{"id":78173,"date":"2024-10-01T10:23:30","date_gmt":"2024-10-01T16:23:30","guid":{"rendered":"https:\/\/www.uchealth.org\/today\/?p=78173"},"modified":"2025-03-03T13:23:45","modified_gmt":"2025-03-03T20:23:45","slug":"online-therapy-aims-to-ease-insomnia-for-people-with-tbi","status":"publish","type":"post","link":"https:\/\/www.uchealth.org\/today\/online-therapy-aims-to-ease-insomnia-for-people-with-tbi\/","title":{"rendered":"Online therapy aims to ease insomnia for people with traumatic brain injuries"},"content":{"rendered":"
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Thinking and cognition can be disrupted in people with TBI. Not sleeping well can further exacerbate those cognitive problems. Photo: Getty Images.<\/figcaption><\/figure>\n

The human skull is a bony fortress protecting the brain, a precious cargo weighing only about 3 pounds. No matter how formidable the fortress, though, violent blows after a misstep from a ladder, a slip in the shower, a battlefield blast, a car crash, or a ringing hit in a sports contest can rattle, shake, bounce, twist and injure the brain.<\/p>\n

Millions of Americans each year suffer traumatic brain injuries<\/a> (TBIs) from these kinds of assaults. People with TBIs may struggle to think, move, control their emotions or cope with pain. These problems can be worsened by long nightly battles with insomnia<\/a>. That fight can complicate their recovery significantly.<\/p>\n

Individuals with TBIs are roughly three times more likely to suffer from sleep conditions than members of the general population, said Dr. Lisa Brenner<\/a>, a PhD professor of Physical Medicine and Rehabilitation, Psychiatry, and Neurology<\/a> at the University of Colorado School of Medicine<\/a>. Insomnia can scramble daily life for anyone, but chronic sleeplessness can be particularly challenging for those with TBIs, Brenner said.<\/p>\n

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Dr. Lisa Brenner leads a statewide study that investigates the effectiveness of online cognitive behavioral therapy to treat traumatic brain injury patients who are plagued by insomnia. Photo by the University of Colorado.<\/figcaption><\/figure>\n

\u201cMany things travel together with brain injuries,\u201d Brenner said. \u201cIf you have a traumatic brain injury, your thinking and cognition can obviously be disrupted,\u201d Brenner said. \u201cIf you are not sleeping well, it can further exacerbate people\u2019s cognitive problems.\u201d<\/p>\n

Other severe problems associated with TBIs may worsen if insomnia is added to the mix. For example, about half of people with TBIs also have depression<\/a>, Brenner noted. In addition, a 2023 study<\/a> she co-authored concluded that soldiers who suffered \u201cmilitary-related TBIs\u201d had higher rates of \u201cnew-onset mental health conditions\u201d and were at increased suicide risk. The paper called for \u201cevidence-based interventions\u201d to address the connections between TBIs and mental health disorders.<\/p>\n

TBI and insomnia: A new virtual treatment approach\u00a0<\/strong><\/h2>\n

Brenner now leads a study<\/a>, dubbed CU-REST<\/a>, that tests the effectiveness of computerized cognitive behavioral therapy<\/a> (CBT) to treat insomnia among those with moderate to severe TBIs<\/a>. Online CBT to treat insomnia has been well-studied<\/a> in the general population and shown to be \u201ca win\u201d for patients, Brenner said. She wants to see if that success can extend to the more vulnerable TBI patient population, and just as importantly, improve their access to insomnia treatment.<\/p>\n

\u201cThere is a lack of mental health therapists and evidence-based treatments, especially if you don\u2019t live in an urban area,\u201d she said. \u201cIt may be hard to locate providers. It may be hard to afford it. It may be hard to get there. If people can negotiate an online evidence-based program, they can seek the treatment at a time and place that works for them, and at a pace that works for them.\u201d<\/p>\n

The study is funded by the Colorado Department of Human Services Office of Adult, Aging and Disability Services Mindsource Brain Injury Network<\/a> and is open to people throughout Colorado \u2014 including patients from UCHealth outpatient clinics. It focuses on people between the ages of 18 and 60 who sustained moderate to severe TBIs more than a year ago and experience insomnia. It is not for those who have sports-related or other concussions, Brenner said.<\/p>\n

\u201cThe injuries are those that more frequently impact functioning for a longer period of time,” she said.<\/p>\n

Half the trial participants receive \u201cenhanced treatment as usual,\u201d defined \u201cas any (insomnia) treatment in which they routinely engage.\u201d<\/p>\n

The other half receive the six-week intervention, which consists of six sessions of CBT therapy for insomnia<\/a> and four \u201ccheck-ins\u201d \u00a0to provide data on their progress with the therapy. (Learn more about how cognitive behavioral therapy works.<\/a>)<\/p>\n

The impact of the two approaches, if any, will be measured by comparing results of a test called the Insomnia Severity Index<\/a>, taken at the beginning and at the end of the study. Study participants are equipped with secure email and video, and Brenner\u2019s team gets data collection assistance from REDCap<\/a>, a web-based system supported by the Colorado Clinical and Translational Sciences Institute (CCTSI)<\/a> on the University of Colorado Anschutz Medical Campus<\/a>.<\/p>\n

Assistance for TBI study participants<\/strong><\/h2>\n

The study team provides orientation to the materials and general support for participants throughout the six weeks, Brenner said. For example, the intervention requires participants to maintain \u201csleep diaries\u201d that record when they went to bed and woke up, periods of wakefulness, the quality of their sleep, and so on. This kind of self-reporting is notoriously difficult for people, Brenner said, so the team works with enrollees to help them fill out the diaries.<\/p>\n

In addition, the participants receive a wearable device that provides an objective measure of their nightly activity and sleep patterns.<\/p>\n

In addition to the six CBT self-guided units and sleep diaries, the online intervention includes:<\/p>\n