Real-world evaluation of digital CBT for insomnia in the primary care setting – many should not log on to doze off

Abstract

Cognitive behaviour therapy for insomnia (CBTi) has emerged as the first-line treatment for insomnia where available. Clinical trials of digital CBTi (dCBTi) have demonstrated similar efficacy and drop-out rates to face-to-face CBTi. Most patients entering clinical trials are carefully screened to exclude other sleep disorders. This is a case series review of all those referred to a dCBTi within an 18-month time period. Those initially screened, accepted after exclusion of other sleep disorders, commencing and completing therapy were assessed to understand patient population referred from general practice in the UK. 390 patient referrals were analysed. 135 were suitable for dCBTi with a high rate of other sleep disorders detected in screening. 78 completed therapy (20.0%) and 44.9% had significant improvement in sleep outcomes, achieving ≥20% improvement in final sleep efficiency. dCBTi can be used within the UK NHS with good benefit for those who are selected as having insomnia and who then complete therapy. Many referrals are made with those likely to have distinct primary sleep disorders highlighting the need for education regarding sleep and sleep disorders prior to dCBTi therapy. Key learning aims (1) The use of unsupported digital cognitive behavioural therapy for insomnia (dCBTi) requires proper patient selection. (2) There are many insomnia mimics and also previously unrecognized sleep and psychiatric disturbances that are under-diagnosed in the primary care setting that are contraindications for unsupported dCBTi. (3) The use of a stepped care approach similar to the UK’s Improving Access to Psychological Therapies (IAPT) model using dCBTi could be feasible in the public health setting.