Efficacy of Cognitive Behavioral Therapy for Insomnia to Treat Insomnia Symptoms in Individuals With Multiple Sclerosis

Inclusion Criteria:

• 18-65 years old

• Diagnosis of relapsing-remitting or secondary progressive MS based on establishedguidelines20 and verified by their neurologist

• Mild-to-moderately severe disability (≤ 6 on Patient Determined Disability Steps (PDDS) scale)

• Report of difficulty falling asleep, maintaining sleep, or waking up too early atleast 3 nights/week for the past 3 months with significant distress and impact onfunction despite adequate opportunity for sleep and not due to other sleep disordersas indicated in the DSM-5

• ≥10 on Insomnia Severity Index

• English speaking

• ≥31 on modified Telephone Interview of Cognitive Status23

• Has a high school diploma or equivalent to serve as a proxy measurement of readingability to ensure adequate reading ability to participate in the study

• Report having access to internet service or a data plan and access to a computer,tablet, or smart phone

Exclusion Criteria:

• Known untreated sleep disorder (such as sleep apnea or restless legs syndrome)

• >3 on STOP BANG indicating increased risk of sleep apnea

• Restless legs syndrome as determined by RLS-Diagnosis Index

• Circadian rhythm sleep-wake disorder as determined by the Sleep Disorders-Revised

• Parasomnia as determined by the Sleep Disorders-Revised

• Currently taking benzodiazepines, non-benzodiazepines, or melatonin supplements oragonists for insomnia

• Score of ≥20 on the Patient Health Questionnaire (PHQ-9) indicating severedepression or endorsement of suicidal ideation (answer 1, 2 or 3 on #9 of the PHQ-9)

• Score of ≥15 on the Generalized Anxiety Disorder (GAD-7) indicating severe anxiety

• Current or history (up to 2 years) of alcohol or drug or alcohol abuse as indicatedby DSM-5 criteria

• History of other nervous system disorder such as stroke or Parkinson's disease

• Currently pregnant or intending to become pregnant in the next 6 months

• Severe mental illness such as schizophrenia or bipolar disorder

• Severe neurological or sensory impairments that would interfere significantly withtesting

• Relapse and/or corticosteroid use in the past 8 weeks

• History of (within 5 years) or currently conducting overnight shift work includinghours of midnight-4am

• Currently receiving a behavioral sleep health intervention