Background: Insomnia is among the most common complaints of military personnel, particularly following war zone experiences. Insomnia is a consistent risk factor for depression, suicidality, substance abuse, and post-traumatic stress disorder (PTSD), all of which are important problems in active duty military. Currently, medications are the most commonly used treatments for insomnia in military populations, which is problematic because the potential side effects (e.g., grogginess, slowed cognitive processing, slowed reaction time) can have major implications for military personnel. This is especially pertinent during deployments, which may require individuals to awaken quickly and respond immediately to an ambush, mortar, or rocket attack, or other emergency situation.

Cognitive behavior therapy for insomnia (CBT-I) is the most effective treatment for insomnia in civilian populations, with considerably better long-term outcomes than medications. However, there are not enough providers trained to deliver CBT-I. This is partially because there are very few training opportunities, and the ones that do exist are usually given infrequently in small groups in a few areas around the country. There are no interactive Web-based training programs for CBT-I that are available for military providers.

Objective: The objectives of this study are to (1) develop a sophisticated, user-friendly Web-based provider training course for the non-pharmacological treatment CBT-I that is fully sustainable, accessible with minimal cost (financial and time) to the clinician, and results in knowledge gains similar to those of an in-person training and (2) assess reaction/satisfaction, learning, and behavior throughout alpha- and beta-testing and after a pilot comparison study comparing providers who complete CBT-Iweb to a control group of providers who attend an 8-hour, in-person training workshop using the identical training materials.

Study Design: Similar to the strategies used by this group to develop previous, successful web-based trainings (e.g., treatment of PTSD), CBT-Iweb will be built and refined over the course of three strategic phases: content development, alpha-testing, and beta-testing. Following beta-testing and subsequent revisions, a pilot study to compare the effectiveness of CBT-Iweb compared to typical in-person training will be conducted prior to the launch of the live site.

Impact: Insomnia is a costly condition where an effective intervention may be expected to improve a Service member and Veteran’s (and his or her family’s) future quality of life, reduce the direct costs of medical care to the Department of Defense (DoD), and reduce certain indirect costs to Service members for their remaining lifetime. Expected costs associated with insomnia include medication, outpatient clinic visits, and other follow-up care necessary for management of insomnia and associated problems, as well as possible indirect costs to Service members and Veterans such as lost time from work and underemployment. Given the significant financial burden that insomnia places on active duty and Veterans and the DoD and Veterans Health Administration system (payer), any means to effectively and efficiently train providers to better manage insomnia should be encouraged. If CBT-Iweb reduces provider training times while keeping the level of knowledge gained the same or better than current standards of training, efficiencies are gained.