To address this issue, some investigators have examined whether CBTI programs could be administered through the Internet as a means for disseminating insomnia treatment to a wider audience. There is a lack of well-trained therapists specializing in CBTI to fill the need, given the millions of individuals who may benefit. ĭespite successes with face-to-face therapists, CBTI is not easily accessible to all individuals with insomnia. Randomized trials comparing medications for insomnia versus CBTI indicate that CBTI yields more durable sleep improvement over the course of time with fewer side effects. Pharmacologic treatments, such as benzodiazepine-receptor agonists and low dose antidepressants, are also commonly used therapies for insomnia and are sometimes used in patients based on symptom patterns, coexisting diseases, and previous treatment responses. When administered in-person by a trained therapist, CBTI has been shown to be effective in improving sleep, with clinically meaningful effect sizes. The United States Preventive Services Task Force found that the net benefit of CBTI was moderate from high quality studies. The American Academy of Sleep Medicine recommends CBTI for chronic primary insomnia disorder with and without comorbid conditions. Treatment of insomnia predominantly occurs in primary care and outpatient mental health settings, with cognitive behavioral therapy for insomnia (CBTI) often offered as a first-line therapy in adults. These criteria were recently updated in the third edition of the International Classification of Sleep Disorders (ICSD-3). ĭiagnostic criteria for chronic insomnia disorder include problems with initiating or maintaining sleep for at least 3 months (occurring at least 3 times per week) despite opportunities to sleep, as well as impairment in daytime functioning. Notably, the relationship between insomnia and depression is bi-directional individuals with insomnia are at significantly higher risk of developing depression, and persons with depression are at higher risk of developing insomnia. ![]() In addition, chronic insomnia disorder is associated with other chronic conditions such as obesity, diabetes, hypertension, cardiovascular disease, anxiety and depression. In a population-based longitudinal study characterizing the natural history of insomnia, the point prevalence of insomnia was 24% at baseline and, among individuals with insomnia, 74% reported the persistence of this disorder for at least one year. Not only is insomnia common, it is persistent over time. Insomnia is estimated to affect 9%-15% of the world’s population. ![]() The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.Ĭompeting interests: The authors have declared that no competing interests exist. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.ĭata Availability: Data are available from the Corresponding Author.įunding: This study was supported by the Robert Wood Johnson Foundation Clinical Scholars Program. Received: NovemAccepted: JanuPublished: February 11, 2016Ĭopyright: © 2016 Seyffert et al. PLoS ONE 11(2):Įditor: Raffaele Ferri, Oasi Institute for Research and Prevention of Mental Retardation, ITALY (2016) Internet-Delivered Cognitive Behavioral Therapy to Treat Insomnia: A Systematic Review and Meta-Analysis. There were no statistically significant differences between sleep efficiency, total sleep time, and insomnia severity index for internet-delivered versus in-person therapy with a trained therapist.Ĭitation: Seyffert M, Lagisetty P, Landgraf J, Chopra V, Pfeiffer PN, Conte ML, et al. Improvements in sleep efficiency, the insomnia severity index and depression scores with internet-delivered cognitive behavioral therapy were maintained from 4 to 48 weeks after post-treatment assessment. The severity of depression decreased by 2.3 points (95% CI: -2.9, -1.7 p = 0.013) in individuals who received internet-delivered cognitive behavioral therapy compared to control. Total sleep time averaged 5.7 hours at baseline and increased by 20 minutes with internet-delivered therapy versus control (95% CI: 9, 31 p = 0.004). Internet-delivered cognitive behavioral therapy resulted in a decrease in the insomnia severity index by 4.3 points (95% CI: -7.1, -1.5 p = 0.017) compared to control. Sleep efficiency was 72% at baseline and improved by 7.2% (95% CI: 5.1%, 9.3% p<0.001) with internet-delivered cognitive behavioral therapy versus control. We found 15 trials, all utilizing a pretest-posttest randomized control group design.
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