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| ID | Type | Description | Link |
|---|---|---|---|
| 2019-A00043-54 | Other Identifier | ANSM Number (ID-RCB) |
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| Name | Class |
|---|---|
| University Hospital, Bordeaux | OTHER |
| University of Bordeaux | OTHER |
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Persistant insomnia is a common sleep disorder that affects approximately 20% of the French population. The standard treatment for chronic insomnia is Cognitive-Behavioral Therapy (CBT).
Behavioral measures can be difficult to implement for the patient alone at home.
Spa therapy with psychosomatic orientation allows to implement hygiene rules and structure rhythms of life. In addition, recent studies have shown that spa treatment, including crenotherapy, is effective in somatic complaints related to anxiety and benzodiazepine withdrawal.
The spa treatment could therefore provide ideal conditions for the implementation of behavioral measures for insomnia management.
The objective of SOMNOTHERM study is to measure efficiency on insomnia complaints at 8 weeks of a the implementation of a Behavioral therapy program for insomnia delivered by an internet software combined to a spa treatment compared to implementation of the same program at home (standard care).
Persistant insomnia is a common sleep disorder that affects approximately 20% of the French population.
The standard treatment for chronic insomnia is Cognitive-Behavioral Therapy (CBT). This therapy is based on 4 components: sleep restriction, stimulus control, cognitive therapy and sleep hygiene education. Unfortunately, there are an insufficient number of trained CBT experts especially in France.
Online programs based on CBT principles (e-CBT) have been proved to be effective in improving the sleep and daytime functioning in this population. Thus e-CBT can be an effective alternative to conventional CBT.
Behavioral measures, however, remains difficult for patients to implement alone at home.
Spa therapy with psychosomatic orientation allows to implement hygiene rules and structure rhythms of life. In addition, recent studies have shown that spa treatment, including crenotherapy, is effective in somatic complaints related to anxiety and benzodiazepine withdrawal.
In this context, spa treatment with psychosomatic orientation appears conducive to implement hygiene rules and structure rhythms of life. The spa treatment could therefore provide ideal conditions for the implementation of behavioral measures of insomnia management (sleep hygiene, stimulus control and time in bed restriction) and could have a very beneficial effect on persistent insomnia disorder.
This non-pharmacological therapy could also reduce hypnotics consumption (especially benzodiazepine).
The main hypothesis of the study is that behavioral measures of insomnia management delivered by an internet software program combined to a spa treatment will be more effective on insomnia complaints (evaluated at 8 weeks) than the same program implemented at home.
Patients will be followed during 6 months after the beginning of the program. Subjects' recruitment will be carried out from the list of patients registered for a spa treatment in one of the five spa centers participating in the study (Les Thermes de Saujon, Les Grands Thermes de Bagnères de Bigorre, Les Thermes de Divonne-les-Bains, Les thermes de Néris-les-Bains, Les Thermes d'Ussat-les-Bains).
Study visits will be conducted by the coordinating center (CHU Bordeaux) by telephone interviews or video calls with participants.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Internet Behavioral therapy program + spa therapy | Experimental | Patient following a program of computerized behavioral therapy for insomnia management during a 3 weeks spa treatment. |
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| Internet Behavioral therapy program at home | Active Comparator | Patient following a program of computerized behavioral therapy for insomnia management during 3 weeks at home. |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Computerized behavioral therapy program delivered by internet for insomnia management | Behavioral | The online program consists in restriction of time in bed and stimulus control instructions. First, patient will complete an on-line sleep diary during 2 weeks. The personalized program is then activated by a practitioner (phone interview) who both assesses restriction of time in bed and delivers instructions of stimulus control. Then, restriction of time in bed is administered by the internet-delivered self-help program. The participant still completes his on-line sleep diary every day. Every 7 days, according mean sleep efficiency, a new sleep schedule recommendation is given to the participant. In addition, the program delivers everyday a set of instructions (stimulus control) designed to re-associate the bed/bedroom with sleep and to re-establish a consistent sleep wake schedule. The duration of restriction of time in bed program is 3 weeks (during spa treatment or at home depending on the allocated arm). |
| Measure | Description | Time Frame |
|---|---|---|
| Insomnia Severity Scale (ISI) score | 7-item questionnaire assessing insomnia nature, severity and impact. The global score ranges from 0 to 28. | Week 10 = 8 weeks after beginning of computerized behavioral therapy (starting of time in bed restriction) |
| Measure | Description | Time Frame |
|---|---|---|
| Total sleep time (TST) obtained by sleep diary | Total sleep time = total sleep episode minus awake time. Subject records in his online sleep diary bedtime, wake-up time, time asleep, intra-night awakenings. | Every night between starting of sleep diary completion (Day 0) and Month 6 (study termination) |
| Sleep efficiency (SE) obtained by sleep diary |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Jean-Arthur MICOULAUD-FRANCHI, MDPhD | Contact | 557820173 | +33 | jean-arthur.micoulaud-franchi@chu-bordeaux.fr |
| Cécile KLOCHENDLER | Contact | 557821159 | +33 | cecile.klochendler@chu-bordeaux.fr |
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| University Hospital, Bordeaux | Recruiting | Bordeaux | 33000 | France |
Patient could request investigator or Data Protection Officer an access to IPD according to French regulation (act No. 78-17 of 6 January 1978 on data processing, data files and individual liberties, amended by act No. 2004-801 of 6 August 2004) and he EU General Data Protection Regulation (GDPR) of 27 april 2016 applicable since 25 May 2018.
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| ID | Term |
|---|---|
| D007319 | Sleep Initiation and Maintenance Disorders |
| ID | Term |
|---|---|
| D020919 | Sleep Disorders, Intrinsic |
| D020920 | Dyssomnias |
| D012893 | Sleep Wake Disorders |
| D009422 | Nervous System Diseases |
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| Spa treatment | Other | Spa treatment is harmonized in the different stations. It consists in:
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Ratio of total sleep time (TST) to time in bed (TIB) (multiplied by 100 to yield a percentage). Subject records in his online sleep diary bedtime, wake-up time, time asleep, intra-night awakenings. |
| Every night between starting of sleep diary completion (Day 0) and Month 6 (study termination) |
| Sleep latency obtained by sleep diary | Length of time to accomplish the transition from full wakefulness to sleep. Subject records in his online sleep diary bedtime, wake-up time, time asleep, intra-night awakenings. | Every night between starting of sleep diary completion (Day 0) and Month 6 (study termination) |
| Insomnia Severity Scale (ISI) score | 7-item questionnaire that assesses insomnia nature, severity and impact. | On Day 0, Week 5, Week 7, Month 4, Month 6 |
| EQ-5-D | Standardized instrument for measuring generic health status. | On Day 0, Week 5, Week 7, Week 10, Month 4, Month 6 |
| The Presleep State Arousal Scale (PSAS) | 16-item questionnaire assessing whether the respondent experienced somatic (8 items, eg heart rate) or cognitive hyperarousal (eg racing thoughts) at bedtime | On Day 0, Week 5, Week 7, Week 10, Month 4, Month 6 |
| Hospital Anxiety and Depression Scale (HAD) | 14-item scale that generates ordinal data. Seven of the items relate to anxiety and seven relate to depression. | On Day 0, Week 5, Week 7, Week 10, Month 4, Month 6 |
| Short Version of the Functional Outcomes of Sleep Questionnaire (FOSQ) | 10 item questionnaire assessing the impact of excessive sleepiness on activities of daily living | On Day 0, Week 5, Week 7, Week 10, Month 4, Month 6 |
| Rate of discontinuation and rate of reduction of anxiolytic hypnotic drugs and hypnotics | Every day anxiolytic hypnotic drugs and hypnotics daily dose | On Day 0, Week 5, Week 7, Week 10, Month 4, Month 6 |
| Acceptability E-scale (AES) | 6-item self-reported questionnaire that evaluates the extent to which patients find E-health systems acceptable | On week 10 (after computerized behavioral therapy program) |
| Client Satisfaction Questionnaire (CSQ-8) | 8-item questionnaire easily scored and administered measurement that is designed to measure client satisfaction with services. | On week 10 (after computerized behavioral therapy program) |
| Sleep Condition Indicator (SCI) | brief 8-item scale which measures sleep problems against the DSM-5 criteria for insomnia disorder | On Day 0 |
| The Pittsburgh Sleep Quality Index (PSQI) | self-report questionnaire that assesses sleep quality over a 1-month time interval | On Day 0 |
| Cognitive Scale of Attachment to Benzodiazepines ("Echelle cognitive d'attachement aux benzodiazépines" ECAB) | 10-item scale assessing cognitive component of attachment to benzodiazepines | On Day 0 |
| The Munich ChronoType Questionnaire (MCTQ) | Questionnaire to determine Chrono Type. | On Day 0 |
| The Epworth Sleepiness Scale (ESS) | 8-item questionnaire assessing daytime sleepiness | On Day 0 |
| Freiburg Mindfulness Inventory - short version (FMI) | questionnaire for measuring mindfulness | On Day 0 |
| Krueger's personality inventory for DSM-5 in its brief form (PID-5-BF) | 25-item self-report questionnaire assessing the presence and severity of the five maladaptive personality traits outlined in DSM-5. | On Day 0 |
| The Arousal Predisposition Scale (APS) | 12-item questionnaire assessing whether the respondent considers her/himself a stressful and emotionally reactive person | On Day 0 |
| The Ford Insomnia to Stress Scale (FIRST) | 9-item questionnaire assessing whether past and future stressful events are likely to affect sleep quality | On Day 0 |
| The "locus of control for technology"-questionnaire ("Kontrollüberzeugungen im Umgang mit Technik" - KUT) | 8-item questionnaire assessing the specific interaction with technical environments of users | On Day 0 |
| D001523 |
| Mental Disorders |