# Sleep-SMART for Veterans with MCI and Insomnia: A Pilot Study

> **NIH VA I21** · VA SAN DIEGO HEALTHCARE SYSTEM · 2024 · —

## Abstract

Background: Mild cognitive impairment (MCI) is an important public health concern for aging Veterans due to
the increased risk for progression to dementia and increased mortality. Insomnia is common in MCI (occurring
in up to 60% of patients) and increases risk for dementia, disability, and poor quality of life. Rates of MCI and
insomnia are higher among Veterans than civilians, thus aging Veterans with MCI and comorbid insomnia
represent a particularly high-risk population. The gold standard treatment for insomnia, Cognitive Behavioral
Therapy for Insomnia (CBT-I), is a multi-component behavioral intervention. However, cognitive impairments
experienced by individuals with MCI may limit the rate of progress in CBT-I. The use of memory support
strategies can improve patient recall of therapeutic information, enhance treatment adherence, and improve
treatment outcomes. Cognitive Symptom Management and Rehabilitation Therapy (CogSMART) provides
compensatory strategies to improve learning, memory, attention, and executive functioning. CogSMART has
been shown to improve cognition, functional capacity, neurobehavioral symptoms, and quality of life in diverse
Veteran populations with cognitive impairment. Incorporating supportive CogSMART cognitive strategies into
CBT-I has the potential to improve treatment learning, adherence, and outcomes for this Veteran population.
Significance: This RR&D SPiRE research project will assist us in developing and evaluating Sleep-SMART
(Sleep Symptom Management and Rehabilitation Therapy), an innovative user-informed approach for
treatment of insomnia in Veterans with MCI. Sleep-SMART is intended to provide the core components of
CBT-I along with training in compensatory cognitive strategies from CogSMART to enhance intervention
adherence and learning. Provision of this supportive cognitive training will assist Veterans with cognitive
impairments in maintaining compliance with the CBT-I regimen, thereby leading to faster and more complete
treatment benefits. Aims: Our principle aims for the investigation include: 1) developing the Sleep-SMART
intervention and treatment manual; 2) assessing the feasibility and acceptability of Sleep-SMART in Veterans
with MCI and insomnia; and 3) exploring the effects of Sleep-SMART on rehabilitation outcomes, quality of life,
sleep, and cognitive functioning. Methodology: We propose to develop the Sleep-SMART intervention and
manual over the first 6 months of the project (Phase I) using a participatory research approach guided by the
Intervention Mapping Adapt framework. We will subsequently assess the feasibility and acceptability of Sleep-
SMART (Phase II) by enrolling 26 Veterans ages 60 and older to receive six 50-minute weekly sessions of
individual Sleep-SMART treatment via secure video-conferencing. Feasibility will be assessed through
recruitment metrics, level of Veteran participation in the treatment, clinician fidelity to the treatment protocol,
and evaluation of barriers t...

## Key facts

- **NIH application ID:** 10923781
- **Project number:** 5I21RX003721-03
- **Recipient organization:** VA SAN DIEGO HEALTHCARE SYSTEM
- **Principal Investigator:** ERIN ALMKLOV
- **Activity code:** I21 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2024
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2021-10-01 → 2023-12-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10923781

## Citation

> US National Institutes of Health, RePORTER application 10923781, Sleep-SMART for Veterans with MCI and Insomnia: A Pilot Study (5I21RX003721-03). Retrieved via AI Analytics 2026-05-25 from https://api.ai-analytics.org/grant/nih/10923781. Licensed CC0.

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