Insomnia Treatment

Link: https://www.veterantraining.va.gov/insomnia/index.asp

Status: Currently available to consumers for free

Description: The Path to Better Sleep course was developed by the Department of Veteran Affairs but is available to all users. The program begins with a “sleep check up,” or an insomnia questionnaire. The course is designed to be completed over six weeks and is delivered using an interactive user interface with video guides on the following topics: 1) an overview of CBT-I; 2) sleep scheduling; 3) stimulus control; 4) controlling worries; 5) challenging thoughts; and 6) relapse prevention. The course also includes videos of real veterans who recovered from insomnia, a learning log, and weekly sleep diary entries.

Self-help workbook (Veteran Focused): Improve Your Sleep

Evidence: According to the VA website, this course is based on the self-help guide, “Improve your Sleep: A Self-Guided Approach for Veterans with Insomnia.” No additional research particular to this program has been found at this point in time.

References:

Ulmer CS, Farrell-Carnahan L, Hughes JM, Manber R, Leggett MK, Tatum J, and the Mid-Atlantic (VISN 6) Mental Illness Research, Education and Clinical Center (MIRECC). (2018). Improve your Sleep: A Self-Guided Approach for Veterans with Insomnia (Self-Help Workbook).

Link: https://www.sleepio.com/

Status: Currently available to research participants and certain employer plans after a brief online sleep assessment.

Description: Sleepio is a web-based, cognitive-behavioral treatment program for a variety of sleep problems based on the CBT-I treatment model. Users begin by setting treatment goals and completing an in-depth questionnaire battery. From there, a treatment program is developed, which includes weekly 20-minute sessions with a virtual sleep expert targeting the following sleep-related areas: 1) thoughts and worries about sleep, 2) nighttime sleep schedules, 3) lifestyles, and 4) the bedroom. Users also have access to a moderated social network/community of users.

Evidence: One randomized clinical trial has been published on the Sleepio program. Sleepio was compared to Imagery Relief Therapy, and treatment as usual. Sleepio resulted in significantly better improvements in sleep efficiency and sleep-wake functioning from baseline to post-treatment.

References:

Espie CA, Kyle SD, Williams C, et al. A randomized, placebo-controlled trial of online cognitive behavioral therapy for chronic insomnia disorder delivered via an automated media-rich web application. Sleep. 2012;35(6):769-81.

Website: somryst.com

Status: Currently available for Research: https://peartx.formstack.com/forms/clinical_trial_application

Soon (as of 7/1/2020) to be available by prescription from Physicians. For more information: https://peartx.formstack.com/forms/somryst_inquiries

Description: SHUTi is a web-based, cognitive-behavioral treatment program for insomnia based on the Cognitive Behavioral Therapy for Insomnia treatment model. SHUTi begins with an overview of educational information on sleep problems and an evaluation of patients’ sleep problems and treatment goals. Users then participate in five, weekly, 45- to 60-minute modules focused on specific methods for improving quantity and quality of sleep. After each module, users spend a week practicing what they have learned in their daily routines. These include exercises designed to help develop new sleep habits and skills. Users also complete a daily Sleep Diary which allow SHUTi to make personalized treatment recommendations.

Evidence: One randomized controlled trial comparing SHUTi to a waitlist control found that SHUTi resulted in significantly improved scores on the Insomnia Severity Index and sleep efficiency, and that treatment gains were maintained at 6-month follow-up (Ritterband, Thorndike et al., 2009). Follow-up analyses found significant improvements in psychological symptoms, mental health quality of life, and fatigue (Thorndike, Ritterband et al., 2013)). Another trial with cancer survivors with insomnia comparing SHUTi to a waitlist control found significant improvement in insomnia severity, sleep efficiency, sleep onset latency, soundness of sleep, restored feeling upon wakening, and general fatigue (Ritterband, bailey et al., 2012). Another randomized controlled trial with patients with insomnia and depression symptoms found that SHUTi, compared to an interactive, attention-matched, internet-based placebo control program resulted in significantly improved depression symptoms at post-treatment and 6-month post-treatment (Christensen et al., 2016).

References:

Ritterband LM, Thorndike FP, Gonder-frederick LA, et al. Efficacy of an Internet-based behavioral intervention for adults with insomnia. Arch Gen Psychiatry. 2009;66(7):692-8.

Ritterband LM, Bailey ET, Thorndike FP, Lord HR, Farrell-carnahan L, Baum LD. Initial evaluation of an Internet intervention to improve the sleep of cancer survivors with insomnia. Psychooncology. 2012;21(7):695-705.

Thorndike FP, Ritterband LM, Gonder-frederick LA, Lord HR, Ingersoll KS, Morin CM. A randomized controlled trial of an internet intervention for adults with insomnia: effects on comorbid psychological and fatigue symptoms. J Clin Psychol. 2013;69(10):1078-93.

Christensen H, Batterham PJ, Gosling JA, et al. Effectiveness of an online insomnia program (SHUTi) for prevention of depressive episodes (the GoodNight Study): a randomised controlled trial. Lancet Psychiatry. 2016;3(4):333-41.

Link: https://www.cbtforinsomnia.com/

Status: Currently available to consumers

Description: The Conquering Insomnia program is a web-based program based on the CBT-I treatment model. Users participate in five sessions provided sequentially over five weeks and are delivered in a PDF format. These sessions include: 1) basic facts about sleep and an insomnia assessment; 2) sleep scheduling and stimulus control techniques; 3) cognitive restructuring and sleep medication tapering techniques; 4) daytime relaxation techniques and developing stress-reducing, sleep enhancing attitudes and beliefs; and 5) bedtime relaxation techniques and lifestyle habits that improve sleep. Users also complete a weekly sleep diary that can be emailed to the program developer, Dr. Gregg Jacobs, who provides individualized guidelines and feedback on CBT-I techniques based on the sleep diary results. Lastly, the program offers weekly summaries of goals and tips for meeting goals and articles and blogs on insomnia.

Evidence: This web-based program was developed based on a randomized controlled trial of CBT-I compared to sleep medication, a combination of CBT-I and sleep medication, and a pill placebo. CBT-I resulted in the largest changes in sleep-onset latency and sleep efficiency and fewer insomnia diagnoses at post-treatment, and treatment gains were maintained at long-term follow-up. Thus far, no trials have been conducted on the web-based delivery of this program.

References:

Jacobs GD, Pace-Schott E, Stickgold R, Otto M. Cognitive-behavioral therapy and pharmacotherapy for insomnia: a randomized controlled trial and direct comparison. Arch Intern Med. 2004;164:1888-96.

Link: http://www.cobalttx.com/Products/restore.html / https://www.return2sleep.com/

Status: Does not appear to be available to consumers

Description: RESTORE is a web-based program based on the CBT-I treatment model. The program includes the following seven sessions delivered over five weeks: 1) introduction and psychoeducation; 2) applied relaxation; 3) stimulus control; 4) impactful thoughts; 5) sleep hygiene; 6) mindfulness; and 7) a closing session.

Evidence: The initial randomized controlled trial compared the program to a waitlist control and found that the program resulted in improved sleep quality, insomnia severity, daytime fatigue, pre-sleep cognitive arousal, and dysfunctional beliefs about sleep. Since this trial, there have been numerous publications about the program (see below).

References:

Vincent, N., & Lewycky, S. (2009). Logging in for Better Sleep: A randomized controlled trial of the effectiveness of online treatment for chronic insomnia. Sleep, 32, 807-815 .

Beaulac, J., Vincent, N., & Walsh, K. (2014). Dissemination of an Internet-Based Treatment for Chronic Insomnia Into Primary Care. Behavioral Sleep Medicine,12, 1–16

Holmqvist, M., Vincent, N., & Walsh, K. (2013). Web-based vs telehealth-based delivery of CBT-I: A randomized controlled trial. Sleep Medicine, 15, 187-195.

Vincent, N., Walsh, K., & Lewycky, S. (2013). Determinants of success for computerized CBT: Examination of an insomnia program. Behavioral Sleep Medicine, 11, 1-13 .

Vincent, N., Walsh, K., & Lewycky, S. (2010). Sleep locus of control and computerized cognitive behavioural therapy (cCBT) . Behaviour Research and Therapy, 48 , 779-783.

Vincent, N., Lewycky, S., Hart Swain, K., & Holmqvist, M. (2009). Logging on for Nodding off: Empowering patients through the use of computerized cognitive behavioural therapy (cCBT). The Behavior Thera pist. 32 ,123-126.

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