Outcomes from a combined cognitive behavioral therapy for insomnia (CBT-I) and sleep-related medication and substance use reduction treatment

BACKGROUND: Cognitive behavioral therapy for insomnia (CBT-I) is a first-line treatment for insomnia. However, most CBT-I programs do not address the prevalent use of sleep-related medication and substance use. Integrating deprescribing protocols into CBT-I may improve outcomes. OBJECTIVE: To evaluate the effectiveness, feasibility, and acceptability of a telehealth group-based CBT-I program that incorporates gradual dose reduction (GDR) protocols for sleep-related medication and substance use. METHODS: We conducted a retrospective cohort study of 204 adults with DSM-5-diagnosed insomnia disorder who participated in a 7-week CBT-I group medical visit program at an academic integrative health clinic. The program included one intake session, five weekly group sessions, and one follow-up session. Individualized GDR protocols targeted a broad range of substances. We assessed pre-post changes in insomnia symptoms, consensus sleep diary (CSD) metrics, medication/substance use, and treatment acceptability. RESULTS: Insomnia Severity Index (ISI) scores improved by 8.28 points (95 % CI 7.56, 9.01, d = -1.63) and Pittsburgh Sleep Quality Index (PSQI) scores by 4.96 points (95 % CI 4.42, 5.51, d = -1.30). Clinical response rates were 63.4 % (≥7-point ISI improvement) and 75.9 % (≥3-point PSQI improvement). Sleep efficiency increased by 10.69 % (95 % CI 9.44, 11.95) without significant change in total sleep time. Patients reduced or discontinued benzodiazepines, Z-drugs, orexin antagonists, melatonin, antihistamines, antidepressants, cannabis, and alcohol. Acceptability ratings were high; qualitative feedback emphasized empowerment, confidence, and facilitator effectiveness. CONCLUSIONS: A telehealth group CBT-I program with integrated GDR protocols is feasible and effective, supporting broader dissemination of deprescribing interventions in behavioral sleep care.