Online Cognitive Behavioral Therapy For Insomnia

Editorial

10 March 2025

Editorial: Online cognitive behavioral therapy for insomnia

Stuart F. Quan

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Editors

Stuart F Quan

Harvard Medical School

Sara Nowakowski

Baylor College of Medicine

Montserrat Diaz-Abad

University of Maryland

Impact

Between-group changes in mean (95%CI) Epworth Sleepiness Scale scores during each weekly digital CBTi session. Dashed line indicates commencement of personalized sleep restriction therapy during Session 2.

Original Research

13 March 2024

Effect of high-risk sleep apnea on treatment-response to a tailored digital cognitive behavioral therapy for insomnia program: a quasi-experimental trial

Alexander Sweetman

, 6 more and

Cele Richardson

Introduction: Therapist-delivered Cognitive Behavioral Therapy for Insomnia (CBTi) is an effective but largely inaccessible treatment for people with Co-Morbid Insomnia and Sleep Apnea (COMISA). To increase CBTi access for COMISA, we aimed to develop a self-guided interactive 5-session digital CBTi program that is appropriate for people with insomnia-alone and COMISA, and compare its effectiveness between people with insomnia-alone, vs. comorbid insomnia and high-risk sleep apnea.

Methods: Data from 62 adults with insomnia symptoms were used. High-risk sleep apnea was defined as a score of ≥5 on the OSA50. Participants self-reported symptoms of insomnia (ISI), depression, anxiety, sleepiness (ESS), fatigue, and maladaptive sleep-related beliefs (DBAS-16) at baseline, 8-week, and 16-week follow-up. ESS scores were additionally assessed during each CBTi session. Intent-to-treat mixed models and complete-case chi² analyses were used.

Results: There were more participants with insomnia-alone [n = 43, age M (sd) = 51.8 (17.0), 86.1% female] than suspected COMISA [n = 19, age = 54.0 (14.8), 73.7% female]. There were no between-group differences in baseline questionnaire data, or rates of missing follow-up data. There were no significant group by time interactions on any outcomes. Main effects of time indicated moderate-to-large and sustained improvements in insomnia (d = 3.3), depression (d = 1.2), anxiety (d = 0.6), ESS (d = 0.5), fatigue (d = 1.2), and DBAS-16 symptoms (d = 1.2) at 16-weeks. ESS scores did not increase significantly during any CBTi session.

Conclusion: This interactive digital CBTi program is effective in people with insomnia-alone, and people with co-morbid insomnia and high-risk sleep apnea. Further research is required to determine the effectiveness, safety and acceptability of digital CBTi in people with insomnia and confirmed sleep apnea.

Clinical Trial Registration: This trial was prospectively registered on the Australian and New Zealand Clinical Trials Registry (ANZCTR, ACTRN12621001395820).

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2 citations

Mini Review

08 February 2024

Current sleep interventions for shift workers: a mini review to shape a new preventative, multicomponent sleep management programme

Amber F. Tout

, 6 more and

Talar R. Moukhtarian

Current non-pharmacological sleep interventions for shift workers, most (1) to least (7) frequently implemented.

Introduction: Shift work can lead to sleep disturbances and insomnia during the sleeping period, as well as excessive sleepiness and fatigue during the waking period. While Cognitive Behavioral Therapy (CBT-i) is recommended as the first line of treatment for insomnia, key elements of CBT-i, such as maintaining a consistent sleep schedule, can be challenging for shift workers, highlighting the need for tailored sleep interventions. This mini review provides a narrative synthesis of non-pharmacological sleep interventions for shift workers and informs the development of a preventative, multicomponent sleep management programme.

Method: An informal review was conducted in line with Phase 1 of the Framework for the Development and Evaluation of Complex Interventions.

Results: A variety of strategies have been employed to help manage the impacts of shift work on sleep, including: CBT-i, adjusting shift schedules, controlled light exposure, sleep hygiene education, planned napping, caffeine consumption, and mind-body interventions (e.g., yogic relaxation).

Discussion: Recommendations, limitations, and directions for future research are discussed; notably, the role of the family, the commute to and from the workplace, and the eating behaviors of employees appear to have been overlooked in current intervention efforts. Digital CBT-i platforms could help to provide an effective, scalable, and low-cost method of reducing insomnia in shift workers.

4,870 views

3 citations