Online Cognitive Behavioral Therapy Can Improve Sleep

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A recent review in Current Psychiatry shows that cognitive behavioral therapy for insomnia is an effective treatment to improve sleep and depression. Important signs of insomnia include difficulty sleeping at least three nights a week, having more trouble functioning during the day and feeling more stressed from lack of sleep.

The review examined eight recent research studies that offered participants cognitive behavioral therapy for insomnia (CBT-I), one of the most recommended standard treatment for chronic insomnia—an approach that is often underutilized even though it is highly effective. CBT-I consist of a series of steps and structured sleep approaches that focus on improving sleep quality first and then sleep quantity. Here are seven main takeaways across the recent sleep studies:

1. Digital or self-guided online cognitive behavioral therapy for insomnia (CBT-I) improves insomnia just as well as therapist-guided CBT-I. One of the reasons CBT-I is underutilized is because there are not many therapists certified in CBT-I and, as a result, it may be difficult to find a therapist specifically trained in offering CBT-I. However, there are several CBT-I online programs and apps available online (some are paid subscriptions). Research has found that digital CBT-I that is internet-based, online, or app-based CBT-I can be equally effective and these programs are often more accessible and affordable. For example, the VA Hospital system offers a CBT-I app called CBT-iCoach.

2. CBT-I can help both with insomnia as well depressive symptoms that are often associated with insomnia. Many studies have found that CBT-I can help both improve depression and have a sustained antidepressant effect. Furthermore, CBT-I is useful to prevent depression, reducing the risk of developing depression in people dealing with insomnia.

3. The benefits of cognitive behavioral therapy for insomnia, including the digital or online versions, are long-lasting and can help improve sleep for over a year. One study found that nine weeks of fully-automated, internet-based CBT-I was able to help with daytime functioning up to 18 months after finishing the online program.

4. Cognitive behavioral therapy for insomnia can help people with sleep apnea accept and learn to use continuous positive airway pressure (CPAP) therapy (a treatment for sleep apnea), which can often be uncomfortable. One study found that CBT-I helped people learn to accept and use CPAP more regularly.

5. CBT-I helped people regardless of their natural sleep patterns or circadian rhythm. One study found that people with depression and insomnia were able to improve their depression outcomes using CBT-I, regardless of their typical circadian preference for morning or evenings.

6. CBT-I reduces nightmares for people with post traumatic stress disorder (PTSD). One study of veterans found that CBT-I reduced PTSD-related nightmares-- nearly one-quarter of participants were able to recover fully.

7. CBT-I improves sleep for women going through menopause. Sleep is often disrupted during and after menopause due to hormonal changes. CBT-I has been found to be effective to improve sleep and reduce daytime fatigue in women dealing with menopause-related insomnia.

These studies of CBT-I show that it is a useful, effective, and powerful approach to improve sleep in a sustainable and long-lasting way.

Marlynn Wei, M.D., PLLC © Copyright 2020.