P055 Maintaining effectiveness and mitigating sleepiness: A tailored digital CBT-i approach.

BACKGROUND: Bedtime restriction therapy, a core component of cognitive behavioural therapy for insomnia (CBT-i), often leads to an acute increase in daytime sleepiness. To mitigate the effect of bedtime restriction on accident-risk, we aimed to develop and test a 5-session self-guided digital CBT-i program that incorporates self-reported sleepiness into personalised treatment algorithms. METHODS: We recruited people with insomnia symptoms (ISI≥15) reporting no excessive daytime sleepiness (ESS<16) to a clinical trial. We assessed weekly self-reported sleepiness (ESS), nocturnal insomnia severity (Range: 0 [no symptoms] to 12 [worst symptoms]), and self-reported sleep/wake parameters during each digital CBT-i session. Intention-to-treat mixed models were used to investigate changes in weekly symptoms. RESULTS: Peri-treatment data from 52 people were used (Age M [sd] = 54.2 [15.7]; 81% female). Average ESS scores did not change from session one (M [±95%CI] = 5.9 [1.1]) to sessions two (6.2 [1.1]), three (6.2 [1.2]), four (5.4 [1.2]), or five (5.2 [1.2]). Improvements from sessions one to five were observed in; nocturnal insomnia severity (M [±95%CI] reduction = 4.0 [1.1], d = 2.3), and self-reported sleep onset latency (M reduction = 26.1 minutes [16.5], d = 0.6), wake after sleep onset (M reduction = 73.6 minutes [29.2], d = 1.0), sleep duration (M increase = 36.2 minutes [31.0], d = 0.5), and sleep efficiency (M increase = 17.9% [6.6], d = 1.2). CONCLUSION: This digital CBT-i program improved insomnia symptoms without increasing average daytime sleepiness during any session. Further research is required in people commencing treatment with excessive daytime sleepiness.