E-therapy may help ease insomnia

People with insomnia who receive a digitised version of cognitive behavioral therapy (CBT) as part of their treatment may find more symptom relief than those who only receive tips to improve their sleep routines, a recent experiment suggests.

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 (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.

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.”