# SEdative-Hypnotic Deprescribing Assisted by a Technology-Driven Insomnia InterVEntion (SEDATIVE)

> **NIH VA I21** · VETERANS HEALTH ADMINISTRATION · 2024 · —

## Abstract

Background: Chronic insomnia, one of the most common health problems among Veterans increases risk for
medical and psychiatric disorders, higher rates of accidents and injuries, and functional impairment. The most
common forms of treatment are prescription sedative-hypnotic medications and cognitive behavioral therapy
for insomnia (CBT-I), a multi-component psychotherapy. Despite strong evidence in support for CBT-I as the
first line treatment, sedative-hypnotics remain the most common. Sedative-hypnotic use is linked to potential
tolerance, dependence, and abuse as well as risk for daytime fatigue and cognitive and physical impairment.
Furthermore, sedative-hypnotics treat symptoms while CBT-I focuses on the cognitive/behavioral causal
factors. Notably, deprescribing sedative-hypnotics, which may help to reduce associated risk and improve
Veteran function and quality of life, is often accompanied by the return or worsening of insomnia symptoms.
Thus, to improve Veteran sleep outcomes, deprescribing and CBT-I should occur simultaneously. Furthermore,
a telehealth-based intervention that combines CBT-I with deprescribing could result in improved Veteran sleep,
function, and quality of life while also increasing access to care in an efficient and scalable manner.
Significance/Impact: Both deprescribing and CBT-I are evidence-based interventions regularly delivered
within VA; however, a combined intervention that can streamline care and optimize Veteran outcomes is not
readily available. The Clinician Operated Assistive Sleep Technology (COAST) is an evidence-based, digital
sleep platform that combines aspects of in-person CBT-I (personalized care) with the benefits of telehealth (in
home care, flexible scheduling). COAST’s unique approach utilizes artificial intelligence to develop tailored
recommendations and integrates provider expertise and personalized deprescribing in an easy to use, efficient,
and scalable package. The proposed intervention has potential to significantly impact, and improve, Veteran
health and the delivery of sedative-hypnotic deprescribing and CBT-I in VA. This proposal is consistent with VA
RR&D’s scope to translate research into clinical practice in order to maximize Veterans’ functional
independence, quality of life, and participation in their lives and community.
Innovativeness: This pilot study is pragmatic and unique. There are currently no funded studies that combine
deprescribing and CBT-I, delivered by a scalable and efficient digital platform like COAST. Focusing on sleep
and functional outcomes will also ensure that this intervention can improve Veterans’ functional capabilities
and quality of life in addition to the reduction of clinical symptoms and improvement of care delivery.
Specific Aims: Aim 1 will assess the feasibility of recruiting Veterans with chronic sedative-hypnotic use and
their participation in a dual deprescribing and insomnia intervention, delivered through a digital health platform.
Aim 2 will...

## Key facts

- **NIH application ID:** 11049005
- **Project number:** 5I21RX003732-03
- **Recipient organization:** VETERANS HEALTH ADMINISTRATION
- **Principal Investigator:** ADAM DANIEL BRAMOWETH
- **Activity code:** I21 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2024
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2022-05-01 → 2024-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/11049005

## Citation

> US National Institutes of Health, RePORTER application 11049005, SEdative-Hypnotic Deprescribing Assisted by a Technology-Driven Insomnia InterVEntion (SEDATIVE) (5I21RX003732-03). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/11049005. Licensed CC0.

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