{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T00:39:36Z","timestamp":1789778376271,"version":"4.0.1"},"reference-count":57,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2024,8,8]],"date-time":"2024-08-08T00:00:00Z","timestamp":1723075200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"DOI":"10.13039\/100000049","name":"National Institute of Aging","doi-asserted-by":"publisher","award":["R01AG057500-03"],"award-info":[{"award-number":["R01AG057500-03"]}],"id":[{"id":"10.13039\/100000049","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Stanford School of Medicine Research Office"},{"DOI":"10.13039\/100000097","name":"National Center for Research Resources","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000097","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100006108","name":"National Center for Advancing Translational Sciences","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100006108","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["UL1 TR001085"],"award-info":[{"award-number":["UL1 TR001085"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,1,13]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Study Objectives<\/jats:title>\n                    <jats:p>Evaluate a triaged stepped-care strategy among adults 50 and older with insomnia disorder.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Participants (N\u2005=\u2005245) were classified at baseline by a Triage Checklist. Those projected to do better if they start treatment with therapist versus digitally delivered CBT-I (tCBT-I vs dCBT-I) constituted the YES stratum (n\u2005=\u2005137); the rest constituted the NO stratum (n\u2005=\u2005108). Participants were randomized within stratum to a strategy that utilized only dCBT-I (ONLN) or to a strategy that prospectively allocated the first step of care to dCBT-I or tCBT-I based on the Triage Checklist and switched dCBT-I nonresponders at 2-months to tCBT-I (STEP). Co-primary outcomes were the insomnia severity index (ISI) and the average nightly amount of prescription hypnotic medications used (MEDS), assessed at 2, 4, 6, 9, and 12 months postrandomization.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Mixed effects models revealed that, compared to ONLN, participants in STEP had greater reductions in ISI (p\u2005=\u2005.001; \u03b72\u2005=\u20050.01) and MEDS (p\u2005=\u2005.019, \u03b72\u2005=\u20050.01). Within the YES stratum, compared to ONLN, those in STEP had greater reductions in ISI (p\u2005=\u2005.0001, \u03b72\u2005=\u20050.023) and MEDS (p\u2005=\u2005.018, \u03b72\u2005=\u20050.01). Within the ONLN arm, compared to the YES stratum, those in the NO stratum had greater reductions in ISI (p\u2005=\u2005.015, \u03b72\u2005=\u20050.01) but not in MEDS. Results did not change with treatment-dose covariate adjustment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Triaged-stepped care can help guide the allocation of limited CBT-I treatment resources to promote effective and safe treatment of chronic insomnia among middle-aged and older adults. Further refinement of the Triage Checklist and optimization of the timing and switching criteria may improve the balance between effectiveness and use of resources.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical Trial Information<\/jats:title>\n                    <jats:p>Name: The RESTING Insomnia Study: Randomized Controlled Study on Effectiveness of Stepped-Care Sleep Therapy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration ID<\/jats:title>\n                    <jats:p>NCT03532282. URL: https:\/\/clinicaltrials.gov\/study\/NCT03532282<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/sleep\/zsae182","type":"journal-article","created":{"date-parts":[[2024,8,7]],"date-time":"2024-08-07T21:20:21Z","timestamp":1723065621000},"source":"Crossref","is-referenced-by-count":6,"title":["Effects of a Triage Checklist to optimize insomnia treatment outcomes and reduce hypnotic use: the RCT of the effectiveness of stepped-care sleep therapy in general practice study"],"prefix":"10.1093","volume":"48","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2829-8892","authenticated-orcid":false,"given":"Rachel","family":"Manber","sequence":"first","affiliation":[{"name":"Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine , Stanford, CA ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1502-1985","authenticated-orcid":false,"given":"Nicole 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