# data[].attributes.headline
Logging on for better sleep: RCT of the effectiveness of online treatment for insomnia

# data[].attributes.subject
Logging on for better sleep: RCT of the effectiveness of online treatment for insomnia

# data[].attributes.attachment_link.readable_text
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Affiliations

¹ Adelaide Institute for Sleep Health and Flinders Health and Medical Research Institute: Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia.

² College of Education, Psychology and Social Work, Flinders University, Adelaide, South Australia, Australia.

³ School of Psychological Science, University of Western Australia, Perth, Western Australia, Australia.

Randomized Controlled Trial

Affiliations

¹ Adelaide Institute for Sleep Health and Flinders Health and Medical Research Institute: Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia.

² College of Education, Psychology and Social Work, Flinders University, Adelaide, South Australia, Australia.

³ School of Psychological Science, University of Western Australia, Perth, Western Australia, Australia.

Abstract

Background: Insomnia is a prevalent condition in Australia that increases the risk of depression and anxiety symptoms. Cognitive behaviour therapy for insomnia (CBT-i) is the recommended 'first line' treatment but is accessed by a minority of people with insomnia.

Aims: To improve CBT-i access in Australia, we aimed to develop and test a self-guided interactive digital CBT-i program.

Methods: An online randomised controlled trial was conducted from August 2022 to August 2023 to investigate the effect of digital CBT-i, versus digital sleep education control, on symptoms of insomnia (ISI), depression (PHQ-9), anxiety (GAD-7), fatigue, sleepiness and maladaptive beliefs about sleep at 8-week follow-up. The control group accessed the intervention after the 8-week follow-up. Questionnaires were additionally administered at 16 and 24 weeks. Intent-to-treat mixed models and complete-case chi-squared analyses were used.

Results: Participants included 62 adults with insomnia symptoms (age M (SD) = 52.5 (16.3), 82% female, ISI = 18.6 (2.9)). There were no between-group differences in baseline characteristics or missing 8-week data (14.5%). After adjusting for baseline scores, CBT-i was associated with lower insomnia (Diff adj (95% CI) = 7.32 (5.0-9.6), P < 0.001, d = 1.64), depression (3.36 (1.3-5.4), p = 0.002, d = 0.84), fatigue (5.2 (2.5-7.9), P < 0.001, d = 1.00) and maladaptive beliefs about sleep (11.0 (4.1-18.0), P = 0.002, d = 0.82), but not anxiety symptoms at 8 weeks (1.84 (-0.1 to 3.8), p = 0.060, d = 0.50). Compared to control, CBT-i was associated with greater rates of insomnia remission (ISI <8; 0.0%, vs 40.0%, P < 0.001) and response at 8 weeks (ISI reduction ≥6; 7.1% vs 72.0%, P < 0.001). Improvements in insomnia and depression were maintained at 24 weeks in the CBT-i group.

Conclusions: This interactive digital CBT-i program resulted in large and sustained improvements in symptoms of insomnia, depression, fatigue and maladaptive beliefs about sleep in Australian adults with insomnia symptoms. Implementation programs are required to increase digital CBT-i access and uptake.

Keywords: CBT‐i; difficulties initiating and maintaining sleep; eHealth; non‐pharmacological; online.

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Ohayon M. Epidemiology of insomnia: what we know and what we still need to learn. Sleep Med Rev 2002; 6: 97-111.

Reynolds A, Appleton S, Gill T, Adams R. Chronic Insomnia Disorder in Australia: A Report to the Sleep Health Foundation. Sleep Health Foundation Special Report. 2019.

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Sweetman A, Van Ryswyk E, Vakulin A, Lack L, Reed R, Battersby M et al. Co‐occurring depression and insomnia in Australian primary care: a narrative review of recent scientific evidence. Med J Aust 2021; 215: 230-236.

# data[].attributes.attachment_link.keywords[]
sleep initiation and maintenance disorders* / therapy

# data[].attributes.attachment_link.keywords[]
national center for biotechnology information

# data[].attributes.attachment_link.title
Digital cognitive behavioural therapy for insomnia versus digital sleep education control in an Australian community-based sample: a randomised controlled trial - PubMed

# data[].attributes.attachment_link.description
This interactive digital CBT-i program resulted in large and sustained improvements in symptoms of insomnia, depression, fatigue and maladaptive beliefs about sleep in Australian adults with insomnia symptoms. Implementation programs are required to increase digital CBT-i access and uptake.

# data[].attributes.headline
Randomised control trial assessing the efficacy of online CBT for moderate to severe anxiety

# data[].attributes.subject
Randomised control trial assessing the efficacy of online CBT for moderate to severe anxiety

# data[].attributes.body
Sleep disturbance is a key metric asssessed in the study

# data[].attributes.attachment_link.title
Efficacy of digital cognitive behavioral therapy for moderate-to-severe symptoms of generalized anxiety disorder: A randomized controlled trial - PubMed

# data[].attributes.attachment_link.description
Digital CBT (Daylight) appears to be safe and efficacious for symptoms of anxiety, worry, and further measures of mental health compared with waitlist control in individuals with GAD.

# data[].attributes.headline
RCT on digital CBT for both sleep and other hrql

# data[].attributes.subject
RCT on digital CBT for both sleep and other hrql

# data[].attributes.attachment_link.readable_text
The .gov means it's official.
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Randomized Controlled Trial

. 2019 Jan 1;76(1):21-30.

doi: 10.1001/jamapsychiatry.2018.2745.

Affiliations

¹ Sleep & Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom.

² Big Health Ltd, London, United Kingdom.

³ Biostatistics & Health Informatics Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom.

⁴ Susan Wakil School of Nursing and Midwifery, The University of Sydney, Sydney, Australia.

⁵ CIRUS Centre for Integrated Research and Understanding of Sleep, Woolcock Institute of Medical Research, University of Sydney, Sydney, Australia.

⁶ Department of Sleep Disorders and Research Center, Henry Ford Health System, Detroit, Michigan.

⁷ School of Health and Social Care, University of Lincoln, Lincoln, United Kingdom.

⁸ Division of Psychology and Language Sciences, Faculty of Brain Sciences, University College London, London, United Kingdom.

⁹ Feinberg School of Medicine, Northwestern University, Chicago, Illinois.

¹⁰ Sleep & Circadian Neuroscience Institute, Department of Psychiatry, University of Oxford, Oxford, United Kingdom.

¹¹ Department of Health Policy, The London School of Economics and Political Science, London, United Kingdom.

¹² Centre for Biostatistics, School of Health Sciences, The University of Manchester, Manchester, United Kingdom.

Free PMC article

Randomized Controlled Trial

Colin A Espie et al. JAMA Psychiatry.

Free PMC article

. 2019 Jan 1;76(1):21-30.

doi: 10.1001/jamapsychiatry.2018.2745.

Affiliations

¹ Sleep & Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom.

² Big Health Ltd, London, United Kingdom.

³ Biostatistics & Health Informatics Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom.

⁴ Susan Wakil School of Nursing and Midwifery, The University of Sydney, Sydney, Australia.

⁵ CIRUS Centre for Integrated Research and Understanding of Sleep, Woolcock Institute of Medical Research, University of Sydney, Sydney, Australia.

⁶ Department of Sleep Disorders and Research Center, Henry Ford Health System, Detroit, Michigan.

⁷ School of Health and Social Care, University of Lincoln, Lincoln, United Kingdom.

⁸ Division of Psychology and Language Sciences, Faculty of Brain Sciences, University College London, London, United Kingdom.

⁹ Feinberg School of Medicine, Northwestern University, Chicago, Illinois.

¹⁰ Sleep & Circadian Neuroscience Institute, Department of Psychiatry, University of Oxford, Oxford, United Kingdom.

¹¹ Department of Health Policy, The London School of Economics and Political Science, London, United Kingdom.

¹² Centre for Biostatistics, School of Health Sciences, The University of Manchester, Manchester, United Kingdom.

Abstract

Importance: Digital cognitive behavioral therapy (dCBT) is a scalable and effective intervention for treating insomnia. Most people with insomnia, however, seek help because of the daytime consequences of poor sleep, which adversely affects quality of life.

Objectives: To investigate the effect of dCBT for insomnia on functional health, psychological well-being, and sleep-related quality of life and to determine whether a reduction in insomnia symptoms was a mediating factor.

Design, setting, and participants: This online, 2-arm, parallel-group randomized trial comparing dCBT for insomnia with sleep hygiene education (SHE) evaluated 1711 participants with self-reported symptoms of insomnia. Participants were recruited between December 1, 2015, and December 1, 2016, and dCBT was delivered using web and/or mobile channels plus treatment as usual; SHE comprised a website and a downloadable booklet plus treatment as usual. Online assessments took place at 0 (baseline), 4 (midtreatment), 8 (posttreatment), and 24 (follow-up) weeks. Programs were completed within 12 weeks after inclusion.

Main outcomes and measures: Primary outcomes were scores on self-reported measures of functional health (Patient-Reported Outcomes Measurement Information System: Global Health Scale; range, 10-50; higher scores indicate better health); psychological well-being (Warwick-Edinburgh Mental Well-being Scale; range, 14-70; higher scores indicate greater well-being); and sleep-related quality of life (Glasgow Sleep Impact Index; range, 1-100; higher scores indicate greater impairment). Secondary outcomes comprised mood, fatigue, sleepiness, cognitive failures, work productivity, and relationship satisfaction. Insomnia was assessed with the Sleep Condition Indicator (range: 0-32; higher scores indicate better sleep).

Results: Of the 1711 participants included in the intention-to-treat analysis, 1329 (77.7%) were female, mean (SD) age was 48.0 (13.8) years, and 1558 (91.1%) were white. Use of dCBT was associated with a small improvement in functional health compared with SHE (adjusted difference [95% CI] at week 4, 0.90 [0.40-1.40]; week 8, 1.76 [1.24-2.28]; week 24, 1.76 [1.22-2.30]) and psychological well-being (adjusted difference [95% CI] at week 4, 1.04 [0.28-1.80]; week 8, 2.68 [1.89-3.47]; week 24, 2.95 [2.13-3.76]), and with a large improvement in sleep-related quality of life (at week 4, -8.76 [-11.83 to -5.69]; week 8, -17.60 [-20.81 to -14.39]; week 24, -18.72 [-22.04 to -15.41]) (all P < .01). A large improvement in insomnia mediated these outcomes (range mediated, 45.5%-84.0%).

Conclusions and relevance: Use of dCBT is effective in improving functional health, psychological well-being, and sleep-related quality of life in people reporting insomnia symptoms. A reduction in insomnia symptoms mediates these improvements. These results confirm that dCBT improves both daytime and nighttime aspects of insomnia, strengthening existing recommendations of CBT as the treatment of choice for insomnia.

Trial registration: isrctn.org identifier: ISRCTN60530898.

Conflict of interest statement

Conflict of Interest Disclosures: Dr Espie reports being a cofounder, chief medical officer, and shareholder of and receiving salary from Big Health Ltd and being a developer of Sleepio. Drs Kyle and Drake report receiving nonfinancial support from Big Health Ltd (provision of Sleepio for use in clinical trials). Dr Cape reports providing clinical advice and support to Sleepio and receiving payment from Big Health Ltd. Dr Ong reports receiving nonfinancial support from Big Health Ltd (provision of Sleepio for use in clinical trials), providing consultancy support for Sleepio, and receiving payment from Big Health Ltd. Dr Sheaves reports providing monthly support for an online discussion forum run by Sleepio and receiving payment from Big Health Ltd. Dr Freeman reports being a cofounder of the University of Oxford spinout company, Oxford VR; receiving nonfinancial support from Big Health Ltd (provision of Sleepio for use in clinical trials); and being supported by an NIHR Research Professorship. Dr Luik held a research position at the University of Oxford during the conduct of the study that was funded by Big Health Ltd. No other conflicts were reported.

Figures

# data[].attributes.attachment_link.keywords[]
sleep initiation and maintenance disorders / psychology*

# data[].attributes.attachment_link.keywords[]
sleep initiation and maintenance disorders / therapy*

# data[].attributes.attachment_link.keywords[]
national center for biotechnology information

# data[].attributes.attachment_link.title
Effect of Digital Cognitive Behavioral Therapy for Insomnia on Health, Psychological Well-being, and Sleep-Related Quality of Life: A Randomized Clinical Trial - PubMed

# data[].attributes.attachment_link.description
The .gov means it's official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you're on a federal government site. The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

# data[].attributes.headline
2024 systematic review of eHealth vs in person CBT for insomnia 

# data[].attributes.subject
2024 systematic review of eHealth vs in person CBT for insomnia 

# data[].attributes.body
https://mental.jmir.org/2024/1/e58217/

“This, to our knowledge, first systematic review and meta-analysis of randomized head-to-head comparisons of eCBTI and ipCBTI suggests that while the effects tended to be in favor of the latter, the mean differences were generally of small magnitudes, with several approaching 0. Furthermore, the 2 CBTI delivery formats were statistically significantly equivalent for most outcomes examined”

# data[].attributes.attachment_link.title
Efficacy of eHealth Versus In-Person Cognitive Behavioral Therapy for Insomnia: Systematic Review and Meta-Analysis of Equivalence

# data[].attributes.attachment_link.description
Background: Insomnia is a prevalent condition with significant health, societal, and economic impacts. Cognitive behavioral therapy for insomnia (CBTI) is recommended as the first-line treatment. With limited accessibility to in-person–delivered CBTI (ipCBTI), electronically delivered eHealth CBTI (eCBTI), ranging from telephone- and videoconference-delivered interventions to fully automated web-based programs and mobile apps, has emerged as an alternative. However, the relative efficacy of eCBTI compared to ipCBTI has not been conclusively determined.
Objective: This study aims to test the comparability of eCBTI and ipCBTI through a systematic review and meta-analysis of equivalence based on randomized controlled trials directly comparing the 2 delivery formats.
Methods: A comprehensive search across multiple databases was conducted, leading to the identification and analysis of 15 unique randomized head-to-head comparisons of ipCBTI and eCBTI. Data on sleep and nonsleep outcomes were extracted and subjected to both conventional meta-analytical methods and equivalence testing based on predetermined equivalence margins derived from previously suggested minimal important differences. Supplementary Bayesian analyses were conducted to determine the strength of the available evidence.
Results: The meta-analysis included 15 studies with a total of 1083 participants. Conventional comparisons generally favored ipCBTI. However, the effect sizes were small, and the 2 delivery formats were statistically significantly equivalent (P<.05) for most sleep and nonsleep outcomes. Additional within-group analyses showed that both formats led to statistically significant improvements (P<.05) in insomnia severity; sleep quality; and secondary outcomes such as fatigue, anxiety, and depression. Heterogeneity analyses highlighted the role of treatment duration and dropout rates as potential moderators of the differences in treatment efficacy.
Conclusions: eCBTI and ipCBTI were found to be statistically significantly equivalent for treating insomnia for most examined outcomes, indicating eCBTI as a clinically relevant alternative to ipCBTI. This supports the expansion of eCBTI as a viable option to increase accessibility to effective insomnia treatment. Nonetheless, further research is needed to address the limitations noted, including the high risk of bias in some studies and the potential impact of treatment duration and dropout rates on efficacy.
Trial Registration: PROSPERO CRD42023390811; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=390811

# data[].attributes.headline
meta analysis comparing online vs in person CBT for insomnia

# data[].attributes.subject
meta analysis comparing online vs in person CBT for insomnia

# data[].attributes.attachment_link.title
Comparative efficacy of onsite, digital, and other settings for cognitive behavioral therapy for insomnia: a systematic review and network meta-analysis - PubMed

# data[].attributes.attachment_link.description
Given the limited availability and accessibility of onsite cognitive behavioral therapy for insomnia (CBT-I), other CBT-I settings, such as internet-delivered CBT-I (iCBT-I), have been proposed. The primary aim of the study was to compare the efficacy of available CBT-I settings on insomnia severity …

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Online Delivery of Cognitive Behavioral Therapy-Insomnia
Considerations and Controversies

https://www.sleep.theclinics.com/article/S1556-407X(19)30014-1/abstract

# data[].attributes.body
Vincent, Norah, and Samantha Lewycky. "Logging on for better sleep: RCT of the effectiveness of online treatment for insomnia." Sleep 32.6 (2009): 807-815.

# data[].attributes.body
RCT for digital CBT on sleep difficulties in menopausal women

# data[].attributes.attachment_link.readable_text
The .gov means it's official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you're on a federal government site.

The site is secure.
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Affiliations

¹ Nursing Department, College of Applied Medical Sciences, Jouf University, Al-Jawaf, Saskakah, Saudi Arabia.

² Faculty of Nursing, Psychiatric Mental Health Nursing, Cairo University, Cairo, Egypt.

³ Faculty of Nursing, Maternal and New Born Health Nursing, Cairo University, Cairo, Egypt.

Randomized Controlled Trial

Affiliations

¹ Nursing Department, College of Applied Medical Sciences, Jouf University, Al-Jawaf, Saskakah, Saudi Arabia.

² Faculty of Nursing, Psychiatric Mental Health Nursing, Cairo University, Cairo, Egypt.

³ Faculty of Nursing, Maternal and New Born Health Nursing, Cairo University, Cairo, Egypt.

Abstract

Sleeping difficulties are the most significant cause of disability in menopausal women. Cognitive behavioral therapy (CBT) is the first line of management for sleeping difficulties and chronic insomnia.

Purpose: To evaluate the efficacy of an Internet-based CBT program on sleeping difficulties in menopausal women.

Design: This was a randomized controlled trial. A total of 80 eligible menopausal women who fit the criteria of poor sleep quality were randomly and evenly assigned to the CBT intervention group or the control group.

Tools: The tools used for data collection were the demographic sheet, Pittsburgh Sleep Quality Index, Insomnia Severity Index, and sleep diary. Internet-based CBT modules were administered to the intervention group. Six consecutive modules were held weekly for each participant. Sleep quality scores and insomnia index scores were considered the primary outcomes, while sleep diaries were the secondary outcomes. Self-administered questionnaires were given at baseline and 6 weeks after randomization.

Findings: Internet-based CBT is effective in reducing sleeping difficulties, particularly sleep quality scores (-3.60 ± 2.76) and insomnia index scores (-5.10 ± 3.54) from baseline. Moreover, the program induced significant changes in sleep parameters, such as increased total sleep hours (t = 2.734, p = 0.008), increased sleep efficiency ≥85%, (t = 3.558, p = 0.001), and decreased sleep latency (t = 2.180, p = 0.033) compared with the control group.

Conclusion: The strong predictors of having very poor sleep quality were short duration since last menopause, severity of hot flashes, and short duration of sleep difficulties.

Practice implication: Internet-based CBT is a useful practical intervention for managing sleeping difficulties in menopausal women. The current study provides evidence on the efficacy and cost-effectiveness of Internet-based cognitive behavioral intervention; thus, we recommend this method as a practical and accessible intervention to improve sleep in menopausal women.

Keywords: insomnia; intervention; menopause; online program; sleep difficulties; women.

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Bacon, J. L. (2017). The menopausal transition. Obstetrics and Gynecology Clinics of North America, 44(2), 285-296

Baker, F., Zambotti, M., Colrain, I., & Bei, B. (2018). Sleep problems during the menopausal transition: Prevalence, impact, and management challenges. Nature and Science of Sleep, 10, 73-95.

Buysse, J., Reholds, F., Monk, H., Hoch, C., Yeager, L., & Kupfer, J. (1991). Quantification of subjective sleep quality in healthy elderly men and women using Pittsburgh Sleep Quality Index. Sleep, 14(1), 331-338.

Buysse, J., Reynolds, F., Monk, H., Berman, R., & Kupfer, J. (1989). The Pittsburgh Sleep Quality Index: A new instrument for psychiatric practice and research. Journal of Psychiatric Research, 28(2), 193-213.

# data[].attributes.attachment_link.keywords[]
sleep initiation and maintenance disorders* / therapy

# data[].attributes.attachment_link.keywords[]
national center for biotechnology information

# data[].attributes.attachment_link.title
Efficacy of Internet-based cognitive behavioral therapy on sleeping difficulties in menopausal women: A randomized controlled trial - PubMed

# data[].attributes.attachment_link.description
Internet-based CBT is a useful practical intervention for managing sleeping difficulties in menopausal women. The current study provides evidence on the efficacy and cost-effectiveness of Internet-based cognitive behavioral intervention; thus, we recommend this method as a practical and accessible i ...

# data[].attributes.body
Efficacy of internet-delivered cognitive-behavioral therapy for insomnia – A systematic review and meta-analysis of randomized controlled trials

https://www.sciencedirect.com/science/article/abs/pii/S1087079215001483

# data[].attributes.body
Abdelaziz, Enas M., Nadia B. Elsharkawy, and Sayeda M. Mohamed. "Efficacy of Internet‐based cognitive behavioral therapy on sleeping difficulties in menopausal women: A randomized controlled trial." Perspectives in psychiatric care 58.4 (2022): 1907-1917.

# data[].attributes.body
RCT comparing digital CBT with digital sleep education for insomnia

# data[].attributes.attachment_link.readable_text
The .gov means it's official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you're on a federal government site.

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Affiliations

¹ Adelaide Institute for Sleep Health and Flinders Health and Medical Research Institute: Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia.

² College of Education, Psychology and Social Work, Flinders University, Adelaide, South Australia, Australia.

³ School of Psychological Science, University of Western Australia, Perth, Western Australia, Australia.

Randomized Controlled Trial

Affiliations

¹ Adelaide Institute for Sleep Health and Flinders Health and Medical Research Institute: Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia.

² College of Education, Psychology and Social Work, Flinders University, Adelaide, South Australia, Australia.

³ School of Psychological Science, University of Western Australia, Perth, Western Australia, Australia.

Abstract

Background: Insomnia is a prevalent condition in Australia that increases the risk of depression and anxiety symptoms. Cognitive behaviour therapy for insomnia (CBT-i) is the recommended 'first line' treatment but is accessed by a minority of people with insomnia.

Aims: To improve CBT-i access in Australia, we aimed to develop and test a self-guided interactive digital CBT-i program.

Methods: An online randomised controlled trial was conducted from August 2022 to August 2023 to investigate the effect of digital CBT-i, versus digital sleep education control, on symptoms of insomnia (ISI), depression (PHQ-9), anxiety (GAD-7), fatigue, sleepiness and maladaptive beliefs about sleep at 8-week follow-up. The control group accessed the intervention after the 8-week follow-up. Questionnaires were additionally administered at 16 and 24 weeks. Intent-to-treat mixed models and complete-case chi-squared analyses were used.

Results: Participants included 62 adults with insomnia symptoms (age M (SD) = 52.5 (16.3), 82% female, ISI = 18.6 (2.9)). There were no between-group differences in baseline characteristics or missing 8-week data (14.5%). After adjusting for baseline scores, CBT-i was associated with lower insomnia (Diff adj (95% CI) = 7.32 (5.0-9.6), P < 0.001, d = 1.64), depression (3.36 (1.3-5.4), p = 0.002, d = 0.84), fatigue (5.2 (2.5-7.9), P < 0.001, d = 1.00) and maladaptive beliefs about sleep (11.0 (4.1-18.0), P = 0.002, d = 0.82), but not anxiety symptoms at 8 weeks (1.84 (-0.1 to 3.8), p = 0.060, d = 0.50). Compared to control, CBT-i was associated with greater rates of insomnia remission (ISI <8; 0.0%, vs 40.0%, P < 0.001) and response at 8 weeks (ISI reduction ≥6; 7.1% vs 72.0%, P < 0.001). Improvements in insomnia and depression were maintained at 24 weeks in the CBT-i group.

Conclusions: This interactive digital CBT-i program resulted in large and sustained improvements in symptoms of insomnia, depression, fatigue and maladaptive beliefs about sleep in Australian adults with insomnia symptoms. Implementation programs are required to increase digital CBT-i access and uptake.

Keywords: CBT‐i; difficulties initiating and maintaining sleep; eHealth; non‐pharmacological; online.

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sleep initiation and maintenance disorders* / therapy

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national center for biotechnology information

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Digital cognitive behavioural therapy for insomnia versus digital sleep education control in an Australian community-based sample: a randomised controlled trial - PubMed

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This interactive digital CBT-i program resulted in large and sustained improvements in symptoms of insomnia, depression, fatigue and maladaptive beliefs about sleep in Australian adults with insomnia symptoms. Implementation programs are required to increase digital CBT-i access and uptake.