Date of Graduation

Spring 2026

Document Type

Culminating Project

Degree Name

Doctor of Nursing Practice (DNP)

Department

Nursing

Committee Chairperson

Jackie Owens DNP, CRNP, FNP-BC

Committee Member

Sajeeb Adhikary, MD

Abstract

Chronic insomnia is a prevalent condition associated with significant physical, psychological, and functional impairment. Although Cognitive Behavioral Therapy for Insomnia (CBT-I) is recommended as first-line treatment, access remains limited, resulting in continued reliance on pharmacologic therapies. This DNP project evaluated the effectiveness of a nurse practitioner (NP)-facilitated CBT-I program, supported by the CBT-I Coach, in improving sleep outcomes and reducing reliance on sleep medications among adults with chronic insomnia in an outpatient setting. Methods: A pre–post intervention design was utilized. Adult participants with chronic insomnia were enrolled in a structured CBT-I program consisting of an initial 60-minute intake session followed by 4–6 weekly 30-minute NP-led sessions. Core components included sleep restriction, stimulus control, cognitive restructuring, sleep hygiene, and relapse prevention. Participants used the mobile application for daily sleep diary tracking and skill reinforcement. Outcome measures included sleep efficiency (SE), Insomnia Severity Index (ISI) scores, and changes in hypnotic medication use. Results: Participants demonstrated promising results, with noted increases in sleep efficiency and one participant demonstrating a decrease in ISI score. A decrease in pharmacologic sleep aids was not seen due to the nature of the participants’ comorbidities. NP-facilitated CBT-I supported by a digital health tool is a feasible and effective approach to managing chronic insomnia in outpatient settings. This model has the potential to improve access to evidence-based care and supports a shift away from pharmacologic management toward sustainable, nonpharmacologic treatment strategies.

Keywords: insomnia, CBT-I, nurse-facilitated CBT-I, CBT-I Coach

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