Is Telemedicine Effective at Treating Insomnia?

Cognitive behavioral therapy delivered via telemedicine can be as effective as face-to-face interaction as a way to treat insomnia other sleep-related issues, according to preliminary findings from two analyses of an ongoing study. 

Insomnia is a sleep disorder that is characterized by difficulty falling and/or staying asleep

One-third of U.S. adults report that they usually get less than the recommended amount of sleep. Not getting enough sleep is linked with many chronic diseases and conditions-such as type 2 diabetes, heart disease, obesity, and depression, according to the CDC. 

For chronic insomnia, cognitive behavioral therapy for insomnia (CBT-I) combines behavioral strategies, such as setting a consistent sleep schedule and getting out of bed when struggling with sleep, with cognitive strategies, such as replacing fears about sleeplessness with more helpful expectations. CBT-I recommendations are customized to address each patient’s individual needs and symptoms.

The analysis of therapeutic alliance involved 38 adults with insomnia, including 25 women who were recruited through advertisement and insomnia clinics and screened for disqualifying sleep, medical, and mental health disorders. Participants had a mean age of about 52 years. Eligible participants were randomly assigned to six sessions of CBT for insomnia delivered face-to-face or via SleepTM, a telemedicine platform designed by the American Academy of Sleep Medicine (AASM). Participants maintained the consensus sleep diary throughout treatment and completed pre- and post-treatment measures of daytime functioning (fatigue, depression, anxiety, and overall functioning).

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The results showed that both delivery methods were equally effective at improving sleep outcomes. There also were no differences between the two delivery methods in patient perception of therapeutic alliance, warmth, and confidence in the therapist’s skills.

“The most surprising findings in the study were that, contrary to our hypotheses, participants who received CBT for insomnia via telemedicine rated therapist alliance similarly to participants who received face-to-face CBT for insomnia,” said principal investigator J. Todd Arnedt, PhD, an associate professor of psychiatry and neurology and co-director of the Sleep and Circadian Research Laboratory at Michigan Medicine, University of Michigan in Ann Arbor. “In addition, ratings of satisfaction with treatment were equivalent between face-to-face and telemedicine participants. Relative to other remote modalities, telemedicine may offer a unique blend of convenience for the patient while preserving fidelity of the face-to-face interaction.”

“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.”

Both research abstracts were published in an online supplement of Sleep and were presented Monday, June 10, in San Antonio at SLEEP 2019, the 33^rd annual meeting of the Associated Professional Sleep Societies LLC (APSS), which is a joint venture of the American Academy of Sleep Medicine and the Sleep Research Society.