Online CBT for insomnia (CBT I). What are the best online treatments?
Insomnia is commonly perceived as a person having problems getting to sleep, however, it actually covers a vast range of sleep related issues including getting to sleep, staying asleep, broken sleep, and even sleep that doesn’t leave a person feeling restored.
Approximately to 30% of adults will experience some form of insomnia in their lives with many not seeking professional help due to lack of knowledge about effect treatments, anxiety about social perception of visiting a psychologist or simply a lack of free time to attend appointments. Fortunately, there are many scientifically backed methods for overcoming insomnia, which due to the prevalence of fast internet connections, are more convenient to access than ever. One of the more prominent methods is Online Cognitive Behavioral Therapy for insomnia (CBTi).
Online CBTi offers an effective alternative to medications, which can be applied over a 4-8] session program meaning results, and so relief from the debilitating effects of insomnia, can be quickly achieved. So what is online CBTi and how does it work? Online treatment programs typically fall into two categories, the replication of traditional therapy online and automated apps.
Option 1 – Meeting with a Therapist
The option perhaps most familiar to those who do know much about psychological treatments or those who have attended psychological therapy previously is the one to one session with a therapist. Utilising online video calling services such as Skype or Facetime, or even just over the phone, if that is something you would prefer, a therapist can be available to you wherever you are at a time convenient to you.
There are a growing number of companies offering such a service so it is important that you check they are licensed. Online CBTi services like psychologyhelp.com take the time to make sure to match you with a therapist they believe you will be most compatible with, thus helping ensure a more productive and efficient treatment paln.
The advantage such an Online CBTi method is that a treatment plan can be tailored specifically to your needs, rather than as with the ‘one size fits all’ approach of other methods. The therapist can also speak to you about any doubts or difficulties you are having regarding treatment and adaptations can be made as need. There is no need to fit travel time into your schedule as appointments can take place during your lunch break or a free 30 minutes ate home and due to it being appointment based, it is more likely for a person to complete their treatment plan, just like exercising regularly is easier when attending a class rather than going to the gym by yourself.
The value of speaking to a person face to face is underpinned by years of scientific study. A recent study by Lancee et al. (2016) revealed that face to face treatment methods have a greater effect on a person’s insomnia than those methods which simply help guide a person through the process by way of email, with 86.7% of participants reporting continued better sleep 6 months after treatment.
Option 2 – Online apps
As the rise in smart phone use has grown, people are looking to them for more and more convenient ways to improve their health, and that is no different when it comes to sleep. As Apple once famously stated, “There’s an app for that”, and this is true for online Cognitive Behavioral Therapy for insomnia too.
A 2012 study by Espie et al. demonstrated that automated apps can be effective in helping people overcome insomnia, with more than two thirds of those competing their plans reporting significantly better sleeping behaviour.
Apps are available at various price points, from free to well into the hundreds of dollars. So which one should you choose? Below is an overview of four of the more prominent apps available.
CBT-I Coach (Free):
Designed to supplement face to face therapy rather than as a replacement, CBT-I was initially used as tool to help soldiers suffering from insomnia due to PTSD. However, it has since been adapted to help those suffering with insomnia for other reason, and to good effect.
The app allows users to determine if they have a sleep problem though assessments and questionnaires. Then after completing a 5-day sleep diary the app provides a personalised sleep plan. This plan includes advice on positive behaviours which can be incorporated into a person night-time routine, including relaxation techniques and audio and visual exercises.
There is an information section which provides users a way to better understand the issues around sleep and the problems many have with it, and the app send the user reminders to help keep them on the road to recovery. Perhaps the only issue is the lack of security, with no option to create an account or add a password.
Findings by Kuhn et al. (2016) showed that users of CBT-I Coach found it much easier to adhere to the ‘homework’ provided by their regular therapist and felt that the results of their treatment was much stronger as a result.
RESTORE by Cobalt Therapeutics (£99 – £229)
The critically acclaimed Restore by Cobalt Therapeutics is a 5 week, 7-session online online Cognitive Behavioral Therapy for insomnia program which provides users with downloadable and printable material to read so that they have a better understanding of why they may be having difficulties sleeping, and practise exercises designed to aid better sleeping behaviours. Higher priced packages also include coaching sessions and professional support.
A large number of studies have been carried out into Restore with results consistently showing greater than 80% of users reporting an improvement in their sleep, including better total sleep time, feeling more ready to sleep before bed, waking up feeling more refreshed and a resultant improvement in daytime productivity. However, sticking to the plan can be more difficult than with face to face sessions, with fewer users completing the plan.
SHUTi ($149 – $249)
SHUTi offers a 6 session, 6-week, fully customisable, interactive online CBTi program Features include a personalised sleep schedule, homework tasks, a sleep diary and progress reports to allow users to follow their sleep behaviour and development in detail. There is also a library of learning materials so users can follow up on suggestions made by the app improve their understanding of those issues. Furthermore, the app can be connected to personal fitness devices to track a person’s daily activity to better tailor their program.
Clinical trials have revealed users report sleeping up to an extra 6.4 hours per week and can continue to feel the benefits, including falling asleep faster and waking less, for up to a year and beyond. Whilst the app requires quite a bit of time to fully interact with, in particular the sleep diary, it results suggest that this is time well spent.
Whilst Sleepio may be the most expensive app on this list, that price is for 1 year of full access. It is also the only one which offers a 100% money back guarantee, giving you piece of mind when making such an investment into your health. If in doubt however, it may be covered on your existing healthcare plan or it can be accessed for free through participation in a research study.
Sleepio allows you to provide the app with your specific needs and goals and from this build a program that is right for you. At every step, a virtual assistant, The Prof, is on hand to provide information and recommendations to better improve your experience and results.
A report by NICE reports the opinions of users and healthcare professionals. Whilst it is recognised that completing any mobile app based treatment program requires significant dedication by the user, the results are generally positive.
Each of these options makes CBTi available on a scale like never before. With the efficacy of Online CBT for insomnia demonstrated though numerous studies, this can only mean better sleep is within reach of us all. As with all medial issues though, be sure to check with you doctor if you have any concerns.