Digital cognitive behavioral therapy (CBT) improves not only insomnia symptoms, but functional health, psychological well-being, and sleep-related quality of life, according to a year-long study involving 1,711 people.
A major limitation of insomnia treatments is the lack of providers to deliver CBT, but this study, which appears in JAMA Psychiatry, used an online platform that made it easily accessible to users. It also automated and tailored the treatment around the user’s sleep patterns.
There is a four-to-six month wait for an insomnia patient to get an appointment in his sleep clinic, says coauthor Jason Ong, associate professor of neurology in sleep medicine at Northwestern University Feinberg School of Medicine. “We can reach many more patients with insomnia by using a digitally based program.”
Previous research has identified insomnia as a risk factor for the development of mental health disorders, cardiovascular disease, and type 2 diabetes.
“Sleep ranks with air, water, and food as one of the essentials of life, yet 10 to 12 percent of the population doesn’t get enough of it due to insomnia,” says lead author Colin Espie, professor of sleep medicine at Oxford University and chief medical officer of Big Health, a provider of automated and personalized behavioral medicine programs for mental health.
“Our study suggests that digital medicine could be a powerful way to help millions of people not just sleep better, but achieve better mental and physical well-being as a result,” Espie says.
The study provides new evidence that the clinical benefits of digital CBT extend beyond sleep to also improve a person’s daytime functioning.
“Typically, what leads patients to seek treatment is when their insomnia begins to impact their quality of life or daytime functioning,” Ong says. “The fact that we saw improvements in both of these areas shows that the digital program has benefits around the clock.”
Before sleeping pills
Though people with insomnia have traditionally received treatment with pharmaceuticals, new guidelines the American College of Physicians published in 2016 recommend that CBT be used first-line, ahead of sleeping pills.
For the study, participants received treatment using the Sleepioprogram and an associated iOS app. Sleepio, a digital sleep improvement program featuring CBT techniques that Espie designed, is a product of Big Health.
Delivery was structured into six sessions lasting an average of 20 minutes each, with participants having access to the intervention for up to 12 weeks. Researchers assessed participants online at 0 weeks (baseline), four weeks (mid-treatment), eight weeks (post-treatment), and 24 weeks (follow-up). Program content was based on CBT manuals and included behavioral, cognitive and educational components.
“In clinical studies, dCBT has repeatedly achieved statistically significant and clinically meaningful results for outcomes including sleep, mental health, and daytime functioning,” Espie says. “Our latest results indicate that dCBT can be an effective, inexpensive way to help insomnia sufferers achieve better health over the long term through behavior change.”
Big Health (Sleepio) Ltd. funded the work. Grants awarded to the University of Oxford also provided funding.
Source: Northwestern University