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 Although cognitive behavior therapy for insomnia (CBT-I) is the
first-line treatment for adults with chronic insomnia, there aren’t
enough trained clinicians to deliver the treatment, according to Dr.
Lee Ritterband of the University of Virginia School of Medicine in
Charlottesville and colleagues.
To investigate whether web-based CBT-I is effective over the long
term and might enable more people to benefit, the team randomly
assigned 303 adults with chronic insomnia to a six-week automated,
interactive and tailored web-based program (Sleep Healthy Using the
Internet, or SHUTi, at http://www.myshuti.com) or an online,
nontailored patient education program about insomnia.
To be included in the study, participants had to take more than half
an hour to fall asleep at the beginning of the night or be awake for
more than half an hour after initially falling asleep at least three
nights per week for at least six months; average 6.5 hours or less
sleep time nightly; and experience significant stress or impaired
functioning due to sleep disturbances. About half of participants
also had at least one medical or psychiatric condition.
Most of the participants - 77 in the SHUTi group (51 percent) and 69
in the patient education group (46 percent) - had taken a sleep aid
at least once.
The research team reports in JAMA Psychiatry that SHUTi was
significantly more effective than the patient education program with
respect to insomnia severity, delay until sleep onset and time awake
after sleep onset. By one year, insomnia was no longer a problem for
57 percent of SHUTi participants versus 27 percent of those
receiving education.
In addition, 70 percent of SHUTi participants had seen at least some
improvement, compared to 43 percent of participants who received
education.
Ritterband told Reuters Health that the online intervention is not
intended to replace face-to-face CBT-I, “but rather to expand the
availability and access (to CBT-I) to meet the needs of the millions
of people.”
“Internet interventions are not for everyone . . . Those who prefer
face-to-face therapy can still have that as a possibility if
available, but those who are interested in a web-based program, or
who do not otherwise have access to a CBT-I specialist in their
region, could now have an option,” he said by email.
“Given the high prevalence of insomnia and its costly impact, from
both a personal and economic perspective, it is critical that we
continue to develop and evaluate methods of care that can make a
meaningful public health impact,” he concluded.
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Dr. Aric Prather of the University of California, San Francisco,
coauthor of an accompanying editorial, told Reuters Health, “This
study provides the strongest evidence to date that web-based CBT-I
is efficacious for treating patients with insomnia, including those
with some psychiatric and medical comorbidities. These findings
further highlight how technology can help scale the disseminations
of needed interventions.”
“There is often a misplaced concern that the Internet will replace
the skilled clinician,” he said by email. “While web-based
therapies, including SHUTi, will certainly increase the swath of
individuals who receive treatment, there will likely always be a
need for skilled therapists to meet the needs of patients who prefer
face-to-face encounters or present with complex cases that require
personalized care.”
Dr. Shelby Harris, director, Behavioral Sleep Medicine at the
Sleep-Wake Disorders Center at Montefiore Hospital in New York City,
pointed out that the authors of the study made sure in advance that
participants did not have any untreated sleep disorders.
“Given that sleep apnea is extremely common,” she told Reuters
Health by email, “it is important that patients make sure that any
other sleep disorders are thoroughly evaluated (and treated if
necessary) by a sleep physician.”
Harris concluded, “Early treatment is best, so this is a great
resource for patients initially struggling with insomnia who may
first present to a primary care office.”
Ritterband and three coauthors have equity ownership in BeHealth
Solutions, which licensed the SHUTi program and platform from the
University of Virginia.
SOURCE: http://bit.ly/2h3y6Uu and http://bit.ly/2gzJSSV JAMA
Psychiatry, online November 30, 2016.
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