Background & Aims
Insomnia is a significant problem affecting people with HIV (PWH), affecting an estimated 70% of PWH compared to 30% in the general population. Insomnia has also been shown to present unique risks to PWH. Chronic pain is another highly prevalent symptom among PWH affecting up to an estimated 85% of PWH, significantly higher than the 20.5% of the general population. Chronic pain in PWH is associated with worse HIV outcomes. Chronic pain and insomnia are frequently reported together among PWH and may present additive risk. Addressing insomnia has the potential to improve sleep and pain in PWH. Nonpharmacological treatments for insomnia, like CBT-I, are the gold standard, but are time-consuming and have barriers to access. Brief Behavioral Treatment for Insomnia (BBTI) may not have these same barriers, however little is known about BBTI in PWH. There is no current literature available examining the feasibility or potential outcomes of BBTI compared to an active control in PWH.
Methods
Twenty participants enrolled in the study will be randomized into two treatment groups, BBTI and the active control, mindfulness. Each treatment will occur via telephone over four weeks. Participants will complete actigraphy protocols and sleep diary pre- and post treatments. Sleep diary data will also collect data regarding patients pain experiences. Additionally, patients will complete self-report questionnaires and a battery of quantitative sensorsy testing pre- and post-treatment assessing sleep, pain, and relevant cognitions in two in-lab sessions. Participants will also complete forms during the post-treatment lab session regarding the feasibility and acceptability of the treatments and protocol. Participants will complete sleep and pain questionnaires via telephone at one month followup.
Results
Primary outcomes provided by this protocol will be regarding the feasibility and acceptability of the interventions and protocol. Participants matriculation through the study will be closely monitored and any missing data and attrition will be reported. Participants responses to questionnaires regarding the favorability of the intervention and protocol will also be reported. Secondary outcomes will explore any initial treatment effects of BBTI and mindfulness on sleep and pain outcomes via both objective and subjective measures.
Conclusions
BBTI is hypothesized to be more accessible than other non pharmaceutical interventions for insomnia, such as cognitive behavioral therapy for insomnia (CBT-I). Successful matrictulation through the proposed protocol with little to no attrition would provide evidence that BBTI may be an attractive alternative to CBT-I for special populations that experience additional burden and may have difficulty accessing healthcare. Additionally, initial treatment effects observed may provide evidence that improvement in sleep through BBTI could lead to downstream effects in pain symptoms and would warrant additional research with a larger sample.
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