Abstract

Background: At least 40% of individuals with multiple sclerosis (MS) experience chronic insomnia. Recent studies indicate that cognitive behavioral therapy for insomnia (CBT-I) is an effective treatment for insomnia symptoms in individuals with MS. CBT-I delivered using web-based applications has been shown to be effective and may increase access to CBT-I for individuals with MS who have mobility difficulties, fatigue, or live in rural areas. Therefore, the purpose of this study was to assess the feasibility and treatment effect of CBT-I delivered using a web-based application with or without biweekly phone calls to improve sleep quality and fatigue in individuals with MS and symptoms of insomnia.

Methods: Forty-one individuals with MS and symptoms of insomnia were randomized into either a group that participated in a 6-week web-based CBT-I program (wCBT-I) or a group that participated in a web-based CBT-I program and received biweekly support phone calls (wCBT-I+PC). Participants completed surveys online to assess insomnia severity, sleep quality, fatigue, sleep self-efficacy, depression, anxiety, and motivation to change their sleep behavior.

Results: The overall retention rate was 48.8%, and the adherence rate was 96.34%. Both groups had a significant improvement in insomnia severity, sleep quality, anxiety, and sleep self-efficacy. Only the wCBT-I group had a significant improvement in depression and fatigue.

Conclusions: Web-delivered CBT-I is feasible and effective in improving sleep outcomes and concomitant symptoms in individuals with MS. Web-based CBT-I may increase the accessibility of CBT-I treatment and provide a stepped-care approach to treating chronic insomnia in individuals with MS.

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