Cognitive behavioral therapy for insomnia, improving non pharmacological sleep resources in a prison setting

Abstract

Problem Statement: While sleeping issues are widely present within the general population, insomnia rates can be as high as 61% within prison settings. The consequences of untreated insomnia in these settings can attribute to increases in irritability, impulsiveness, anger, aggression, and overutilization of the prison health care system. Insomnia is known to increase the prevalence and severity of anxiety and depression, but it can also increase suicidality, suicide attempts, and suicide completions. The first line treatment method for insomnia is Cognitive Behavioral Therapy for Insomnia (CBT-I). Implementation of Cognitive Behavioral Therapy for Insomnia has the potential to decrease the prescription of sleeping medications in this setting as patients experience symptom reduction and remission from insomnia and no longer need medication treatment. Methods: A clinical practice guideline suggesting the addition of Cognitive Behavioral Therapy for Insomnia video resources to the inmate electronic tablet system was presented to multiple stakeholders within the organization. Qualitative feedback was gathered and analyzed following this presentation. Results: Feedback was organized into 8 themes; limited barriers to implementation, validation of issues with the current process, language changes to be made, initiating implementation at the facility's intake unit, the potential increase in patient trust and autonomy, the referral process and accessibility, feedback reports, and future directions. Conclusions: This guideline would be edited to include feedback provided by stakeholders, then evaluated again using the AGREE-II tool before it would be implemented.