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Digital Health Interventions for Insomnia: Turning Promise into Reality

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Abstract

Purpose of Review

This article discusses existing research in internet-delivered cognitive behavioral therapy for insomnia (iCBT-I) and three domains that researchers identified as the critical gaps to be addressed in the next wave of clinical trials. Our focus is on iCBT-I interventions in which delivery of clinical content has been automated, rather than CBT-I-based telemedicine interventions involving synchronous clinician participation.

Recent Findings

Despite its effectiveness and potential to revolutionize insomnia care, iCBT-I faces several challenges regarding real-world implementation.

Summary

First, research into patient characteristics predicting treatment response may reveal novel patient trajectories and help clinicians match individuals to interventions. Second, optimizing iCBT-I treatments to be maximally effective while requiring minimum investment from patients may be vital to uptake. Lastly, an understanding of the cost-effectiveness of iCBT-I relative to other treatment modalities will support administrators and insurers in allocating financial resources to iCBT-I. Ultimately, widespread implementation of iCBT-I hinges upon how these questions are answered in the coming years.

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References

  1. van der Zweerde T, Bisdounis L, Kyle SD, Lancee J, van Straten A. Cognitive behavioral therapy for insomnia: a meta-analysis of long-term effects in controlled studies. Sleep Med Rev. 2019;48:101208.

    Article  PubMed  Google Scholar 

  2. Thomas A, Grandner M, Nowakowski S, Nesom G, Corbitt C, Perlis ML. Where are the behavioral sleep medicine providers and where are they needed? A geographic assessment. Behav Sleep Med. 2016;14:687–98.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Seyffert M, Lagisetty P, Landgraf J, Chopra V, Pfeiffer PN, Conte ML, Rogers MAM. Internet-delivered cognitive behavioral therapy to treat insomnia: a systematic review and meta-analysis. PLoS One. 2016;11:e0149139.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Zachariae R, Lyby MS, Ritterband LM, O’Toole MS. Efficacy of internet-delivered cognitive-behavioral therapy for insomnia: a systematic review and meta-analysis of randomized controlled trials. Sleep Med Rev. 2016;30:1–10.

    Article  PubMed  Google Scholar 

  5. Siebmanns S, Johansson P, Ulander M, Johansson L, Andersson G, Broström A. The effect of nurse-led internet-based cognitive behavioural therapy for insomnia on patients with cardiovascular disease: a randomized controlled trial with 6-month follow-up. Nurs Open. 2021;8:1755–68.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Amidi A, Buskbjerg CR, Damholdt MF, Dahlgaard J, Thorndike FP, Ritterband L, Zachariae R. Changes in sleep following internet-delivered cognitive-behavioral therapy for insomnia in women treated for breast cancer: a 3-year follow-up assessment. Sleep Med. 2022;96:35–41.

    Article  PubMed  Google Scholar 

  7. Ritterband LM, Bailey ET, Thorndike FP, Lord HR, Farrell LV, Baum LD. Initial evaluation of an internet intervention to improve the sleep of cancer survivors with insomnia. Psychooncology. 2012;21:695–705.

    Article  PubMed  Google Scholar 

  8. Ye Y-Y, Zhang Y-F, Chen J, Liu J, Li X-J, Liu Y-Z, Lang Y, Lin L, Yang X-J, Jiang X-J. Internet-based cognitive behavioral therapy for insomnia (ICBT-i) improves comorbid anxiety and depression-a meta-analysis of randomized controlled trials. PLoS ONE. 2015;10:e0142258.

    Article  PubMed  PubMed Central  Google Scholar 

  9. van der Zweerde T, van Straten A, Effting M, Kyle SD, Lancee J. Does online insomnia treatment reduce depressive symptoms? A randomized controlled trial in individuals with both insomnia and depressive symptoms. Psychol Med. 2019;49:501–9.

    Article  PubMed  Google Scholar 

  10. McCrae CS, Curtis AF, Williams JM, et al. Efficacy of brief behavioral treatment for insomnia in older adults: examination of sleep, mood, and cognitive outcomes. Sleep Med. 2018;51:153–66.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Wang J, Wei Q, Wu X, Zhong Z, Li G. Brief behavioral treatment for patients with treatment-resistant insomnia. Neuropsychiatr Dis Treat. 2016;12:1967–75.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Panesar A. Precision Healthcare in Practice. In: Panesar A, editor. Precision health and artificial intelligence: with privacy, ethics, bias, health equity, best practices, and case studies. Berkeley, CA: Apress; 2023. p. 121–63.

    Chapter  Google Scholar 

  13. van Bronswijk SC, DeRubeis RJ, Lemmens LHJM, Peeters FPML, Keefe JR, Cohen ZD, Huibers MJH. Precision medicine for long-term depression outcomes using the personalized advantage index approach: cognitive therapy or interpersonal psychotherapy? Psychol Med. 2021;51:279–89.

    Article  PubMed  Google Scholar 

  14. Boland E, Goldschmied J, Kayser MS, Gehrman PR. Precision medicine for insomnia. Sleep Med Clin. 2019;14:291–9.

    Article  PubMed  Google Scholar 

  15. Luik AI, Kyle SD, Espie CA. Digital cognitive behavioral therapy (dCBT) for insomnia: a state-of-the-science review. Curr Sleep Med Rep. 2017;3:48–56.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Yeung W-F, Chung K-F, Ho FY-Y, Ho L-M. Predictors of dropout from internet-based self-help cognitive behavioral therapy for insomnia. Behav Res Ther. 2015;73:19–24.

    Article  PubMed  Google Scholar 

  17. Zhou ES, Ritterband LM, Bethea TN, Robles YP, Heeren TC, Rosenberg L. Effect of culturally tailored, internet-delivered cognitive behavioral therapy for insomnia in black women: a randomized clinical trial. JAMA Psychiat. 2022;79:538–49.

    Article  Google Scholar 

  18. Vincent N, Walsh K. Stepped care for insomnia: an evaluation of implementation in routine practice. J Clin Sleep Med. 2013;09:227–34.

    Article  Google Scholar 

  19. Drerup ML, Ahmed-Jauregui S. Online delivery of cognitive behavioral therapy-insomnia. Sleep Med Clin. 2019;14:283–90.

    Article  PubMed  Google Scholar 

  20. Siebmanns S, JohanssonP Ulander M, Johansson L, Andersson G, Broström A. The effect ofnurse-led Internet-based cognitive behavioural therapy for insomnia on patientswith cardiovascular disease: A randomized controlled trial with 6-monthfollow-up. Nurs Open. 2021;8:1755–68.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Kutana S, Garland SN. Qualitative Assessment of Needs and Preferences for a Smartphone App to Treat Insomnia in Cancer Survivors. Poster presented at the International Psycho Oncology Society/Canadian Association of Psychosocial Oncology Conference, 29–31 August 2022, Toronto, ON.

  22. Werner-Seidler A, Johnston L, Christensen H. Digitally-delivered cognitive-behavioural therapy for youth insomnia: a systematic review. Internet Interv. 2018;11:71–8.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Bramoweth AD, Lederer LG, Youk AO, Germain A, Chinman MJ. Brief behavioral treatment for insomnia vs. cognitive behavioral therapy for insomnia: results of a randomized noninferiority clinical trial among veterans. Behav Ther. 2020;51:535–47.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Germain A, Buysse DJ. Brief behavioral treatment of insomnia. In: Behavioral treatments for sleep disorders. Elsevier; 2011. p. 143–50.

    Chapter  Google Scholar 

  25. Gunn HE, Tutek J, Buysse DJ. Brief behavioral treatment of insomnia. Sleep Med Clin. 2019;14:235–43.

    Article  PubMed  Google Scholar 

  26. Buysse DJ, Germain A, Moul DE, et al. Efficacy of brief behavioral treatment for chronic insomnia in older adults. Arch Intern Med. 2011;171:887–95.

    Article  PubMed  PubMed Central  Google Scholar 

  27. MacDonell KK, Wang B, Phanuphak N, Janamnuaysook R, Srimanus P, Rongkavilit C, Naar S. Optimizing an mHealth intervention to improve uptake and adherence to HIV pre-exposure prophylaxis in young transgender women: protocol for a multi-phase trial. JMIR Research Protocols. 2022;11:e37659.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Collins LM, Murphy SA, Strecher V. The multiphase optimization strategy (MOST) and the sequential multiple assignment randomized trial (SMART): new methods for more potent eHealth interventions. Am J Prev Med. 2007;32:S112-118.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Klasnja P, Rosenberg DE, Zhou J, Anau J, Gupta A, Arterburn DE. A quality-improvement optimization pilot of BariFit, a mobile health intervention to promote physical activity after bariatric surgery. Translational Behavioral Medicine. 2021;11:530–9.

    Article  PubMed  Google Scholar 

  30. Baka A, van der Zweerde T, Lancee J, Bosmans JE, van Straten A. Cost-effectiveness of guided internet-delivered cognitive behavioral therapy in comparison with care-as-usual for patients with insomnia in general practice. Behav Sleep Med. 2022;20:188–203.

    Article  PubMed  Google Scholar 

  31. Savard J, Ivers H, Morin CM, Lacroix G. Video cognitive-behavioral therapy for insomnia in cancer patients: a cost-effective alternative. Psychooncology. 2021;30:44–51.

    Article  PubMed  Google Scholar 

  32. Kuhn E, Miller KE, Puran D, Wielgosz J, YorkWilliams SL, Owen JE, Jaworski BK, Hallenbeck HW, McCaslin SE, Taylor KL. A pilot randomized controlled trial of the Insomnia Coach mobile app to assess its feasibility, acceptability, and potential efficacy. Behav Ther. 2022;53:440–57.

    Article  PubMed  Google Scholar 

  33. Espie CA, Bostock S, Kyle S, Paluzzi B, Hames P. Who benefits from online CBT for insomnia? Factors associated with change in sleep efficiency in a large online treatment cohort. In: Proceedings of the 28th annual meeting of the Association of Professional Sleep Societies. SLEEP: May 31 - June 5; Minneapolis (MN). Darien (IL); 2014 May [cited 2023 June 19] p. A205.

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Funding

Samlau Kutana is a trainee in the Cancer Research Training Program of the Beatrice Hunter Cancer Research Institute, with funds provided by the Canadian Cancer Society’s JD Irving, Limited–Excellence in Cancer Research Fund. Sheila N. Garland is supported by a Canadian Cancer Society Emerging Scholar Award, Survivorship (#707146). Eric S. Zhou is supported by a Clinician Scientist Development Grant (CSDG-21–080-01–CTPS) from the American Cancer Society.

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Authors and Affiliations

  1. Department of Psychology, Memorial University, St. John’s, Newfoundland and Labrador, Canada

    Samlau Kutana & Sheila N. Garland

  2. Beatrice Hunter Cancer Research Institute, Halifax, NS, Canada

    Samlau Kutana & Sheila N. Garland

  3. Discipline of Oncology, Memorial University, St. John’s, Newfoundland and Labrador, Canada

    Sheila N. Garland

  4. Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA

    Eric S. Zhou

  5. Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, USA

    Eric S. Zhou

Authors
  1. Samlau Kutana
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Correspondence to Eric S. Zhou.

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Conflict of Interest

Eric S. Zhou has received grant funding from Jazz Pharmaceuticals and Harmony Biosciences and consulting fees from MindUP and Samsung for work unrelated to the content of this manuscript.

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Kutana, S., Garland, S.N. & Zhou, E.S. Digital Health Interventions for Insomnia: Turning Promise into Reality. Curr Sleep Medicine Rep 9, 197–204 (2023). https://doi.org/10.1007/s40675-023-00260-x

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