Insomnia treatment that’s delivered through a Web-based program or videoconference may help people feel less tired during the day, according to a small study from Canada.

Researchers found over half of people who had chronic insomnia at the start of the study no longer had severe difficulty functioning after receiving therapy through one of those methods.

“I think the biggest takeaway is . . . cognitive behavioral therapy (CBT) for insomnia can be delivered effectively in a variety of formats - not just face to face but also using different technologies and even self-directed,” Maxine Holmqvist, the study’s lead author, told Reuters Health.

She is an assistant professor at University of Manitoba in Winnipeg.

More than one-quarter of people in the U.S. report not getting enough sleep every now and then, according to the Centers for Disease Control and Prevention. About one in 10 Americans reports chronic insomnia.

Symptoms of chronic insomnia include regularly having trouble falling asleep, waking up too early in the morning and waking up in the middle of the night. This often results in people feeling tired during the day.

One treatment for chronic insomnia is CBT, which consists of therapist-guided sessions that teach people methods to help them get better sleep. Those sessions include lessons about insomnia, relaxation techniques, ignoring stimuli and creating good sleeping habits.

People who live in rural areas may not have access to such therapy, however.

For people without easily accessible treatment, videoconferencing (also known as telehealth) is sometimes used in Canada to bring together patients and doctors, write the researchers in the journal Sleep Medicine.

There is also some evidence, they write, that CBT can be delivered through the Internet.

For the new study, the researchers recruited 73 adults living in a rural Canadian province and randomly assigned them to either receive CBT through an Internet-based program or through a group videoconference at clinics near their homes.

At the start of the study, all of the participants had insomnia, according to a questionnaire that scores how well a person functions during the day.

After six CBT sessions delivered over six weeks, the researchers found that 55 percent of the telehealth group and about 62 percent of the Web-based treatment group no longer scored high enough on the questionnaire to be considered to have insomnia.

The researchers write that the difference in results between the two delivery methods could have been due to chance. With more people they may be able to say whether one works better than the other.

“Overall, our study suggests that both Web- and telehealth-based treatments of insomnia show promise and are worthy of further development and study,” they write.

Philip Gehrman, who is certified in behavioral sleep medicine but wasn’t involved in the new study, said he is not surprised by the new results. He has been using telehealth to see patients within the U.S. Veterans Affairs Health System. But he said it’s not necessarily accessible to the average person.

“In terms of traditional in-person treatment, there are directories of people who specialize in this type of treatment,” Gehrman, from the Perelman School of Medicine at the University of Pennsylvania in Philadelphia, told Reuters Health. “For a lot of people, there might be people in their area who might be able to do it in person.”

As for Web-based treatments, he said there are some commercial products available.

In addition to people knowing there are insomnia treatments besides sleeping pills, “the take-home message of this article is that treatment doesn’t necessarily have to be a one-size-fits-all approach,” Gehrman said.

Holmqvist said the same may be true for an increasing number of treatments.

“I think people who are seriously looking at these questions - not just in sleep - are finding that some of these technologies work for other methods,” she said.

SOURCE: Sleep Medicine, online January 2, 2014

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Web-vs telehealth-based delivery of cognitive behavioral therapy for insomnia: a randomized controlled trial

Objectives
The purpose of our study was to evaluate and compare 2 methods of service delivery (web-based and telehealth-based) for chronic insomnia with regard to patient preference, clinical effectiveness, and patient satisfaction.

Methods
Our study was a randomized controlled trial with manualized telehealth- and web-based delivery conditions (nonblinded). The sample comprised 73 adults with chronic insomnia. Participants received web-based delivery from their homes or telehealth-based delivery from a nearby clinic. Both interventions consisted of identical psychoeducation, sleep hygiene and stimulus control instruction, sleep restriction treatment, relaxation training, cognitive therapy, mindfulness meditation, and medication tapering assistance.

Results
Using a linear mixed model analysis, results showed that both delivery methods produced equivalent changes in insomnia severity, with large effect sizes. Attendance patterns favored telehealth, whereas homework adherence and preference data favored web-based delivery.

Conclusions
Web- and telehealth-based delivery are both helpful in treating chronic insomnia in rural-dwelling adults.

  M. Holmqvist,
  N. Vincent,
  K. Walsh