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Randomized Controlled Trial
. 2025 May 8:27:e58024.
doi: 10.2196/58024.

Efficacy of a Self-Guided Internet Intervention With Optional On-Demand Feedback Versus Digital Psychoeducation on Sleep Hygiene for University Students With Insomnia: Randomized Controlled Trial

Anna-Carlotta Zarski  1   2 , Karina Bernstein  2 , Harald Baumeister  3 , Dirk Lehr  4 , Stella Wernicke  2 , Ann-Marie Küchler  3 , Fanny Kählke  2   5 , Kai Spiegelhalder  6 , David Daniel Ebert  2
Affiliations
Randomized Controlled Trial

Efficacy of a Self-Guided Internet Intervention With Optional On-Demand Feedback Versus Digital Psychoeducation on Sleep Hygiene for University Students With Insomnia: Randomized Controlled Trial

Anna-Carlotta Zarski et al. J Med Internet Res. .

Abstract

Background: Internet-based cognitive behavioral therapy for insomnia (iCBT-I) provides flexibility but requires significant time and includes potentially challenging components such as sleep restriction therapy. This raises questions about its incremental effectiveness compared to less demanding minimal interventions such as sleep hygiene psychoeducation.

Objective: This study aimed to assess the incremental efficacy of self-guided iCBT-I with optional on-demand feedback for university students with insomnia compared to a single session of digital psychoeducation on sleep hygiene.

Methods: In a randomized controlled trial, 90 students with insomnia (Insomnia Severity Index ≥10) were randomly allocated to self-help-based iCBT-I (45/90, 50%) or one session of digital sleep hygiene psychoeducation with stimulus control instructions (active control group [aCG]: 45/90, 50%). The self-help-based iCBT-I consisted of 6 sessions on psychoeducation, sleep restriction, and stimulus control, including written feedback on demand from an eCoach. Assessments occurred at baseline (T1), 8 weeks after treatment (T2), and at a 6-month follow-up (T3) via web-based self-assessment and diagnostic telephone interviews. The primary outcome was insomnia severity at T2. Analyses of covariance were conducted in an intention-to-treat sample. Secondary outcomes included diagnoses of insomnia and major depression, sleep quality, sleep efficiency, worrying, recovery experiences, recovery activities, presenteeism, procrastination, cognitive irritation, and recuperation in sleep.

Results: There was no difference in insomnia severity at T2 between the iCBT-I group (mean 11.27, SD 5.21) and aCG group (mean 12.36, SD 4.16; F1,989.03=1.12; P=.29; d=-0.26; 95% CI 0.68 to 0.17). A significant difference emerged at T3 (iCBT-I: mean 9.43, SD 5.36; aCG: mean 12.44, SD 5.39; F1,426.15=4.72; P=.03), favoring iCBT-I with a medium effect (d=-0.57; 95% CI 1.07 to -0.06). Most secondary outcomes revealed no significant differences between the groups. In total, 51% (23/45) of participants in the iCBT-I group completed all 6 sessions, and 69% (31/45) completed the 4 core sessions.

Conclusions: In the short term, students might benefit from low-intensity, easily accessible digital sleep hygiene psychoeducation or iCBT-I. However, it appears that iCBT-I offers superiority over sleep hygiene psychoeducation in the long term.

Trial registration: German Clinical Trials Register DRKS00017737; https://drks.de/search/de/trial/DRKS00017737.

Keywords: CBT-I; active control group; cognitive behavioral therapy for insomnia; insomnia; internet intervention; randomized controlled trial; university students.

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Conflict of interest statement

Conflicts of Interest: ACZ receives royalties for a digital health application (DiGA) for sexual dysfunction implemented in routine care in Germany. She reports having received fees for delivering presentations at scientific conferences and for producing expert videos for a digital health application (DiGA). DDE is a stakeholder of the GET.ON Institute/HelloBetter, which aims to implement scientific findings related to digital health interventions into routine care. DDE has served as a consultant on the scientific advisory boards of Sanofi, Novartis, Minddistrict, Lantern, Schoen Kliniken, Ideamed and German health insurance companies (Barmer and Techniker Krankenkasse), and a number of federal chambers for psychotherapy. HB has received consultancy fees, fees for lectures or workshops from chambers of psychotherapists and training institutes for psychotherapists, and license fees for an internet-based intervention not addressed here. AMK has received fees for conducting lectures and workshops from chambers of psychotherapists and health insurance companies. FK has received fees for conducting lectures and workshops on student mental health. All other authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Study flow. iCBT: intervention group; iCBT-I: internet-based cognitive behavioral therapy for insomnia; ISI: Insomnia Severity Index.
See this image and copyright information in PMC

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