Despite a wealth of evidence supporting the effectiveness of cognitive behavioral therapy for insomnia (CBT-I), access to this first-line treatment is extremely limited due to a shortage of CBT-I-trained psychologists.

In Australia, approximately 90% of primary care patients with insomnia are managed with sleeping pills while only 1% are referred to psychologists for CBT-I. 

To increase accessibility to CBT-I and reduce the reliance on sleeping pills, sleep experts at Flinders University and the University of Western Australia designed and tested the effectiveness of a self-guided digital CBT-I program called “Bedtime Window” to treat insomnia.

“We tested a new CBT-I 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 Flinders University’s Alexander Sweetman, PhD, who led the latest research published in Frontiers in Sleep, in a release. “We know that CBT-I 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 apnoea (OSA) are the two most prevalent sleep disorders and frequently co-occur. Approximately 30-40% of people with insomnia have co-morbid OSA; however, most people with OSA remain 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,” says Sweetman in a release.

Recent studies found that people with COMISA experience a 50-70% increased risk of mortality over 10 to 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,” he says in a release. “To increase CBT-I access for people with COMISA, we developed the self-guided interactive digital CBT-I program that is appropriate for people with insomnia-alone and COMISA and compared its effectiveness between people with insomnia-alone, versus comorbid insomnia and high-risk sleep apnea.”

Sixty-two adults with insomnia symptoms used “Bedroom Window” over an 18-month period and reported significant and sustained improvements in symptoms of insomnia and associated mental health symptoms.

The program is designed for people with insomnia alone and COMISA. Each weekly session lasts for approximately 20 to 30 minutes and includes short videos, images, and text-based information. Treatment components include psychoeducation, 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.

“The positive results of our study highlight the potential to investigate the effectiveness, safety, and acceptability of this digital CBT-I program in people with a confirmed diagnosis of OSA before increasing access to people with COMISA throughout the health system,” says Sweetman in a release.

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