Sleep for Health Study on the Effects of Cognitive Behavioral Therapy for Insomnia on Diabetes Risk

Eligibility Criteria

• * Age ≥ 22 years and \< 80 years of age
• * Prediabetes
• * Insomnia
• * Regular access to device with internet access
• * Adequate data at baseline
• * BMI \> 40 kg/m2
• * Sleep comorbidities detected in medical record or via medical history
• * Shift work or significant, externally imposed irregular sleep schedule
• * OSA by home sleep apnea test as part of trial protocol
• * Received a full course of CBT-I in the last 12 months
• * Current use of medication with glycemic effects:
• * History of type 1 or type 2 diabetes or recent/planned use of hypoglycemic agents (e.g., metformin, insulin)
• * Recent history of bariatric surgery or planning bariatric surgery in the next year
• * Current or recent use of weight loss meds
• * Unstable sleep medication regimen (recent change to schedule or dosage)
• * Significant comorbidity that may interfere with CBT-I uptake or increase risks
• * Unwilling or unable to limit heavy machinery use/long bouts of driving or unstable illness that would be worsened by sleep restriction
• * High risk of falls
• * Epilepsy
• * Medical conditions that interfere with dCBT-I or contribute to insomnia or diabetes risk (e.g., hyperthyroidism, significant kidney disease, active cancer treatment, any medical condition that requires chronic steroid use)
• * Significant alcohol or substance use disorder
• * Active or recent history of eating disorder, recent weight change of \>10%
• * Women: pregnancy (current or planned), breastfeeding, \< 1 year postpartum
• * Use of hydroxyurea
• * Extensive skin changes or adhesive allergy making CGM sensor use problematic