Self-Guided CBT for Insomnia is Effective for People with Insomnia, Co-Morbid OSA

A new study found a self-guided digital cognitive behavior therapy (CBT) for insomnia was an effective treatment option for people with insomnia and co-morbid obstructive sleep apnea (OSA), a new study found.¹

About 30 – 40% of individuals with insomnia have co-morbid OSA, and these individuals have worse sleep; daytime function; mental health; physical health; productivity; and quality of life than individuals with lone insomnia or OSA. Worse, OSA often remains undiagnosed.

“Recent studies found that people with [co-morbid insomnia and sleep apnea] experience a 50-70 percent increased risk of mortality over 10-20 years of follow-up, compared to people with neither condition,” said lead investigator Alexander Sweetman, PhD, from the Adelaide Institute for Sleep Health and Flinders Health in a press release.²

Investigators conducted a study in Australia assessing the effectiveness of a self-guided digital CBT program called “Bedtime Window” to treat insomnia, hoping to increase accessibility for those with co-morbid OSA as well.¹ With a self-guided CBT digital program for insomnia, people would no longer need to rely on medication.

“We know that (CBT) improves insomnia, mental health, and quality of life, and we want to see more people accessing this treatment because it can reduce the need for sleeping pills or other interventions which may not tackle long-term sleep [problems],” Sweetman said.²

The study, including 62 adults aged ≥18 years, compared the effectiveness of a self-guided CBT program for people with just insomnia (n = 43 [mean age, 51.8; 86.1% female]) and people with insomnia suspected to have co-morbid OSA (n = 19 [mean age, 54; 73.7% female]).¹ Participants had an Insomnia Severity Index score of >15, and an OSA risk was defined as a score of ≥5 on the OSA50. Participants self-reported symptoms of insomnia, depression, anxiety, sleepiness, fatigue, and maladaptive sleep-related beliefs at baseline, week 8, and the week 16 follow-up.

The team designed the 5-session program “Bedroom Window,” which lasted 18 months and included a 20 – 30-minute weekly session with “short videos, images, and text-based information.” The program included psychoeducation; stimulus control therapy; sleep restriction therapy; relaxation therapy cognitive therapy; and sleep hygiene information. Investigators assessed ESS scores after each CBT session.

“The program includes algorithms that continuously assess for symptoms of sleepiness and alertness and provides tailored and interactive recommendations to treat insomnia without worsening levels of daytime sleepiness,” Sweetman said.²

The team found participants had significant and sustained improvements in insomnia symptoms (P < .001) by week 8 and no significant change from week 8 to 16 (M reduction, 1.02; 95% CI, -0.9 to 3.03; P = .0657).¹ They also saw improvements with associated mental health symptoms including depression, anxiety ESS, fatigue, and DBAS-16 symptoms.

Investigators outlined several limitations, including defining insomnia and co-morbid OSA through self-reported symptoms and not a clinician diagnosis or overnight sleep studies. Additionally, the sample might not be able to be generalized to the public due to most of the participants being female, having low levels of daytime sleepiness, and having moderate insomnia severity. Furthermore, the team did not collect information on neurocognitive functioning.

“The positive results of our study highlight the potential to investigate the effectiveness, safety and acceptability of this digital (CBT) program in people with a confirmed diagnosis of OSA, before increasing access to people with [co-morbid insomnia and sleep apnea] throughout the health system,” Sweetman said.²

^References

1. ^{Sweetman, A. Effect of High-Risk Sleep Apnea On Treatment-Response To A Tailored Digital Cognitive Behavioral Therapy For Insomnia Program: A Quasi-Experimental Trial. Front. 2024 (3) https://doi.org/10.3389/frsle.2024.1355468.}
2. ^{Hope For Treating Sleep Disorders, No Pills Required. EurekAlert! March 13, 2024. https://www.eurekalert.org/news-releases/1037449. Accessed March 27, 2024}