# Path To Better Sleep + Virtual Coaching: The Effectiveness and Implementation of Internet-Based Self-Management Program for Insomnia in a Regional Healthcare System

> **NIH VA I01** · VA CONNECTICUT HEALTHCARE SYSTEM · 2024 · —

## Abstract

Background: As many as 1.8 million individuals using VA services meet criteria for insomnia disorder, a
condition associated with suicide, poor functioning, and medical and mental health disorders. Cognitive
Behavioral Therapy for insomnia (CBTi) is the gold-standard treatment. However, only a small fraction of
Veterans receive CBTi due to a host of barriers. A digital intervention delivering CBTi, Path to Better Sleep
(PTBS), has been developed by VA specifically for Veterans. PTBS, enhanced by personal coaching, may
mitigate barriers to CBTi by enabling self-management beyond clinic walls.
Significance: Current PTBS dissemination practices consist of inadequate messaging, poor integration into
clinical workflow, and no personal support. Preliminary data indicate that while PTBS has increased access to
CBTi, only an estimated 0.8% of Veterans with insomnia disorder have visited the PTBS site. To address these
gaps, (1) coaching must be integrated with PTBS (Coached PTBS) to increase engagement/adherence and (2)
Coached PTBS must be embedded in current VA care practices using a scalable implementation strategy. The
prevalence of insomnia far outweighs VA’s capacity to deliver gold-standard treatment through any single
modality. An array of treatment options is needed. Moreover, PTBS coaching delivered through a hub-and-
spoke model is a scalable approach to MISSION Act directives mandating evidence-based care in rural areas.
Innovation and Impact: PTBS is the first digital CBTi designed for Veterans. PTBS is open access and meets
stringent VA information security requirements. Coaching integrated into PTBS will increase engagement and
adherence. A hub-and-spoke model of coaching limits reliance on local facility resources. A scalable
implementation strategy for digital interventions, optimized in prior research, will be used. The VISN 1 clinical
trials network allows access to a rural Veteran population and provides research coordination resources.
Specific Aims:
1. [Establish effectiveness of Coached PTBS when implemented in rural-facing VISN 1 facilities]
 H1: Veterans randomized to Coached PTBS will report greater improvement in insomnia severity (primary)
and sleep parameters (secondary) compared to [PTBS + Contact (enhanced treatment as usual control)]
2. Evaluate the quantitative outcomes of REP-DI, the strategy used to embed Coached PTBS in VA care.
 H2: REP-DI will result in adequate Reach among Veterans, Adoption among providers, and Maintenance.
3. Conduct a 3-part formative evaluation of implementation. Interviews with Veterans, providers, and staff will
 be informed by constructs from the Consolidated Framework for Implementation Research (CFIR). Data
 will optimize implementation in real time by tailoring implementation strategy elements to specific contexts.
Methodology: A pragmatic hybrid type-2 effectiveness/implementation mixed-methods trial will be used.
Outpatients with insomnia disorder will be referred by providers and random...

## Key facts

- **NIH application ID:** 10640052
- **Project number:** 5I01HX003366-02
- **Recipient organization:** VA CONNECTICUT HEALTHCARE SYSTEM
- **Principal Investigator:** ERIC HERMES
- **Activity code:** I01 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2024
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2022-10-01 → 2026-09-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10640052

## Citation

> US National Institutes of Health, RePORTER application 10640052, Path To Better Sleep + Virtual Coaching: The Effectiveness and Implementation of Internet-Based Self-Management Program for Insomnia in a Regional Healthcare System (5I01HX003366-02). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10640052. Licensed CC0.

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