Date of Award
2025
Document Type
Doctor of Nursing Practice (DNP)
Degree Name
Doctor of Nursing Practice (DNP)
Department
Nursing
Committee Chair
Haley Hoy
Subject(s)
Insomnia--Treatment, Cognitive therapy, Medical telematics
Abstract
Insomnia is one of the most prevalent sleep and mental health disorders, often presenting with difficulty falling or staying asleep and resulting in daytime fatigue and impaired functioning. Cognitive Behavioral Therapy for Insomnia (CBT-I) is a first-line, evidence-based, non-pharmacologic intervention; however, access is often limited due to a shortage of trained clinicians, transportation barriers, and systemic inequities. This project implemented a telehealth-facilitated CBT-I program to expand treatment options and improve sleep quality among individuals diagnosed with insomnia. The initiative introduced an evidence-based intervention into a Federally Qualified Health Center (FQHC) that previously had not offered this service. The population included adults aged 18–65 diagnosed with insomnia per the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR). Participants were referred by primary care providers, psychiatrists, psychologists, and psychiatric-mental health nurse practitioners. Six participants completed an eight-session CBT-I program over four to eight weeks. Each session incorporated core components of CBT-I, including sleep education, sleep hygiene, sleep restriction, stimulus control, cognitive restructuring, and relapse prevention. Sleep quality was measured using the Pittsburgh Sleep Quality Index (PSQI) pre- and post-intervention. Median PSQI score improved by almost 69 %, from 15 to 4.67 (p = 0.031), making a clear shift from poor to good sleep quality. Across six participants, a total of 48 telehealth sessions were delivered by a single psychiatric–mental health nurse practitioner, demonstrating that the new CBT-I service line is both feasible and scalable within an FQHC setting. Participants reflected the racial and ethnic diversity of Oregon’s population, indicating that telehealth can facilitate CBT-I and promote equitable access for underserved adults. Collectively, these findings highlight feasibility, intense engagement, and meaningful clinical improvement within a federally qualified health center.
Recommended Citation
Smith, Dianne Kelly, "Implementing telehealth-facilitated cognitive behavioral therapy for insomnia in mental health patients" (2025). Doctor of Nursing Practice (DNP). 151.
https://louis.uah.edu/uah-dnp/151