0442 A Qualitative Assessment of Digital Cognitive Behavioral Therapy for Insomnia in Heavy Drinkers with Insomnia

Abstract Introduction Insomnia, a public health problem impacting approximately 10-30% of the population, is both a risk factor for Alcohol Use Disorder and a common comorbid condition. Evidence suggests that intervening on sleep problems could serve as a novel and efficacious means of simultaneously improving sleep and problematic drinking. This study qualitatively and quantitatively assessed a well-validated, interactive version of digital cognitive behavioral therapy for insomnia (dCBTI) in heavy drinkers with insomnia. We report on qualitative themes related to beliefs about alcohol’s impact on sleep, self-reported positive outcomes of the dCBTI program, and aspects of the program that participants found most helpful. Methods Heavy drinking men (n = 28) and women (n = 42) with insomnia were randomly assigned to complete either the dCBTI program or a control patient education program. Semi-structured qualitative interviews were conducted at baseline and after program completion. Interviews were digitally recorded, professionally transcribed, and lasted approximately 45 minutes on average. The first and second authors conducted and coded the interviews using a multi-stage, inductive process aided by NVIVO software. Here we report on data from pre-intervention interviews with all 70 subjects and post-intervention interviews with the dCBTI subjects (n=40). Results At baseline most participants did not associate their heavy drinking habits with their difficulties in falling or staying asleep. Some participants reported using alcohol to help them fall asleep more quickly or “pass out.” Participants who participated in the dCBTI program reported improved ease in falling asleep, fewer nighttime awakenings, and the ability to fall more readily back asleep if they experienced early or nighttime awakenings. These participants also reported a new or increased understanding of the ways in which alcohol use impacted their sleep. Participants reported that having to track their daily number of drinks, and learning to stop drinking several hours before bedtime were the most helpful components of the dCBTI program. Conclusion Heavy drinkers with insomnia may lack awareness of how alcohol use impacts their sleep or believe that alcohol helps them sleep. Using a well-validated version of dCBTI may be an accessible, efficacious means of improving two burgeoning public health problems. Support (if any) NIAAA R21 AA029201, T32 AA027488