ADELAIDE, Australia — Sleep aid medications like Ambien may work nicely as a short-term fix for sleep problems, but relying on pills to stave off insomnia over the long-term runs a serious risk of dependency and side-effects. Now, however, researchers from Flinders University assert that self-guided digital behavioral therapy is a valid alternative solution for those struggling to get enough sleep.
While there is a wealth of relevant evidence advocating for the usefulness of cognitive behavioral therapy for insomnia (CBTi), accessibility to “first line” treatments remains very limited due to fact there is a major shortage of CBTi trained psychologists. For example, in Australia, roughly 90 percent of primary care patients with insomnia are simply prescribed sleeping pills. Just one percent receive referrals to psychologists for CBTi.
So, in an effort to increase awareness and accessibility to CBTi, and reduce sleeping pill reliance, a team of sleep experts from Flinders University and the University of Western Australia designed, put together, and tested a self-guided digital CBTi program called “Bedtime Window” intended to treat insomnia.
“We tested a new CBTi program in people with insomnia symptoms throughout Australia and found it very easy to use, delivering significant and sustained improvements in sleep, daytime function and mental health,” says Dr. Alexander Sweetman, who led the latest research, in a media release.
“We know that CBTi improves insomnia, mental health and quality of life and we want to see more people accessing this treatment because it can reduce the need for sleeping pills or other interventions which may not tackle long-term sleep problems.”
Insomnia and obstructive sleep apnea (OSA) rank as the two most prevalent sleep disorders, and often occur together. Roughly 30 to 40 percent of people with insomnia have co-morbid OSA, but most people with sleep apnea go undiagnosed and untreated.
“People with co-morbid insomnia and sleep apnea (COMISA) generally have worse sleep, daytime function, mental health, physical health, productivity and quality of life when compared to people with neither sleep disorder, and often when compared to people with either insomnia-alone or OSA-alone,” Dr. Sweetman explains. “Recent studies found that people with COMISA experience a 50-70 per cent increased risk of mortality over 10-20 years of follow-up, compared to people with neither condition.”
“Given the high prevalence and adverse health risks of COMISA, it is vital that we develop and implement an effective evidence-based management approach for this condition,” Sweetman continues. “To increase CBTi access for people with COMISA, we developed the self-guided interactive digital CBTi program that is appropriate for people with insomnia-alone and COMISA and compared its effectiveness between people with insomnia-alone, versus co-morbid insomnia and high-risk sleep apnea.”
In all, 62 adults with insomnia symptoms used Bedroom Window over the course of an 18-month period and ended up reporting significant and sustained improvements in symptoms related to insomnia and associated mental health symptoms.
“The program is designed for people with insomnia-alone and COMISA. Each weekly session lasts for approximately 20-30 minutes and includes short videos, images and text-based information,” Sweetman says.
“Treatment components include psycho-education, stimulus control therapy, sleep restriction therapy, relaxation therapy, cognitive therapy and sleep hygiene information.”
“The program includes algorithms that continuously assess for symptoms of sleepiness and alertness and provides tailored and interactive recommendations to treat insomnia without worsening levels of daytime sleepiness,” Dr. Sweetman concludes. “The positive results of our study highlight the potential to investigate the effectiveness, safety and acceptability of this digital CBTi program in people with a confirmed diagnosis of OSA, before increasing access to people with COMISA throughout the health system.”
The study is published in the journal Frontiers in Sleep.