Does treating insomnia with digital cognitive behavioural therapy (Sleepio) mediate improvements in anxiety for those with insomnia and comorbid anxiety? An analysis using individual participant data from two large randomised controlled trials

Jun 30, 2023Journal of affective disorders

Does digital therapy for insomnia help reduce anxiety in people with both insomnia and anxiety? Analysis of data from two large studies

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Abstract

In a sample of 2172 participants, digital cognitive behavioral therapy (dCBT) significantly reduced insomnia and anxiety symptoms.

dCBT for insomnia was more effective than control in decreasing both insomnia (Hedges' g range = 0.77-0.81; p < 0.001) and anxiety symptoms (Hedges' g range = 0.39-0.44; p < 0.001) across all assessment points.
Improvements in sleep were associated with a substantial reduction in anxiety symptoms at follow-up, with 84% of the effect mediated by sleep improvements.
Baseline insomnia symptoms influenced the effectiveness of dCBT on insomnia, but no factors were found to moderate its impact on anxiety.

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BACKGROUND: Considerable comorbidity exists between insomnia and anxiety, and evidence shows that the benefits of CBT for insomnia extend to anxiety. Using data from two large trials of digital CBT (dCBT) for insomnia, we evaluated whether improving sleep is an effective treatment target to reduce both insomnia and anxiety symptoms in individuals with insomnia and clinically significant anxiety.

METHODS: This was a controlled sub-analysis combining individual participant data from two previous randomised controlled trials of dCBT for insomnia (Sleepio). Participants (N = 2172) with insomnia disorder and clinically significant anxiety symptoms were included in this sub-analysis and received either dCBT or control (usual care or sleep hygiene education). Assessments were evaluated at baseline, post-intervention (week 8 or 10), and follow-up (week 22 or 24). Mediation was evaluated using structural equation models.

RESULTS: dCBT for insomnia was superior to control at reducing both insomnia (Hedges' g range = 0.77-0.81; both p < 0.001) and anxiety symptoms (Hedges' g range = 0.39-0.44; both p < 0.001) at all time points. Baseline insomnia symptoms moderated the effects of dCBT on insomnia, however no variables moderated treatment effects on anxiety. Reductions in anxiety symptoms at follow-up were mediated by improvements in sleep at post-intervention (% mediated = 84 %), suggesting a causal pathway.

LIMITATIONS: Participants did not have a formal anxiety disorder diagnosis and so the effects of dCBT for insomnia on anxiety may differ by anxiety disorder.

CONCLUSIONS: Addressing sleep using dCBT for insomnia may serve as a treatment target from which to improve anxiety in individuals with insomnia and clinically significant comorbid anxiety.

CLINICAL TRIAL REGISTRATIONS: Digital Insomnia therapy to Assist your Life as well as your Sleep (DIALS) - ISRCTN60530898 http://www.isrctn.com/ISRCTN60530898. Oxford Access for Students Improving Sleep (OASIS) - ISRCTN61272251 http://www.isrctn.com/ISRCTN61272251.

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Does treating insomnia with digital cognitive behavioural therapy (Sleepio) mediate improvements in anxiety for those with insomnia and comorbid anxiety? An analysis using individual participant data from two large randomised controlled trials

Abstract

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