Insomnia is a major health problem with significant psychological, health, and economic consequences. However, availability to one of the most effective insomnia treatments, Cognitive Behavioral Therapy (CBT), is significantly limited. The Internet may be a key conduit for delivering this intervention.
To evaluate the efficacy of a structured behavioral Internet intervention for adults with insomnia.
Design, Setting, and Participants:
45 adults were randomly assigned to an Internet intervention (n=22) or wait-list control group (n=23). 44 eligible participants were included in the analyses (mean age, 44.86±11.03 years; 34 women), who had, on average, a history of sleep difficulties greater than 10 years (10.59±8.89).
The Internet intervention is based on well-established face-to-face CBT, incorporating the primary components of sleep restriction, stimulus control, sleep hygiene, cognitive restructuring, and relapse prevention.
Main Outcome Measure(s):
The Insomnia Severity Index (ISI) and daily sleep diary data were used to determine changes in insomnia severity and the main sleep variables, including wake after sleep onset (WASO) and sleep efficiency (SE).
Intent-to-treat analyses showed that scores on the ISI significantly improved from 15.73 (95% CI, 14.07-17.39) to 6.59 (95% CI, 4.73-8.45) for the Internet group, but did not change for the control group, 16.27 (95% CI, 14.61-17.94) to 15.50 (95% CI, 13.64-17.36), F (1, 42) = 29.64, p<.001. The Internet group maintained their gains at six month follow-up. Internet participants also achieved significant decreases in WASO (55%; 95% CI, 34%-76%) and increases in SE (16%; 95% CI, 9%-22%) compared to the non-significant control group changes of WASO (8%; 95% CI, −17%-33%) and SE (3%; 95% CI, −4%-9%).
Participants who received the Internet intervention for insomnia significantly improved their sleep, whereas the control group did not change. The Internet appears to have considerable potential in delivering a structured behavioral program for insomnia.