Investigating the subjective and objective efficacy of a cognitive behavioural therapy for insomnia (CBT‐I)‐based smartphone app on sleep: A randomised controlled trial

Dec 29, 2023Journal of sleep research

How a CBT-I Smartphone App May Improve Sleep: A Randomized Controlled Trial

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Abstract

Fifty-seven volunteers aged 20-76 participated in a 6-week trial of a CBT-I-based app for insomnia treatment.

Improvements in sleep quality were observed in the experimental group, as indicated by significant changes in the Insomnia Severity Index (ISI) and Pittsburgh Sleep Quality Index (PSQI).
No significant improvements were noted in the control group, which only received sleep monitoring without the app's training component.
A reduction in wake after sleep onset (WASO) was suggested in the experimental group, although this finding was marginally significant.
During app usage, the experimental group showed improvements in sleep efficiency, sleep onset latency, and WASO.
Both groups experienced a reduction in subjective-objective sleep discrepancies (SOSD) related to total sleep time.

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Due to insufficient treatment options for insomnia, effective solutions are urgently needed. We evaluated the effects of a CBT-I-based app combining sleep training with subjective and objective sleep monitoring on (i) sleep and (ii) subjective-objective sleep discrepancies (SOSD). Fifty-seven volunteers (20-76 years; M = 45.67 ± 16.38; 39 female) suffering from sleep problems were randomly assigned to an experimental group (EG, n = 28) or a waitlist control group (CG, n = 29). During the 6-week app phase, the EG used the CBT-I-based programme and a heart rate sensor for daily sleep monitoring and -feedback, while the CG used sleep monitoring only. Sleep was measured (i) subjectively via questionnaires (Insomnia Severity Index, ISI; Pittsburgh Sleep Quality Index, PSQI), (ii) objectively via ambulatory polysomnography (PSG), and (iii) continuously via heart-rate sensor and sleep diaries. Data revealed interactions for ISI (p = 0.003, ƞ = 0.11) and PSQI (p = 0.050, ƞ = 0.05), indicating training-specific improvements in EG, yet not in CG. While PSG-derived outcomes appear to be less training-specific, a tendential reduction in wake after sleep onset (WASO) was found in EG (p = 0.061, d = 0.55). Regarding changes in SOSD, the results indicate improvements during the app phase (EG) for sleep efficiency, sleep onset latency, and WASO (p ≤ 0.022, d ≥ 0.46); for total sleep time both groups showed a SOSD reduction. The findings indicate beneficial effects of a novel smartphone app on sleep and SOSD. More scientific evaluation of such digital programmes is needed to ultimately help in reducing the gap in non-pharmacological insomnia treatment. Age part part2 2

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Investigating the subjective and objective efficacy of a cognitive behavioural therapy for insomnia (CBT‐I)‐based smartphone app on sleep: A randomised controlled trial

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