Can you do CBT for sleep disorders online?

Is online insomnia treatment - that is seeing a sleep specialist via a video treatment session - as effective as in-person treatment for insomnia?

We often get asked this question because our service is a telemedicine based treatment service (we do insomnia treatment online using video sessions via Zoom, but doing online treatment using any video platform, MS Teams and the like, is known as “telemedicine” or “telehealth” in healthcare circles). We particularly like the telemedicine approach as it enables us to offer evidence-based treatment to individuals with insomnia throughout New Zealand and overseas.

As you've probably heard, the most effective treatment for chronic insomnia is cognitive behavioral therapy for insomnia aka CBT-i.

In fact, multiple scientific studies show that cognitive behavioral therapy for chronic insomnia is more effective than any sleep aid or medication that a doctor can prescribe - that's why cognitive behavior therapy for insomnia is the recommended first line treatment for people with insomnia by all Sleep Associations and Medical Colleges.

But most studies on the effectiveness of CBTi have been done on in person treatment.
And scientific studies are what we use to answer the question: "Is a therapy for insomnia effective?"

So it's been an open question as to whether sleep disorders treatment by video show improvements in insomnia symptoms comparable to standard treatment.

And importantly, it’s an open question whether cognitive behavioural therapy for insomnia via video is as effective as in-person insomnia disorder treatment with cognitive behavior therapy?

But now there's an answer.

What A Systematic Review Tells Us About The Effectiveness Of Online Insomnia Treatment Using CBT-i

Researchers at Baylor College of Medicine, Houston conducted a systematic review and meta-analysis of randomized controlled trials (676 different studies were considered) to look at whether treating insomnia online could be as effective as traditional in-person sleep medicine service for the diagnosis, follow-up, and treatment of insomnia.

The studies included were randomized controlled trials because they are the strongest kind of scientific studies.
Studies included a range of different populations, including those with:

• primary insomnia only;

• insomnia and co-occuring mental health conditions, such as veterans with PTSD & older patients with depression;

• physical health conditions;

• medical conditions such as breast cancer patients.

So what did the researchers find?

The researchers found that insomnia treatment, that is cbt-i treatment, was more effective in improving chronic insomnia when delivered by telemedicine than when conducted as face-to-face CBT-i.

The researchers stated:

"The results of meta-analysis showed that telemedicine methods are more effective in treating chronic insomnia than face-to-face methods,”

Wait. What?

Yep, you read it right.

Online cognitive behavioral therapy for those experiencing insomnia is more effective than face-to-face treatment.

And we already know that face-to-face treatment is more effective than digital cognitive behavioural therapy (i.e. an app-based sleep program with no sleep therapist interaction).

This means online is the most effective treatment for insomnia.

The researchers continued:

“Therefore, the treatment of insomnia using telemedicine methods should receive further attention. These methods are very useful in critical situations such as the COVID-19 pandemic and in areas where specialized facilities are not available for face-to-face visits.”

Other Benefits Of Treatment For Chronic Insomnia Online

The authors of the meta-analysis pointed out that other studies have also shown a range of benefits of telemedicine, including:

• increases patient satisfaction;

• improves adherence to treatment (i.e. doing the treatment);

• treatment is more accessible online;

• reduced wait time for appointments;

• reduced travel time for appointments; and

• reduced health care costs.

Is Online Sleep Medicine Therapy For Insomnia The Way Of The Future?

There are a range of scientific studies that suggest online treatments are the future for patients with insomnia.

A systematic review by McLay et al., in 2020 provided evidence of a positive effect of telehealth delivered behavioral sleep medicine interventions on sleep problems in children and adolescents.

Another study in 2017 showed that the use of telemedicine online programs in sleep, changes behavior, improves sleep patterns and leads to better sleep.

Where Can I Get Treatment For Insomnia Online?

Though insomnia can be managed with cognitive-behavioral therapy for insomnia, it can be hard to get insomnia treatment as qualified and experienced clinicians are hard to find. 

That leads to those suffering from insomnia relying on having to get a prescription of insomnia medication (sleeping pills) which, in some cases, is dangerous and is not recommended as a long-term solution.

At The Better Sleep Clinic we provide online cognitive behavioral treatment of chronic insomnia disorder using the full, recommended session by session CBTi program for insomnia.

As psychologists, we also provide online mental health treatment for other mental health conditions that are associated with insomnia.

If you read our 50+ 5 star reviews you'll note many clients refer to an "insomnia program" but CBT treatment is actually based off an individual treatment plan that is tailored to the insomnia symptoms and sleep habits of each individual seeking treatment (because no two insomnia cases are the same and symptoms of insomnia vary from person to person).

What can you expect from treatment?

Note that CBTi is not the same as sleep hygiene / good sleep habits recommendations you see online, nor is it typically " relaxation therapy " or relaxation techniques. Most of our clients have already tried this stuff.

Traditionally real insomnia treatment may involve getting a good medical history of your symptoms and problems falling or staying asleep, keeping a sleep diary, potentially using stimulus control and sleep restriction (more correctly: sleep opportunity restriction), addressing dysfunctional thoughts about sleep and ultimately ensuring a person has a really good understanding of how sleep works and what will get in the way if you want to get a good night's sleep. We do all of that, where needed, and more. But importantly, tailored to your individual needs.

Not sure if you need treatment? Take the insomnia severity index questionnaire to see if you need treatment.

The study was published in Sleep Medicine (Sharafkhaneh et al., 2020).