This application is submitted by Jerome Yesavage, M.D., Director of the VISN 21 Mental Illness Research, Educational and Clinical Center (MIRECC) at the VA Palo Alto Health Care System. The VISN 21 MIRECC has a long research history addressing sleep disorders in Veterans including several research projects on insomnia in Veterans. In recent years over 650 VA mental health clinicians have been trained in CBT-I by the VISN 21 MIRECC. In collaboration with the three War Related Illness and Injury Study Centers (WRIISCs), Dr. Yesavage will focus on Cognitive Behavior Therapy for Insomnia (CBT-I) in Gulf War Veterans (GWVs) attempting to personalize CBT-I to the types of insomnia experienced by these Veterans. Components of CBT-I often include both behavioral interventions and cognitive therapy. A commonly used behavioral intervention is Sleep Restriction (SR) designed to reduce excessive time spent in bed to the actual amount of the subject's sleep time, thereby increasing sleep pressure that leads to higher quality sleep. Cognitive therapy (CT) for insomnia, like CT for other disorders, focuses on changing intrusive thoughts that interfere with sleep. The primary hypothesis is that the efficacy of these treatments will depend upon an individual subject's baseline characteristics. For SR, we expect that baseline measures of excessive time spent in bed may predict response, and for CT, we expect that baseline measures of cognitive arousal and pain may predict response. Exploratory analyses using signal detection techniques will systematically compare and contrast the potential usefulness of a number of additional potential moderator measures. The research will be conducted in two groups of 50 GWVs each. SR and CT will be compared using the Insomnia Severity Index, sleep logs, quality of life measures and relevant mediator and moderator measures. Ultimately the results from this study will allow VA clinicians trained in CBT-I to assign GWV patients to the optimal therapy for their insomnia.
Insomnia is a serious health problem in Gulf War Veterans that is often associated with extensive prescription of sleeping medications. Although safer, even the latest 'sleeping pills' can lead to cognitive impairment and risk of abuse. Thus non-pharmacological treatments for insomnia have been pursued as alternatives to medications. Cognitive Behavior Therapy for Insomnia (CBT-I) is the term widely used to describe therapies that combine behavioral and cognitive therapies for insomnia. The combined CBT-I approach has well-documented efficacy. Between 2012 and 2014 over 650 VA mental health clinicians have received extensive training in CBT-I. Although CBT-I is efficacious, the optimal target populations for its major components has not yet been well-defined for Gulf War Veterans. We propose to address this gap and develop tools for clinicians to identify the best treatment for insomnia for individual Gulf War Veterans.
