0955 Subjectively Reported Barriers to Sleep in People with Spinal Cord Injuries

Introduction Poor sleep is highly prevalent in people with spinal cord injury (SCI) and has been associated with multiple adverse health outcomes. Little attention has been focused, however, on the circumstances specific to SCI that may impact sleep. The purpose of this study was to examine the experience of sleep among individuals with SCI. Methods Secondary analysis of qualitative data from an ethnographic study of 20 community-dwelling adults with SCI. Participants in the primary study were recruited from a rehabilitation facility specializing in treating SCI. Data were collected through unstructured interviews and naturalistic observation; average data collection window was two years. For this analysis, all transcripts and field notes were reviewed, and sections relating to sleep were extracted and formally coded. Transcripts were reviewed and independently coded by at least two researchers. The research team then discussed the codes and identified overarching themes. After coding was finalized, transcripts were reviewed and re-coded as needed. Results Sleep-related data were found in transcripts for 90% of the sample. Participants descriptions of their sleep included characteristics of both insomnia (initial and maintenance, non-restorative sleep) and circadian rhythm disorders (frequent daytime sleep, highly variable sleep/wake patterns). Factors contributing to poor sleep that were identified included SCI-related dysfunction and care, sleep environment, and co-morbid conditions (pain, anxiety, and depression). Unexpectedly, multiple participants reported using daytime sleep to reduce boredom and/or avoid aversive situations. Conclusion Cognitive behavioral therapy for insomnia (CBT-I) has been shown to be effective in improving sleep in the general population and in multiple clinical populations. However, its efficacy in those with SCI has not been demonstrated, and findings from this analysis suggest that tailoring CBT-I to the unique needs of this population would maximize its efficacy. Significant attention should be paid to increasing homeostatic sleep drive, and standard stimulus control procedures would need to be adapted to accommodate motoric limitations. Finally, problem-solving strategies to address issues related to sleep surfaces and environments would need to be included in the treatment protocol. Support (If Any) NIDRR/DoE (H133G000062); NICHD/NIH (K01HD076183); AHRQ (K01HS022907)