Increasing Access and Adherence to Cognitive Behavioral Therapy for Insomnia (CBTi) for Adults: A Quality Improvement Project
Date of Award
College or School
Program or Major
Doctor of Nursing Practice
BACKGROUND: Insomnia is a sleep disorder that is becoming more prevalent. It can significantly impact a person's quality of life and it contributes to a substantial economic financial burden. Cognitive behavioral therapy for insomnia (CBTi) is the primary treatment for insomnia, but patients are rarely referred for this treatment. This quality improvement project focused on implementing motivational interviewing to increase patient utilization of CBTi. It also encouraged utilization of CBTi Coach, a free phone application that has all of the CBTi components, a rigid sleep behavioral plan and frequent follow-up appointments to improve sleep quantity and quality.
INTERVENTION: Patients that met the inclusion and exclusion criteria were scheduled three follow-up appointments at two-week intervals. The clinician employed motivational interviewing to help patients identify ambivalence about CBTi and helped the patients set two short-term goals at each visit and one long-term goal at the initial consult. Patients were given a sleep prescription and encouraged to utilize CBTi Coach. Patients were asked to fill out a daily sleep diary and weekly insomnia severity index scale.
RESULTS: Motivational interviewing was measured by whether or not a patient met their goals. All patients fully met their first goal at every follow-up appointment. At the first follow-up appointment only one patient met their second goal, two partially met their goal and one patient did not meet their goal. At the second follow-up appointment two patients fully met their second goal and two patients partially met their goal. At the third and final follow-up appointment all patients met their second goal. All patients met their long-term goal. A trend analysis was used to measure sleep diary indicators and the insomnia severity index. There were downward trends for sleep onset latency, total nightly awakenings, and time spent awake after sleep onset. There were upward treads for total sleep time and sleep efficiency. There was a downward trend for the insomnia severity index tool.
CONCLUSIONS: Motivation interviewing was established to be effective to encourage patients to utilize CBTi therapy. Following a sleep behavioral plan with a sleep prescription, tracking a nightly sleep diary and attending frequent follow-up appointments demonstrated an enhancement in sleep quality and quantity.
Newell, Kristen, "Increasing Access and Adherence to Cognitive Behavioral Therapy for Insomnia (CBTi) for Adults: A Quality Improvement Project" (2023). DNP Scholarly Projects. 84.