/2025
- Academic Unit
- Psychological and Brain Sciences; Iowa Neuroscience Institute
- Record Identifier
- 9984833484002771
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