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04:34
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Published on: February 17, 2023
Stepped care for insomnia: an evaluation of implementation in routine practice
1Department of Clinical Health Psychology, University of Manitoba, Winnipeg, Manitoba, Canada. Nvincent@exchange.hsc.mb.ca
Summary
Predictors of treatment escalation in chronic insomnia were identified. Younger, employed individuals with better sleep quality and latency were less likely to need more intensive services, improving care efficiency.
Area of Science:
- Sleep Medicine
- Psychiatry
Background:
- Stepped care models for chronic insomnia are emerging but require further investigation.
- Understanding patient movement within these pathways is crucial for optimizing treatment delivery.
Purpose of the Study:
- To identify predictors of progression to more intensive services in a stepped care model for chronic insomnia.
- To evaluate the efficiency of stepped care in managing adult chronic insomnia outpatients.
Main Methods:
- A sample of 50 adult outpatients with chronic insomnia participated.
- Data collected included daily sleep diaries, Insomnia Severity Index, Multi-Dimensional Fatigue Inventory (MFI), and Dysfunctional Beliefs and Attitudes about Sleep Scale (DBAS-10).
- Multinomial logistic regression analyzed predictors of receiving more intensive services (individual consultation, group or individual therapy).
Main Results:
- Age, employment status, and sleep parameters (quality, latency) significantly predicted the need for more intensive services.
- Psychiatric and sleep comorbidities, dysfunctional sleep beliefs, and insomnia severity did not predict service escalation.
Conclusions:
- Stepped care models demonstrated a 69% improvement in efficiency.
- Low-intensity, step 1 treatments may be sufficient for younger, employed individuals, and those with better baseline sleep.
- Findings inform resource allocation and treatment tailoring within stepped care for insomnia.
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