CBTi – can you really treat insomnia online?

Insomnia is the most prevalent of all sleep disorders. This is due in part to the general nature of the diagnosis. Difficulty falling asleep, staying asleep, waking up too early, or feeling generally unrefreshed the next day all fall under the insomnia umbrella.

Another reason why insomnia is so common is because sleep is easily disrupted by many things such as stress, illness, or even travel. It’s been estimated that about 1 in 3 adults will experience a bout of insomnia within any given year and for 1 in 10 the problem will be chronic, lasting 3 months or longer.

Insomnia can be more than an annoyance. If left unchecked, chronic insomnia can lead to impairments in daytime alertness, cognition, and performance. It is also a major contributor to the development of depression and anxiety disorders.

If you suffer from chronic insomnia, you may have found your treatment options somewhat limited. In the initial stages of your sleep struggle, you might have resorted to options most readily available.

Traditional ‘remedies’ for insomnia

Perhaps you started out dabbling with herbs, “sleepy teas”, melatonin, or over- the-counter sedating antihistamines such as diphenhydramine (Benadryl). Probably a Google search for “insomnia treatment” was in the mix at some point. Failing these attempts, the next step might have been to talk to your doctor about the problem.

But this move might have been accompanied with some trepidation. The insomnia solution offered by most physicians is prescription sleeping pills. Many patients are wary of this approach and for good reasons.

While potentially effective, sleep meds are fraught with major downsides such as side effects, tolerance, and the potential for dependency. If you’ve been reluctant to head down the sleeping pill path, there may be new hope.

Cognitive behavioral therapy for insomnia

In recent years, well-controlled studies have been published showing that non-drug treatment for insomnia, in the form of cognitive behavioral treatment for insomnia (CBTi), can be highly effective. CBTi may not be new to insomnia veterans who likely encountered it in self-help books on sleep.

What is new is that CBTi is increasingly available online. For the uninitiated, CBTi is a constellation of behavioral and cognitive therapy techniques aimed at improving natural sleep.

CBTi has been shown to be as effective as sleeping pills at about 6 weeks of treatment and more effective long term, up to two years. One of the reasons for the superiority of CBTi is that, unlike sleep meds which address the symptom of insomnia, CBTi addresses and aims to correct underlying causes.

CBTi is traditionally conducted by trained a practitioner in-person, either individually or in small groups. One limiting factor has been access to treatment. There are only about 300 credentialed CBTi therapists in the U.S. The opportunity to see a CBTi therapist has, therefore, been extremely limited for most insomnia suffers.

The good news is that advances in online and mobile technology have made CBTi increasingly available via the internet which has greatly widened access to this highly effective treatment. There are now almost half a dozen digital CBTi platforms available to consumers and to employers wanting to provide sleep wellness services to their workers.

Benefits of online CBTi

Studies on the effectiveness of online CBTi are now emerging and the results have been very encouraging. Online CBTI appears to be as effective as in-person treatment and in some cases has shown better outcomes. In addition to providing benefit to the public at large, online CBTi has also been deployed in the workplace environment.

Here, it has been demonstrated to significantly improve sleep, overall health, and productivity among employees in the workplace. These findings have been a boon to employers who have concerns about the effects of sleep deprivation on employee health, healthcare costs, absenteeism, and presenteeism (reduced work productivity while on the job).

Online CBTi is available now as a component of the health and wellness services many large companies now offer their employees.

Online CBTi is a scalable solution and therefore has the potential to provide benefit to a large number of insomnia sufferers and employers interested in improving sleep health.

Not a magic bullet

While the potential for online CBTi is significant, it is important to be aware of its limitations. Insomnia symptoms may be caused by or be secondary to other sleep or medical conditions. Sleep apnea, chronic pain, depression, and anxiety disorders, for example, can lead to symptoms of insomnia.

While online CBTi may be of some benefit, even in these cases, the best treatment outcome may also require a consultation with an appropriate medical provider. In this regard, it should be noted that some online sleep health platforms are capable of assessing risk for these other important contributing factors which can serve as notice to the user to seek medical attention.

Dr. Loewy is part of the clinical team at Optisom and has worked within sleep medicine for over 25 years, including extensive involvement in sleep research, consulting with the sleep industry, and practicing clinical sleep medicine. As Co-Founder and Clinical Director of San Diego’s Integrative Insomnia and Sleep Health Center, Dr. Loewy worked closely with sleep challenged patients to overcome a wide range of disorders.

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