![]() Insomnia is endemic among military personnel as well as veterans. ![]() These impairments span a variety of domains of functioning including memory and concentration difficulties, irritability, somatic symptoms, worry, and absenteeism. Chronic insomnia disorder is defined as difficulty falling or staying asleep that persists for at least 3 months and is associated with daytime impairments. This implementation-effectiveness hybrid type 3 trial aims to implement a large-scale, cluster-randomized pragmatic demonstration to inform behavioral sleep medicine practices and policies for active duty service members (ADSMs), veterans, and other beneficiaries with chronic insomnia disorder who receive care in military treatment facilities (MTFs) and affiliated clinics and wellness centers. Engaging providers, stakeholders, patients, and decision-makers is key in identifying strategies to support the deployment of digital health technologies that can promote quality care and result in clinically meaningful sleep improvements, positive systemic change, and enhanced readiness and health among service members. This can augment the scalability and cost-effectiveness of CBTI without compromising patient outcomes. Discussionĭigital health technologies and machine learning-assisted clinical decision support tools have substantial potential for scaling access to insomnia treatment. We hypothesize that reach, adoption, and sustainability and the magnitude of improvements in insomnia will be superior in the EF and EF/IF groups relative to the COAST-only group. ![]() The second aim is to quantify improvements in insomnia among patients who receive behavioral sleep care via the COAST platform. The first aim is to compare three clinician- and system-centered implementation strategies on the reach, adoption, and sustainability of the COAST digital platform by offering (1) COAST only, (2) COAST plus external facilitation (EF: assistance and consultation to providers by NOCTEM’s sleep experts), or (3) COAST plus EF and internal facilitation (EF/IF: assistance/consultation to providers by NOCTEM’s sleep experts and local champions). COAST includes a clinician portal and a patient app, and it utilizes algorithms that facilitate detection of sleep disordered patterns, support clinical decision-making, and personalize sleep interventions. This is a hybrid type 3 implementation-effectiveness randomized trial using a scalable evidence-based digital health software platform, NOCTEM™’s Clinician-Operated Assistive Sleep Technology (COAST™). Digital technologies offer a unique opportunity to overcome these challenges by providing scalable, personalized, resource-sensitive, adaptive, and cost-effective approaches for evidence-based insomnia treatment. Three main factors inhibit access to and delivery of CBTI including restricted availability of clinical expertise rigid, resource-intensive treatment formats and limited capacities for just-in-time monitoring and treatment personalization. Despite its effectiveness, CBTI has limited scalability. ![]() CBTI is typically delivered in-person or online over one-to-four sessions (brief versions) or five-to-eight sessions (standard versions) by a licensed doctoral or masters-level clinician with extensive training in behavioral sleep medicine. The first-line recommended treatment for insomnia is cognitive-behavioral therapy for insomnia (CBTI). Insomnia affects almost one in four military service members and veterans.
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