0396 Intensive Sleep Retraining and Sleep Deprivation for Treating Chronic Insomnia: A Randomized Controlled Trial

Abstract Introduction Intensive sleep retraining (ISR) is a promising alternative treatment option for individuals who do not respond to standard cognitive behavioral therapy for insomnia. ISR capitalizes on two potential modes of actions: 1) a reconditioning between the bed and bedroom with rapid sleep onset and 2) an increase in the homeostatic sleep drive due to sleep deprivation. The present study compares the efficacy of ISR with total sleep deprivation for the treatment of chronic insomnia. Methods 34 adults (10 males, 24 females, mean age 33.8 years) with chronic sleep-onset insomnia (with or without sleep maintenance difficulties) were randomized to ISR, total sleep deprivation (TSD) or a control (CTL) condition. The ISR treatment consisted of 42 sleep onset trials over a 21-hour sleep deprivation period, the TSD treatment consisted of an equivalent 21-hour sleep deprivation without sleep onset trials, and the CTL condition consisted of one night of habitual sleep in the laboratory. Participants completed several measures including the Insomnia Severity Index (ISI) and daily sleep diaries at pre-treatment, post-treatment, and at 1, 2, and 3 months after treatment. Results From pre-treatment to 3-month follow-up, significant and large decreases in insomnia severity were observed in both ISR (M = -5.91 units, p < .001, d = -1.99) and TSD (-5.41 units, p < .001, d = -1.82). Mean pre-treatment ISI scores (16.3) were in the moderate severity range and fell into the subthreshold insomnia category at post-treatment for both ISR (M = 12.4) and TSD (M = 12.6) groups and remained in that range at follow-up. From the same pre-treatment to 3-month follow-up period, a significant and moderate reduction in sleep onset latency was observed for the ISR group (M = -11.66 min, p < .05, d = -0.76), but not for the other two groups. Conclusion Both ISR and TSD were effective in reducing insomnia symptoms severity, but ISR produced a superior treatment response on sleep onset latency and this improvement was generally maintained up to 3 months after treatment. Support (if any) This research was supported by a grant from the Canadian Institutes of Health Research (#148410).