ROCKVILLE, MD. – Using a digital application could allow more adults to try cognitive-behavioral therapy (CBT) to combat insomnia and expand access to a technique that’s been shown to ward off depression, a researcher said at a National Institute of Mental Health conference on mental health services research.
Previous research has shown that CBT for insomnia (CBT-I) that’s conducted in person is not only effective for insomnia but also can reduce co-occurring depression. In fact, the treatment effects for depression are roughly the same magnitude as antidepressants but with fewer side effects and contraindications, said Philip C. Cheng, PhD, of the Sleep Disorders & Research Center at the Henry Ford Health System in Detroit. He cited a systematic literature review published recently that found CBT-I to be a promising treatment for depression comorbid with insomnia (J Psychosom Res. 2018 Mar;106:1-2).
“We’ve got a two-birds-with-one-stone kind of a deal,” Dr. Cheng said, referring to the ability of CBT-I to address both disorders. “It’s hard to resist the impulse to say: ‘This is great. Let’s get this out to everyone who has insomnia.’ ”
But there’s only a limited pool of about 1,200 health care professionals experienced in CBT-I to serve a much larger pool of people who might need help warding off depression, he said. The NIMH estimates that 16.2 million adults in the United States had at least one major depressive episode in 2016, which is about 6.7% of all U.S. adults. To address the shortage, developers have created digital apps such as Sleepio, which Dr. Cheng and his colleagues used in their research.
For this study, they recruited people with insomnia who did not at the time have depression. Patients were assigned to either use the Sleepio app or follow a more traditional sleep education program. The latter consisted of six weekly emails with tips on sleep hygiene, Dr. Cheng said. These contained the typical messages that a patient would receive from a physician to address a sleep disorder, he added.
“The doctor says: ‘Don’t drink caffeine; make sure you sleep in a dark room,’ things like that,” Dr. Cheng said. “A lot of evidence has shown that this is not an effective stand-alone treatment for insomnia.”
With Sleepio, users get online assistance in addressing their challenges with sleep. Dr. Cheng said he and his colleagues used Sleepio because of its grounding in CBT methods. Other apps built with the same commitment to CBT might deliver similar results, according to Dr. Cheng. He presented the results seen in 166 people who used the digital CBT-I approach and 146 who received sleep education.
An interim analysis of results showed that within a period of 12 months after treatment, 20% of those in the sleep education control group developed incident depression, whereas only 10% of those in the CBT-I did, Dr. Cheng said. Analyzing the results, Dr. Cheng and his colleagues said those numbers indicate that the number needed to treat to prevent one case of depression was 10.
The subscription for this online tool costs about $400 a year, so it would cost $4,000 to prevent one case of depression, Dr. Cheng said.
Sleepio, also available on web-based platforms, is compatible with personal tracking devices, such as Fitbit. Sleepio users also have online community members who can share their experiences and support (Cogn Behav Pract. 2018 Aug;25:442-8). It was created by Colin Espie, PhD, DSc, of the University of Oxford (England) and Peter Hames. Dr. Espie and Mr. Hames are cofounders of Big Health, a company that creates automated behavioral programs.
The Robert Wood Johnson Foundation funded the study. Dr. Cheng also is funded by a National Institutes of Health grant (K23HL138166). Sleepio provided its product for the study free of charge. Dr. Cheng said that he has no relevant conflicts of interest and that he has funding from Harmony Biosciences for a study unrelated to this work.