Espie CA, et al. - Researchers examined the effect of digital cognitive behavioral therapy (dCBT) for insomnia on functional health, psychological well-being, and sleep-related quality of life (QoL) in this two-arm, parallel-group, randomized clinical trial. In addition, they determined whether a reduction in insomnia symptoms was a mediating factor. Individuals reporting insomnia symptoms exhibited improved functional health, psychological well-being, and sleep-related QoL in correlation with the dCBT. These improvements were mediated by a reduction in insomnia symptoms. These results extended further support for the efficacy of dCBT in improving both daytime and nighttime aspects of insomnia, as well as existing recommendations of CBT as the treatment of choice for insomnia.

Methods

• Researchers compared dCBT for insomnia to sleep hygiene education (SHE) in 1,711 participants with self-reported symptoms of insomnia.
• Participants were recruited from December 1, 2015, to December 1, 2016. The investigators delivered dCBT using web and/or mobile channels in combination with treatment as usual; SHE consisted of a website and downloadable booklet plus treatment as usual.
• The investigators conducted online assessments at 0 (baseline), 4 (mid-treatment), 8 (post-treatment), and 24 (follow-up) weeks.
• Programs were completed within 12 weeks following inclusion.
• They primarily assessed scores on self-reported measures of functional health (Patient-Reported Outcomes Measurement Information System: Global Health Scale; range, 10-50; higher scores indicated better health), psychological well-being (Warwick-Edinburgh Mental Well-being Scale; range, 14-70; higher scores indicated greater well-being), and sleep-related QoL (Glasgow Sleep Impact Index; range, 1-100; higher scores indicated greater impairment).
• Mood, fatigue, sleepiness, cognitive failures, work productivity, and relationship satisfaction were assessed as the secondary outcomes.
• They assessed insomnia with the Sleep Condition Indicator (range, 0-32; higher scores indicated better sleep).

Results

• Use of dCBT resulted in a small improvement in functional health vs SHE (adjusted difference [95% CI] at week 4, 0.90 [0.40-1.40]; week 8, 1.76 [1.24-2.28]; week 24, 1.76 [1.22-2.30]) and psychological well-being (adjusted difference [95% CI] at week 4, 1.04 [0.28-1.80]; week 8, 2.68 [1.89-3.47]; week 24, 2.95 [2.13-3.76]), and a large improvement in sleep-related QoL (at week 4, −8.76 [−11.83 to −5.69]; week 8, –17.60 [−20.81 to −14.39]; week 24, −18.72 [−22.04 to −15.41]; all P < 0.01).
• These outcomes were mediated by a large improvement in insomnia (range mediated, 45.5% to 84.0%).