Objective: To demonstrate benefit of computerized cognitive behavioral therapy for insomnia (CCBT-I) in Parkinson’s disease (PD) patients. We are unaware of any study on CCBT-I for insomnia in PD.

Background: PD is associated with a high prevalence of sleep disorders affecting up to 88% of patients. Despite the high prevalence and life-quality impact of insomnia in PD, there are only a few pharmacotherapy studies in literature. Cognitive behavioral therapy (CBT) is a treatment option with durable effects shown in primary insomnia. CBT evaluates then promotes modifications in behaviors that perpetuate insomnia. However, the lack of accessibility and expense can be limiting. For these reasons, CCBT-I has been developed. The CCBT-I program involves a 6-week course in a series of daily lessons, homework assignments, learnable skills and appropriate recommendations.

Methods: We conducted a single-center, pilot, randomized controlled trial on CCBT-I versus standardized non-pharmacological therapy for insomnia in PD. Twenty-eight subjects with PD experiencing insomnia defined by a score >11 on Insomnia Severity Index (ISI) were recruited for this study. Patients were randomized to either the CCBT-I 6-week treatment arm or the control arm consisting of standardized advice on sleep hygiene.

Results: A total of 28 patients were recruited. 8/14 patients randomized to treatment arm versus 13/14 patients randomized to the control arm completed the study. Amongst patients who completed the study, ISI scores improved from baseline to endpoint in both treatment (p<0.002) and control(p<0.008) arms. The ISI improved more in treatment than control (p=0.03). However, when performing an intention to treat analysis, including all patients recruited into the study, the change in ISI score between treatment versus control arms was not significant (p=0.48).

Conclusions: PD patients may have a hard time completing CCBT-I for various reasons. However, amongst those who were able to complete the therapy, a significant benefit was noted. Larger studies are needed to verify our preliminary findings.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/a-computerized-cognitive-behavioral-therapy-randomized-controlled-pilot-trial-for-insomnia-in-parkinsons-disease-the-accord-pd-study/