We all have that friend that’s a self-proclaimed insomniac. But not everyone that has problems with sleep is considered an insomnia patient. What’s classified as true insomnia? The sleep complaints need to be frequent, not caused by any other external factor, and must impact daily behavior to meet the criteria for clinical chronic insomnia.
How to treat clinical insomnia?
Cognitive Behavioral Therapy for Insomnia (CBT-I) is recommended as the first treatment for clinical insomnia. In face-to-face sessions with a therapist, the sleep issues are assessed and, using a structured program, thoughts, and behaviors that cause or worsen sleep problems are identified and replaced with habits that promote sound sleep. It has been shown effective in improving both sleep and daytime functioning in insomniacs is considered safe (i.e. not having the side effects of hypnotics), and has long-term benefits.
Treatment goes digital
CBT-I has entered the digital era, and the CBT-I tools are now delivered in a fully automated fashion, as app services or via online resources, without any actual therapist involved, referred to as Digital CBT-I (dCBT-I). This comes in part because of the limited availability of qualified therapists available to deliver the therapy, and the rise of mobile technologies meeting health and wellness needs.
Can these digital therapies help those with insomnia symptoms? Can it change sleep in the long run? And could it be helpful even to those with intermittent sleep problems? Two recent studies addressed these questions.
Study 1: dCBT-I vs. Sleep tips
The study of Luik et al in the August 2020 volume of the Journal of Sleep Research addressed the potential long-term benefits of dCBT-I. A follow-up was executed on a 24-week study (also called a randomized clinical trial) in 1711 adults with insomnia symptoms. Half of the participants went through a 6-week dCBT-I program, and the other half received sleep tips on how to improve sleep (also called sleep hygiene education) for the same six weeks. By the end of the 24 weeks, the group who underwent the dCBT-I program reported better sleep, less insomnia, and better health & well-being compared to the group that only received the sleep tips.
At the end of this study, the group that got the sleep tips were then offered the dCBT-I program. This allowed the researchers to look at the long-term effects in week 48 for all the participants that were still in the study at that time. As compared to the start of the study, after 48 weeks, those in the study still reported better sleep, less insomnia and better health and well-being. The authors concluded that dCBT-I resulted in sustained benefits to insomnia and its daytime outcomes, helping the people with insomnia symptoms to enjoy both better days and nights in the short and long-term.
Study 2: dCBT-I vs. Puzzles
The study of Denis er al in the February volume of the journal Sleep Medicine addressed the question: does dCBT-I help those that do not meet the criteria for insomnia symptoms (so-called sub-threshold insomnia), but still have poor sleep, without a specific other cause? 199 young adult females were included in the study, including both those that met the clinical insomnia criteria as well as those who were sub-threshold. 50% underwent a weekly dCBT-I program (the same as in the aforementioned study by Luik et al), while the other group was asked to solve puzzles every week (acting as a general activity that took roughly the same amount of time as the dCBT-I), in both groups for 6 .
At the end of these six weeks, the group that completed the dCBT-I showed greater improvement in their insomnia symptoms as compared to the group that worked on the puzzles. These results were similar in both the insomniacs and the pre-clinical insomniacs. The authors concluded that dCBT-I could be a useful tool for tackling mild symptoms of insomnia.
The ideal stepped-care approach
It’s clear that dCBT-I is a great first option that those with milder complaints can try before trying in-person CBT-I, if needed. And with access just a few clicks away and no prescription required, this first line of treatment continues to prove effective for a multitude of sleepers looking for relief.
Curious what dCBT-I was used in both studies? Check out the SleepScore validated product Sleepio in the SleepScore Store.