Treat Yourself for Insomnia on the Web

Summary and Comment |
December 12, 2016

Treat Yourself for Insomnia on the Web

  1. Steven Dubovsky, MD

An automated therapy may produce lasting improvement — primarily for Internet-savvy patients without major psychiatric disorders.

  1. Steven Dubovsky, MD

Cognitive-behavioral therapy (CBT) is the first-line treatment for insomnia, which is clinically important in as much as 20% of the population, but few trained therapists are available. To determine the usefulness of an automated, Internet-based version of CBT for insomnia (Sleep Healthy Using the Internet [SHUTi]), researchers recruited 303 people with insomnia over the Internet and randomized them to a 9-week course of SHUTi or an automated insomnia education program. Insomnia was defined by self-reports of taking >30 minutes to fall asleep initially (sleep latency), >30 minutes of wake time after sleep onset (WASO), sleeping ≤6.5 hours/night, and sleep disturbances or daytime symptoms producing considerable distress or impaired function.

Both treatments significantly reduced sleep latency, WASO, and self-ratings of insomnia severity; effect sizes were large to very large for SHUTi (0.79–1.90) and medium to medium-large for the control (0.37–0.77). Improvement persisted or grew at 1-year follow-up, although SHUTi was significantly better than the control condition. At treatment's end and 1-year follow-up, 41% and 57% of SHUTi recipients, respectively, had remission of insomnia (controls, 11% and 27%).

Comment

Editorialists praise the study's inclusion of insomnia patients with comorbid medical and mild psychiatric disorders. Still, these primarily middle-class patients had substantial familiarity with the Internet and therefore do not represent all patients, as editorialists and researchers point out. Reliance entirely on self-report — which does not correlate with sleep-laboratory assessments (especially of sleep latency and duration) — and lack of objective evaluation of daytime impairment further limit interpretation of the results. However, SHUTi (which costs $135), may be an option for some Internet-savvy individuals without severe psychiatric illnesses.

Editor Disclosures at Time of Publication

  • Disclosures for Steven Dubovsky, MD at time of publication Grant / Research support Otsuka; Tower Foundation; Oshei Foundation; Patrick Lee Foundation; Wendt Foundation; Takeda; Lilly; Sumitomo; Hoffmann-La Roche; Pfizer, Neurim Pharmaceuticals; Neurocrine Biosciences Editorial boards Mind and Brain; Bulletin of the Menninger Clinic; Current Psychiatry; Journal of Psychosomatic Research

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