Web-based therapy for insomnia is an effective option that could reach "previously unimaginable numbers of people," researchers suggest.
Although cognitive behavior therapy for insomnia (CBT-I) is the first-line treatment for adults with chronic insomnia, there aren't enough trained clinicians to deliver the treatment, according to Dr. Lee Ritterband of the University of Virginia School of Medicine in Charlottesville and colleagues.
To investigate whether web-based CBT-I is effective over the long term and might enable more people to benefit, the team randomly assigned 303 adults with chronic insomnia to a six-week automated, interactive and tailored web-based program (Sleep Healthy Using the Internet, or SHUTi, at http://www.myshuti.com) or an online, nontailored patient education program about insomnia.
To be included in the study, participants had to take more than half an hour to fall asleep at the beginning of the night or be awake for more than half an hour after initially falling asleep at least three nights per week for at least six months; average 6.5 hours or less sleep time nightly; and experience significant stress or impaired functioning due to sleep disturbances. About half of participants also had at least one medical or psychiatric condition.
Most of the participants - 77 in the SHUTi group (51 percent) and 69 in the patient education group (46 percent) - had taken a sleep aid at least once.
The research team reports in JAMA Psychiatry that SHUTi was significantly more effective than the patient education program with respect to insomnia severity, delay until sleep onset and time awake after sleep onset. By one year, insomnia was no longer a problem for 57 percent of SHUTi participants versus 27 percent of those receiving education.
In addition, 70 percent of SHUTi participants had seen at least some improvement, compared to 43 percent of participants who received education.
Ritterband told Reuters Health that the online intervention is not intended to replace face-to-face CBT-I, "but rather to expand the availability and access (to CBT-I) to meet the needs of the millions of people."
"Internet interventions are not for everyone . . . Those who prefer face-to-face therapy can still have that as a possibility if available, but those who are interested in a web-based program, or who do not otherwise have access to a CBT-I specialist in their region, could now have an option," he said by email.
"Given the high prevalence of insomnia and its costly impact, from both a personal and economic perspective, it is critical that we continue to develop and evaluate methods of care that can make a meaningful public health impact," he concluded.
Dr. Aric Prather of the University of California, San Francisco, coauthor of an accompanying editorial, told Reuters Health, "This study provides the strongest evidence to date that web-based CBT-I is efficacious for treating patients with insomnia, including those with some psychiatric and medical comorbidities. These findings further highlight how technology can help scale the disseminations of needed interventions."
"There is often a misplaced concern that the Internet will replace the skilled clinician," he said by email. "While web-based therapies, including SHUTi, will certainly increase the swath of individuals who receive treatment, there will likely always be a need for skilled therapists to meet the needs of patients who prefer face-to-face encounters or present with complex cases that require personalized care."
Dr. Shelby Harris, director, Behavioral Sleep Medicine at the Sleep-Wake Disorders Center at Montefiore Hospital in New York City, pointed out that the authors of the study made sure in advance that participants did not have any untreated sleep disorders.
"Given that sleep apnea is extremely common," she told Reuters Health by email, "it is important that patients make sure that any other sleep disorders are thoroughly evaluated (and treated if necessary) by a sleep physician."
Harris concluded, "Early treatment is best, so this is a great resource for patients initially struggling with insomnia who may first present to a primary care office."
Ritterband and three coauthors have equity ownership in BeHealth Solutions, which licensed the SHUTi program and platform from the University of Virginia.