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 Researchers randomly assigned 1,700 insomnia patients to receive
either digital CBT or so-called sleep hygiene education designed to
improve bedtime routines and encourage avoidance of substances like
caffeine and alcohol that can interfere with sleep.
The CBT group used the online Sleepio program (https://bit.ly/1CIZS9u)
and an associated iOS app, which offered a series of 20-minute
therapy sessions people could access for up to 12 weeks.
Patients reported more improvement in their insomnia symptoms after
4, 8 and 24 weeks with digital CBT than they did with sleep hygiene
education, the study team reports in JAMA Psychiatry.
"This new study indicates that digital CBT can help insomnia
sufferers achieve not just better sleep, but better overall health
and quality of life," said lead study author Colin Espie, a
co-founder of Sleepio developer Big Health.
"It also underscores previous findings that better sleep contributes
to better mental health," Espie said by email.
CBT can train people to use techniques that address the mental (or
cognitive) factors associated with insomnia, such as the "racing
mind," and to overcome the worry and other negative emotions that
often accompany inability to sleep. CBT can also help people with
poor sleep establish a healthy bedtime routine and improve sleep
patterns, previous research has found.
"While a fully automated digital solution like Sleepio cannot fully
replicate the power of a trusted, face-to-face relationship between
a patient and clinician, there are several advantages to the digital
format," Espie said.
One key advantage is that the app can be available in the middle of
the night when people need help, and not require patients to wait
for a therapist to offer them an appointment, Espie said. Amid a
shortage of providers trained to offer CBT for insomnia, the app may
also help expand access to care for patients who might otherwise be
unable to receive treatment.
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Patients in the current study were 48 years old on average and most
were female and white.
Roughly half of them consumed caffeine at least twice daily and on
average, this group of patients was slightly overweight - both
things that can get in the way of a good nights' sleep.
To assess the effectiveness of digital CBT, researchers asked
patients to assess the magnitude of improvements in their own
physical health, psychological wellbeing, insomnia and sleep-related
quality of life. On all of these measures, digital CBT appeared to
make a bigger impact than sleep hygiene education, the study found.
Even though the study was a controlled experiment, it wasn't
designed to assess whether or how digital CBT might perform relative
to in-person CBT. It's also possible that results would be different
in more diverse patient populations.
Even so, the results offer fresh evidence of the potential for
mobile and web-based therapy to be one effective option for treating
insomnia, said Ricardo F. Munoz, director of the Institute for
International Internet Interventions for Health (i4Health) and a
professor emeritus at the University of California, San Francisco
"Treating insomnia with CBT has longer lasting effects than, for
example, treating insomnia with medication," Munoz, who wasn't
involved in the study, said by email. "Because CBT involves learning
how to sleep well, what the person learns can be used indefinitely;
medications only work while you are using them and can have harmful
side effects."
SOURCE: https://bit.ly/2J2BCdd JAMA Psychiatry, online September 25,
2018.
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