Digital cognitive behavioral therapy may ease insomnia symptoms: JAMA

Use of digital cognitive behavioral therapy (dCBT) could effectively improve psychological well-being, functional health and sleep-related quality of life in people with insomnia, suggests a new study published in the journal JAMA Psychiatry.

Colin A. Espie, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom, and colleagues conducted the study to investigate the effect of dCBT for insomnia on functional health, psychological well-being, and sleep-related quality of life and to determine whether a reduction in insomnia symptoms was a mediating factor.

Also Read: Pharmacological Management of Chronic insomnia in Elderly

For the study, the researchers randomly assigned 1,700 insomnia patients to receive either dCBT 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 (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 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 well-being, 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.

Also Read: Antidepressants on their own not effective in Insomnia

Key Findings:

• Patients reported more improvement in their insomnia symptoms after 4, 8 and 24 weeks with digital CBT than they did with sleep hygiene education.


• A large improvement in insomnia mediated these outcomes (range mediated, 45.5%-84.0%).

“This new study indicates that digital CBT can help insomnia sufferers achieve not just better sleep, but better overall health and quality of life,” Colin Espie, a co-founder of Sleepio developer Big Health told Reuters 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.

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.

"These results confirm that dCBT improves both daytime and nighttime aspects of insomnia, strengthening existing recommendations of CBT as the treatment of choice for insomnia," concluded the authors.

For further reference log on to 10.1001/jamapsychiatry.2018.2745