Despite being the criterion standard for effective treatment of insomnia, cognitive behavioral therapy-insomnia (CBT-I) delivery is challenged by geographic and economic barriers and the limited number of available health care providers trained in delivering CBT-I. Telemedicine has been widely suggested as a means of overcoming these challenges, and 2 small studies now provide evidence that CBT-I delivered remotely is as effective as in-person CBT-I.
In the first study, an ongoing prospective randomized controlled noninferiority trial, ANOVA analysis showed that remotely delivered CBT-I was noninferior (ie, equally effective) compared with CBT-I delivered in person. Both groups had significant pre-to post-treatment improvements in fatigue, depression symptoms, anxiety symptoms, and overall functioning Other measures including sleep latency, wake after sleep onset, totoal sleep time, and sleep efficiency, all improved for both groups of participants. For this study, 30 individuals with chronic insomnia were randomly assigned to receive CBT-I delivered via the the American Academy of Sleep Medicine (AASM) Sleep platform was compared (n = 17) or CBT-I delivered in person (n = 13).
In the second study, 38 individuals (mean age = 52.5, SD=14; age range = 20-72) received remove CBT-I via the Sleep platform (n = 20) or in person (n = 18). Mean scores on the Working Alliance Inventory ranged between 34 to 60 for those who received remote CBT-I and between 40 to 60 for those who received CBT-I in person. In this study, measures of warmth towards therapist and therapist skill did not differ between groups.
“Preliminary findings from this study suggest that patients undergoing telemedicine for insomnia can feel just as close and supported by their therapist as if they were in the office,” said co-investigator Deirdre Conroy, Ph.D., a clinical associate professor of psychiatry and clinical director of the Behavioral Sleep Medicine Program at Michigan Medicine, University of Michigan in Ann Arbor. “Telemedicine could be utilized more for CBT-I to bridge the gap between supply and demand for this service.”
These data were presented at SLEEP 2019, the 33rd annual meeting of the Associated Professional Sleep Societies LLC (APSS), a joint venture of the American Academy of Sleep Medicine and the Sleep Research Society.
Jill M. Giordano Farmer, DO
Brady Laughlin, DO; Alex Chan, DO; Waimei Amy Tai, MD; and Parham Moftakhar, MD
Elizabeth Carroll, MD; Asya I. Wallach, MD; Arielle Kurzweil, MD; Steven Frucht, MD; Thomas Berk, MD; Michael Boffa, MD; and Ilya Kister, MD