Long-term benefits of digital cognitive behavioural therapy for insomnia: Follow-up report from a randomized clinical trial

doi:10.1111/jsr.13018

Randomized Controlled Trial

. 2020 Aug;29(4):e13018.

doi: 10.1111/jsr.13018. Epub 2020 Feb 28.

Long-term benefits of digital cognitive behavioural therapy for insomnia: Follow-up report from a randomized clinical trial

Annemarie I Luik^{1

2}, Antonia Marsden³, Richard Emsley⁴, Alasdair L Henry^{2

5}, Richard Stott⁵, Christopher B Miller^{2

5}, Colin A Espie^{2

5}

Affiliations

¹ Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
² Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.
³ Centre for Biostatistics, School of Health Sciences, The University of Manchester, Manchester, UK.
⁴ Biostatistics and Health Informatics Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
⁵ Big Health Inc., San Francisco, CA, USA.

PMID: 32112507
DOI: 10.1111/jsr.13018

Randomized Controlled Trial

Long-term benefits of digital cognitive behavioural therapy for insomnia: Follow-up report from a randomized clinical trial

Annemarie I Luik et al. J Sleep Res. 2020 Aug.

. 2020 Aug;29(4):e13018.

doi: 10.1111/jsr.13018. Epub 2020 Feb 28.

Authors

Annemarie I Luik^{1

2}, Antonia Marsden³, Richard Emsley⁴, Alasdair L Henry^{2

5}, Richard Stott⁵, Christopher B Miller^{2

5}, Colin A Espie^{2

5}

Affiliations

¹ Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
² Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.
³ Centre for Biostatistics, School of Health Sciences, The University of Manchester, Manchester, UK.
⁴ Biostatistics and Health Informatics Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
⁵ Big Health Inc., San Francisco, CA, USA.

PMID: 32112507
DOI: 10.1111/jsr.13018

Abstract

Digital cognitive behavioural therapy (dCBT) is an effective treatment for chronic insomnia and also improves well-being and quality of life (QoL). We assessed whether these benefits are sustained and if the effects of dCBT extend to the use of sleep medication and healthcare. In total 1,711 adults (48.0 ± 13.8 years, 77.6% female) with complaints of chronic insomnia participated in a previously published randomized controlled trial (ISRCTN 60530898) comparing dCBT (n = 853) with sleep hygiene education (SHE, n = 858). At weeks 0, 4, 8, 24, 36 and 48, we assessed functional health (Patient-Reported Outcomes Measurement Information System: Global Health Scale); psychological well-being (Warwick-Edinburgh Mental Well-being Scale) and sleep-related QoL (Glasgow Sleep Impact Index), prescribed and non-prescribed sleep medication use, and healthcare utilization. At week 25, those who received SHE at baseline were offered dCBT. dCBT improved functional health (difference: 2.45, 95% confidence interval [CI]: 2.03; 2.88, Cohen's d: 0.50, p < .001), psychological well-being (difference: 4.34, 95% CI: 3.70; 4.98, Cohen's d: 0.55, p < .001) and sleep-related QoL (difference: -44.61, 95%CI: -47.17; -42.05, Cohen's d: -1.44, p < .001) at week 48 compared to baseline. At week 24 dCBT, compared to SHE, also reduced use of prescription and non-prescription sleep medication up to week 24 (adjusted rate ratio [RR]: 0.64, 95% CI: 0.42; 0.97, p = .037 and adjusted RR: 0.52, 95% CI: 0.37; 0.74, p < .0001, respectively), but not healthcare utilization. Uncontrolled follow-up suggests that these effects were sustained for non-prescribed sleep medication (RR: 0.52, 95% CI: 0.40; 0.67, p < .001). In conclusion, this study suggests that dCBT results in sustained benefits to insomnia and its daytime outcomes.

Keywords: cognitive behavioural therapy; healthcare usage; online; quality of life; sleep; sleep medication; well-being.

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References

REFERENCES

1. Espie, C. A., Emsley, R., Kyle, S. D., Gordon, C., Drake, C. L., Siriwardena, A. N., … Luik, A. I. (2018). Effect of digital cognitive behavioral therapy for insomnia on health, psychological well-being, and sleep-related quality of life: A randomized clinical trial. JAMA Psychiatry, 76, 21. https://doi.org/10.1001/jamapsychiatry.2018.2745
1. Espie, C. A., Kyle, S. D., Hames, P., Gardani, M., Fleming, L., & Cape, J. (2014). The Sleep Condition Indicator: A clinical screening tool to evaluate insomnia disorder. British Medical Journal Open, 4, e004183. https://doi.org/10.1136/bmjopen-2013-004183
1. Espie, C. A., Luik, A. I., Cape, J., Drake, C. L., Siriwardena, A. N., Ong, J. C., … Kyle, S. D. (2016). Digital cognitive behavioural therapy for insomnia versus sleep hygiene education: The impact of improved sleep on functional health, quality of life and psychological well-being. Study protocol for a randomised controlled trial. Trials, 17, 257. https://doi.org/10.1186/s13063-016-1364-7
1. Hays, R. D., Bjorner, J. B., Revicki, D. A., Spritzer, K. L., & Cella, D. (2009). Development of physical and mental health summary scores from the patient-reported outcomes measurement information system (PROMIS) global items. Quality of Life Research, 18, 873-880. https://doi.org/10.1007/s11136-009-9496-9
1. Kyle, S. D., Crawford, M. R., Morgan, K., Spiegelhalder, K., Clark, A. A., & Espie, C. A. (2013). The Glasgow Sleep Impact Index (GSII): A novel patient-centred measure for assessing sleep-related quality of life impairment in insomnia disorder. Sleep Medicine, 14, 493-501. https://doi.org/10.1016/j.sleep.2012.10.023

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[1] Espie, C. A., Emsley, R., Kyle, S. D., Gordon, C., Drake, C. L., Siriwardena, A. N., … Luik, A. I. (2018). Effect of digital cognitive behavioral therapy for insomnia on health, psychological well-being, and sleep-related quality of life: A randomized clinical trial. JAMA Psychiatry, 76, 21. https://doi.org/10.1001/jamapsychiatry.2018.2745

[2] Espie, C. A., Emsley, R., Kyle, S. D., Gordon, C., Drake, C. L., Siriwardena, A. N., … Luik, A. I. (2018). Effect of digital cognitive behavioral therapy for insomnia on health, psychological well-being, and sleep-related quality of life: A randomized clinical trial. JAMA Psychiatry, 76, 21. https://doi.org/10.1001/jamapsychiatry.2018.2745

[3] Espie, C. A., Kyle, S. D., Hames, P., Gardani, M., Fleming, L., & Cape, J. (2014). The Sleep Condition Indicator: A clinical screening tool to evaluate insomnia disorder. British Medical Journal Open, 4, e004183. https://doi.org/10.1136/bmjopen-2013-004183

[4] Espie, C. A., Kyle, S. D., Hames, P., Gardani, M., Fleming, L., & Cape, J. (2014). The Sleep Condition Indicator: A clinical screening tool to evaluate insomnia disorder. British Medical Journal Open, 4, e004183. https://doi.org/10.1136/bmjopen-2013-004183

[5] Espie, C. A., Luik, A. I., Cape, J., Drake, C. L., Siriwardena, A. N., Ong, J. C., … Kyle, S. D. (2016). Digital cognitive behavioural therapy for insomnia versus sleep hygiene education: The impact of improved sleep on functional health, quality of life and psychological well-being. Study protocol for a randomised controlled trial. Trials, 17, 257. https://doi.org/10.1186/s13063-016-1364-7

[6] Espie, C. A., Luik, A. I., Cape, J., Drake, C. L., Siriwardena, A. N., Ong, J. C., … Kyle, S. D. (2016). Digital cognitive behavioural therapy for insomnia versus sleep hygiene education: The impact of improved sleep on functional health, quality of life and psychological well-being. Study protocol for a randomised controlled trial. Trials, 17, 257. https://doi.org/10.1186/s13063-016-1364-7

[7] Hays, R. D., Bjorner, J. B., Revicki, D. A., Spritzer, K. L., & Cella, D. (2009). Development of physical and mental health summary scores from the patient-reported outcomes measurement information system (PROMIS) global items. Quality of Life Research, 18, 873-880. https://doi.org/10.1007/s11136-009-9496-9

[8] Hays, R. D., Bjorner, J. B., Revicki, D. A., Spritzer, K. L., & Cella, D. (2009). Development of physical and mental health summary scores from the patient-reported outcomes measurement information system (PROMIS) global items. Quality of Life Research, 18, 873-880. https://doi.org/10.1007/s11136-009-9496-9

[9] Kyle, S. D., Crawford, M. R., Morgan, K., Spiegelhalder, K., Clark, A. A., & Espie, C. A. (2013). The Glasgow Sleep Impact Index (GSII): A novel patient-centred measure for assessing sleep-related quality of life impairment in insomnia disorder. Sleep Medicine, 14, 493-501. https://doi.org/10.1016/j.sleep.2012.10.023

[10] Kyle, S. D., Crawford, M. R., Morgan, K., Spiegelhalder, K., Clark, A. A., & Espie, C. A. (2013). The Glasgow Sleep Impact Index (GSII): A novel patient-centred measure for assessing sleep-related quality of life impairment in insomnia disorder. Sleep Medicine, 14, 493-501. https://doi.org/10.1016/j.sleep.2012.10.023

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Long-term benefits of digital cognitive behavioural therapy for insomnia: Follow-up report from a randomized clinical trial

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Long-term benefits of digital cognitive behavioural therapy for insomnia: Follow-up report from a randomized clinical trial

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