Internet-Delivered Cognitive Behavioral Therapy to Treat Insomnia: A Systematic Review and Meta-Analysis

• Published in: PloS one Vol. 11; no. 2; p. e0149139
• Main Authors: Seyffert, Michael, Lagisetty, Pooja, Landgraf, Jessica, Chopra, Vineet, Pfeiffer, Paul N., Conte, Marisa L., Rogers, Mary A. M.
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 11.02.2016; Public Library of Science (PLoS)
• Subjects: Adult; Adults; Analysis; Behavior modification; Behavioral medicine; Biology and Life Sciences; Care and treatment; Chronic illnesses; Clinical trials; Cognitive ability; Cognitive behavioral therapy; Cognitive Behavioral Therapy - methods; Computer and Information Sciences; Data processing; Depression (Mood disorder); Depression - therapy; Diabetes; Efficiency; Engineering and Technology; Female; Humans; Insomnia; Internal medicine; Internet; Latency; Libraries; Male; Medicine; Medicine and Health Sciences; Mental depression; Mental disorders; Mental health; Meta-analysis; Nocturnal; Nursing; People and Places; Psychiatry; Public health; Randomization; Randomized Controlled Trials as Topic; Regression Analysis; Sleep; Sleep and wakefulness; Sleep disorders; Sleep Initiation and Maintenance Disorders - therapy; Statistical analysis; Studies; Telemedicine - methods; Therapy; Therapy, Computer-Assisted - methods; Treatment Outcome; Type 2 diabetes; Ann Arbor Michigan; United States > US; Michigan
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0149139

Insomnia is of major public health importance. While cognitive behavioral therapy is beneficial, in-person treatment is often unavailable. We assessed the effectiveness of internet-delivered cognitive behavioral therapy for insomnia. The primary objectives were to determine whether online cognitive behavioral therapy for insomnia could improve sleep efficiency and reduce the severity of insomnia in adults. Secondary outcomes included sleep quality, total sleep time, time in bed, sleep onset latency, wake time after sleep onset, and number of nocturnal awakenings. We searched PubMed/MEDLINE, the Cumulative Index to Nursing and Allied Health Literature, PsycInfo, Cochrane Library, Embase, and the Web of Science for randomized trials. Studies were eligible if they were randomized controlled trials in adults that reported application of cognitive behavioral therapy for insomnia via internet delivery. Mean differences in improvement in sleep measures were calculated using the Hartung-Knapp-Sidik-Jonkman method for random effects meta-analysis. We found 15 trials, all utilizing a pretest-posttest randomized control group design. 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. 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. 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). 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. 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. 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. In conclusion, internet-delivered cognitive behavioral therapy is effective in improving sleep in adults with insomnia. Efforts should be made to educate the public and expand access to this therapy. Registration Number, Prospero: CRD42015017622.