Digital cognitive behavioral therapy significantly improved symptoms, functional health, psychological well-being and sleep-related quality of life among people with insomnia, study findings reported in JAMA Psychiatry showed.
“The effects of CBT and [digital] CBT on the nighttime symptoms of insomnia ... appear robust. However, daytime symptoms are a core part of insomnia disorder, integral to its clinical presentation,” Colin A. Espie, PhD, from the Sleep & Circadian Neuroscience Institute at University of Oxford, and colleagues wrote. “Improving constructs such as functional health, psychological well-being and quality of life may therefore be crucial to treating insomnia satisfactorily.”
Researchers reported the effect of digital cognitive behavioral therapy for insomnia on functional health, psychological well-being and sleep-related quality of life at weeks 4, 8 and 24 among 1,711 participants with insomnia symptoms in this online, parallel-group randomized trial. They also examined whether a decrease in insomnia symptoms measured at weeks 4 and 8 mediated the effect of digital CBT on these outcomes.
Participants received digital CBT plus treatment as usual or sleep hygiene education plus treatment as usual. The digital CBT, delivered using the Sleepio program and an associated iOS smartphone app, is structured into six, 20-minute sessions and allowed participants to access the intervention for up to 12 weeks. Treatment content included behavioral, cognitive and educational components. Sleep hygiene education, based on recognized sleep hygiene advice and delivered via website and downloadable booklet, was selected as the behavioral comparator because it is commonly offered to people with insomnia in routine care, according to the researchers.
Study findings showed that digital cognitive behavioral therapy significantly improved symptoms, functional health, psychological well-being and sleep-related quality of life among people with insomnia.
Patients were assessed at baseline, 4 (mid-treatment), 8 (post-treatment) and 24 (follow-up) weeks to determine change in scores on self-reported measures of functional health, psychological well-being and sleep-related quality of life. The investigators also measured participants’ mood, fatigue, sleepiness, cognitive failures, work productivity and relationship satisfaction.
At weeks 4, 8, and 24, digital CBT was linked with improvement in global health and mental well-being as well as a significant decrease in sleep-related impairment to quality of life compared with sleep hygiene education. Specifically, compared with sleep hygiene education, digital CBT use was associated with a large improvement in sleep-related quality of life at week 4 (adjusted difference, –8.76; 95% CI, –11.83 to –5.69), week 8 (adjusted difference, –17.6; 95% CI, –20.81 to –14.39) and week 24 (adjusted difference, –18.72; 95% CI, –22.04 to –15.41). The effects were robust across sensitivity analyses, according to the results.
Espie and colleagued also found that improvement in insomnia associated with digital CBT mediated these outcomes at weeks 8 (51% mediation of functional health, 47% of well-being, and 46% of sleep-related quality of life) and 24 (84% of functional health, 75% of well-being, and 66% of sleep-related quality of life).
In addition, symptoms of depression, anxiety, sleepiness and cognitive failures all showed significant differences in favor of digital CBT.
‘This is the first largescale study demonstrating a causal relationship between CBT mediated reduction in insomnia symptoms and perceived health status and quality of life,” Espie and colleagues wrote. “These findings indicate that [digital] CBT improves both daytime and nighttime aspects of insomnia, lending further weight to the clinical guideline recommendation of CBT as the treatment of choice for insomnia.” – by Savannah Demko
Disclosure: Espie is a cofounder, chief medical officer and shareholder of Big Health Ltd, from which he reports salary. He is also a developer of Sleepio. Please see the study for all other authors’ relevant financial disclosures.