Predictors of Response to Insomnia Treatments for Gulf War Veterans

Inclusion Criteria

• Male or female Gulf War Veterans of any racial or ethnic group
• Independent Living (not in nursing home or VA Extended Care facility)
• Subjective complaint of insomnia on the Insomnia Severity Index (ISI) greater than or equal to 10
• Subjects with PTSD will be included in this study as long as they do not meet criteria for depression described below
• Stable (3 weeks) CNS active medications that could significantly impact sleep or alertness
• Stable adult onset diabetes, controlled with insulin, oral medications or diet is acceptable
• Access to a device with video capabilities and ability to have the video on during study visits.

Exclusion Criteria

Sleep-Related

• Excessive caffeine consumption (4 or more cups of coffee per day) and unable to reduce to 3 cups or less a day before lunch a day for 3 weeks prior to treatment
• Subjects will be initially screened by the Berlin Questionnaire (for sleep apnea)
• Those with responses suggestive of high risk for sleep apnea will be referred to Pulmonary Medicine for standard clinical screening including polysomnography
• Those where apnea is primarily responsible for their sleep complaints will be excluded
• Subjects working a rotating shift or an unconventional daytime shift (ending after 1830h) will be ineligible

Neuropsychiatric

• Hamilton Depression Scale (HDRS 24) and classified as high risk on the Columbia Suicide Severity Rating Scale (C-SSRS) in the past month
• Individuals are considered high risk if they have endorsement of either of the following on the C-SSRS:
• A positive endorsement, relative to the past 30 days, in the "Suicide Thoughts" section of item #4 (Have you had these thoughts and had some intention of acting on them) or item #5 (Have you started to work out or worked out the details of how to kill yourself? Do you intend to carry out this plan?
• A positive endorsement, relative to the past 90 days, in the "Suicide Behavior" section of item #6 (Have you ever done anything, started to do anything, or prepared to do anything to end your life?)
• Current or lifetime history of a psychiatric disorder with primary psychotic features
• Current or lifetime bipolar disorder; prominent suicidal or homicidal ideation
• Current exposure to trauma, or exposure to trauma in the past 3 months
• Current or within the past 30 days: drug abuse or dependence (except nicotine)
• Current or expected cognitive behavior therapy for another condition (e.g.,: depression)
• Excessive alcohol consumption of >14 drinks per week or > 4 drinks per occasion
• Presence of any acute or unstable psychiatric condition(s) that requires referral for treatment
• Montreal Cognitive Assessment (MOCA) 3 times per night)
• Medically unstable congestive heart failure
• Angina
• Other severe cardiac illness as defined by treatment regimen changes in the prior 3 months
• Stroke with serious sequelae
• Cancer if < 1 year since end of treatment
• Asthma
• Emphysema
• Other severe respiratory diseases uncontrolled with medications
• Neurological disorders such as Alzheimer's disease, Parkinson's disease, and/or unstable epilepsy as defined by treatment regimen changes in the prior 3 months
• Unstable adult-onset diabetes will be excluded