Background: Insomnia is a consistent risk factor for depression, substance abuse, PTSD, and suicide, all of which are important problems in active duty military, and is among the most common complaints of military personnel following war zone experiences. 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) that can have major implications for military personnel, especially 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 (CBTi) is the most effective treatment for insomnia in civilian populations, with considerably better long-term outcomes than medications. New studies show Internet administration of CBTi is also effective in civilian populations, albeit with slightly lower effect sizes, and perhaps greater drop-out, than in-person CBTi. Results from civilian CBTi do not easily generalize to the military personnel, who often work erratic schedules and may associate sleep with combat events (e.g., nighttime attacks) not typically addressed by CBTi. Although studies of Internet and in-person CBTi in civilians indicate that the in-person mode might have greater effects, it is possible that the Internet version may be more effective within the military population due to greater computer literacy of military Service Members and easier access to computers than to behavioral health consultants in active military settings.

Objective: The objective of this study is to directly compare three sessions of in-person and Internet-administered CBTi to a wait list control (WLC), within an active duty military population to determine the comparative benefits of these interventions on improvement in sleep as well as domains strongly related to insomnia such as depression, substance abuse, and PTSD symptoms.

Study Design: A total of 189 (63 per group) military personnel with chronic insomnia, aged 18-65, will be recruited and randomized to receive three sessions (over 6 weeks) of CBTi, Internet CBTi, or a wait list control condition. We will compare these three groups on subjective and objective measures of sleep and other variables of interest (e.g., depression, substance abuse, and PTSD symptoms).

Impact: Insomnia is a highly prevalent and debilitating psychological health disorder and a strong risk factor for occupational accidents and the development of depression, PTSD, drug/alcohol abuse, and suicide. Evidence-based interventions for deployment-related insomnia in military personnel have the potential to improve psychological and physical health, decrease accidents, and improve overall war fighter fitness.