Temporal subtypes and characteristics of insomnia treatment responses

This study aims to identify specific characteristics that can predict the treatment efficacy and onset time in patients with insomnia. A retrospective study was conducted on patients who visited the Sleep Disorders Clinic between January 1, 2016, and October 19, 2024 and underwent digital CBT-I. Data on demographic characteristics, Pittsburgh Sleep Quality Index (PSQI), Generalized Anxiety Disorder Scale (GAD-7), Patient Health Questionnaire (PHQ-9), Somatic Symptom Questionnaire (PHQ-15), Epworth Sleepiness Scale (ESS), and Eysenck Personality Questionnaire (EPQ) were collected. The PSQI score reduction rate was used as an indicator of treatment efficacy, where a reduction rate of more than 25% was generally considered effective. Since patients in this study underwent multiple assessments and exhibited varying degrees of treatment response, the average reduction rate was ultimately used to determine treatment effectiveness within this time dimension. Based on the time dimension, patients (N = 834) were categorized into two groups: the early-response group (≤ 8 weeks) and the late-response group (> 8 weeks or non-responsive). The demographic characteristics and scale data of 834 patients indicated no significant differences between the two groups in terms of gender (P = 0.491), family history of insomnia (P = 0.167), and ESS score (P = 0.949). However, significant differences were observed between the two groups in age (P = 0.005), education level (P < 0.001), duration of insomnia (P < 0.001), GAD-7 score (P = 0.031), PHQ-9 score (P = 0.044), and neuroticism personality trait (P = 0.039). The late-response group had a higher mean age, a lower education level, and a longer duration of insomnia than the early-response group. Additionally, the late-response group exhibited lower GAD-7, PHQ-9, and neuroticism personality trait scores compared to the early-response group. Multivariate logistic regression analysis indicated that higher education level (college or above), higher PHQ-9 and PHQ-15 scores, and a neuroticism personality trait were significant predictors of better treatment response and earlier onset of efficacy in insomnia patients. A longer duration of insomnia was identified as a risk factor for poor treatment response and delayed onset of efficacy. Conclusion: Insomnia patients with higher education levels (college or above), higher PHQ-9 and PHQ-15 scores, and a neuroticism personality trait tend to have better treatment outcomes and an earlier onset of efficacy. Longer duration of insomnia, tend to experience poorer treatment outcomes and a delayed response to treatment.