Digital cognitive-behavioral therapy for insomnia in patients with multiple sclerosis: A multiple baseline single-case pilot study

Insomnia has an estimated prevalence of over 20 % in patients with multiple sclerosis (MS) and preliminary evidence suggests that treating insomnia through cognitive behavioral therapy for insomnia (CBT-I) can alleviate fatigue and other secondary symptoms in this population. Video-based CBT-I, an emerging remote treatment modality, has shown promise in previous studies for addressing insomnia in various populations, indicating its potential as an efficient treatment approach for individuals with MS. This pilot study aimed to assess the impact of video-based cognitive behavioral therapy for insomnia (VCBT-I) on individuals with comorbid insomnia and multiple sclerosis (MS). Out of the ten participants, six experienced statistically significant reductions in total wake time during the night, while seven demonstrated clinically significant improvements in waking time, and eight achieved insomnia remission based on the Insomnia Severity Index (ISI). These findings align with prior research indicating the effectiveness of CBT-I in addressing sleep disturbances and its promising potential for insomnia in MS. Moreover, improvements in depression symptoms, as measured by the PHQ-9, and reductions in worry, as assessed by the GAD-7, were observed. Although fatigue outcomes varied, suggesting a potential need for optimal sleep duration, participants reported enhanced quality of life and high treatment satisfaction. These results suggest that VCBT-I is a well-tolerated and effective treatment option for individuals with comorbid MS and insomnia, highlighting its potential to alleviate both sleep-related and psychological symptoms.