Efficacy of an Internet-based behavioral intervention for adults with insomnia.

Publication Type:

Journal Article


Arch Gen Psychiatry, Volume 66, Issue 7, p.692-8 (2009)


Adult, Cognitive Therapy, Feasibility Studies, Female, Follow-Up Studies, Humans, Internet, Male, Middle Aged, Patient Education as Topic, Self Efficacy, Sleep Initiation and Maintenance Disorders, Therapy, Computer-Assisted, Treatment Outcome


<p><b>CONTEXT: </b>Insomnia is a major health problem with significant psychological, health, and economic consequences. However, availability of one of the most effective insomnia treatments, cognitive behavioral therapy, is significantly limited. The Internet may be a key conduit for delivering this intervention.</p><p><b>OBJECTIVE: </b>To evaluate the efficacy of a structured behavioral Internet intervention for adults with insomnia.</p><p><b>DESIGN, SETTING, AND PARTICIPANTS: </b>Forty-five adults were randomly assigned to an Internet intervention (n = 22) or wait-list control group (n = 23). Forty-four eligible participants (mean [SD] age, 44.86 [11.03] years; 34 women) who had a history of sleep difficulties longer than 10 years on average (mean [SD], 10.59 [8.89] years) were included in the analyses.</p><p><b>INTERVENTION: </b>The Internet intervention is based on well-established face-to-face cognitive behavioral therapy incorporating the primary components of sleep restriction, stimulus control, sleep hygiene, cognitive restructuring, and relapse prevention.</p><p><b>MAIN OUTCOME MEASURES: </b>The Insomnia Severity Index and daily sleep diary data were used to determine changes in insomnia severity and the main sleep variables, including wake after sleep onset and sleep efficiency.</p><p><b>RESULTS: </b>Intention-to-treat analyses showed that scores on the Insomnia Severity Index significantly improved from 15.73 (95% confidence interval [CI], 14.07 to 17.39) to 6.59 (95% CI, 4.73 to 8.45) for the Internet group but did not change for the control group (16.27 [95% CI, 14.61 to 17.94] to 15.50 [95% CI, 13.64 to 17.36]) (F(1,42) = 29.64; P < .001). The Internet group maintained their gains at the 6-month follow-up. Internet participants also achieved significant decreases in wake after sleep onset (55% [95% CI, 34% to 76%]) and increases in sleep efficiency (16% [95% CI, 9% to 22%]) compared with the nonsignificant control group changes of wake after sleep onset (8% [95% CI, -17% to 33%) and sleep efficiency (3%; 95% CI, -4% to 9%).</p><p><b>CONCLUSIONS: </b>Participants who received the Internet intervention for insomnia significantly improved their sleep, whereas the control group did not have a significant change. The Internet appears to have considerable potential in delivering a structured behavioral program for insomnia.</p><p><b>TRIAL REGISTRATION: </b>clinicaltrials.gov Identifier: NCT00328250.</p>

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