A 12-week online insomnia program boosted functional health, psychological well-being, and sleep-related quality of life and subsequent reductions in insomnia improved health and well-being even more, according to a study published in JAMA Psychiatry on September 25.
Insomnia affects about 10 to 12 percent of adults in the United States. Typically, the chronic sleep disorder is treated with prescription sleep medications. However, guidelines published by the American College of Physicians in 2016 recommended treating first with cognitive behavioral therapy (CBT).
CBT consists of three components: behavioral, which addresses stimulus control, sleep restriction, and relaxation; cognitive, which focuses on managing sleep-related worries, a racing mind, and intrusive thoughts; and educational, which teaches people about sleep hygiene.
Previous research suggests that CBT, including CBT accessed online, is effective for treating insomnia-related symptoms.
To look more closely at online or digital CBT (dCBT) and how it might affect health, well-being, and sleep-related quality of life, researchers recruited 1,718 adults (77 percent female, 91 percent white) for the Digital Insomnia Therapy to Assist Your Life as Well as Your Sleep (DIALS) study.
DIALS was designed by lead researcher Colin Espie, PhD, of the University of Oxford in the United Kingdom to measure Sleepio, an online sleep therapy program that uses CBT. Big Health Ltd, which markets the program, funded the study.
Participants were randomized to receive either dCBT or sleep hygiene education (SHE) and all were asked to complete a short questionnaire about their treatment goals. All participants also continued with any treatment they were taking prior to the study.
During the 12-week study period, participants in the dCBT group accessed Sleepio to complete six 20-minute sessions presented by a virtual animated therapist. Participants reported sleep information every day throughout the intervention, which allowed the therapist to tailor the program to each individual. Participants also had access to a moderated online community and an online library of information on sleep.
They could also view their online case file, which included a progress review, a reminder of strategies to try out between sessions, an agreed sleep schedule, and a list of further reading.
Those in the control group learned about sleep hygiene, including establishing a regular bedtime routine and limiting alcohol and caffeine intake, through a website and downloadable booklet.
All participants reported their physical health, including physical function, pain, fatigue, emotional distress, and social and mental health, based on a 10-item scale, with higher scores indicating better health.
To assess their sleep health, researchers asked participants to rate sleep-related impairments regarding energy and motivation, work performance, cognitive function, emotional regulation, health and well-being, social functioning, and relationship/family functioning on a 100-point scale, with higher scores indicating greater impairment.
Researchers assessed participants at the beginning of the study and four, eight, and 24 weeks after. At week 25, researchers offered all control group participants dCBT.
Fifty-seven percent of patients randomized to dCBT completed four sessions, and just under half completed all six. Those in the dCBT group experienced small, but significant improvements in health and well-being and a major improvement in sleep-related quality of life.
For example, at week four, participants in the dCBT saw their health scores go up by .9 points. By week eight, the score jumped by 1.8 points. For well-being, scores rose by 1.04 points at week four and by 2.95 points at week 24. Scores on quality of life impairments dropped by 8.7 points at week four. At week 24, impairment scores had dropped by 18.72 points.
Automated web and mobile programs may be an effective intervention for insomnia, the authors concluded.
However, since participants were mostly white and female, they cautioned against extrapolating the findings to the general population.