"The groundwork of all happiness is health." - Leigh Hunt

Cognitive behavioral therapy for insomnia via telemedicine: is it nearly as good as in-person treatment?

Chronic insomnia, characterised by dissatisfaction with sleep quality or duration, is a standard health problem that affects an estimated 10% to fifteen% of American adults. Cognitive behavioral therapy for insomnia, or CBTi, is taken into account a first-line treatment for insomnia. CBTi, often misrepresented as talk therapy or sleep hygiene, involves each behavioral and cognitive therapy to treat insomnia.

The behavioral components transcend the knowledge you often find on the Internet (or what your folks and family inform you), comparable to avoiding caffeine or electronic devices near bedtime, because the entire time in bed The focus is on limiting (yes, you read that accurately, spending. less time in bed), getting off the bed when awake, and maintaining regular sleep and wake times. CBTi may additionally include leisure strategies and mindfulness techniques.

While extensive research has shown that CBTi is an efficient treatment for insomnia, and Current medical guidelines There stays limited access to a small variety of specially trained clinicians recommending CBTi as first-line treatment. It can be known that self-guided methods, comparable to using a book, will not be as effective. CBTi is traditionally delivered in person. However, with the rapid shift to telemedicine through the global pandemic, CBTi is now commonly delivered remotely.

Is CBTi via telemedicine nearly as good as in-person treatment for insomnia patients?

One examined this query. A recent studyLed by Dr. J. Todd Arnedt on the University of Michigan. Dr. Arndt and his team randomized 65 adults with chronic insomnia to 6 individual sessions of CBTi, delivered either in person or via telemedicine. They desired to know if CBTi via telemedicine performed as well (ie, not worse) than in-person CBTi in reducing the severity of insomnia symptoms. They also compared other outcomes: daytime functioning and patient satisfaction with treatment.

What were the outcomes?

At two different time points—at completion of CBTi and at three months—CBTi delivered via telemedicine was inferior (or non-inferior) to CBTi delivered in person. This implies that the telemedicine group performed in addition to the in-person group. Telemedicine was also noninferior for other outcomes, including response rate, daytime functioning, and patient satisfaction.

what's the meaning of this?

This suggests that we now have some evidence that CBTi delivered via telemedicine works, and that the expected response shouldn't be lower than CBTi delivered in person. It's a crucial piece of knowledge — especially now through the pandemic, when telemedicine has been increasingly adopted — and can improve access to more patients. CBTi is an efficient and protected treatment for insomnia, and by eliminating travel time and geographic distance between practitioner and patient, CBTi can turn into more accessible.

However, other barriers still exist for a lot of patients. Patients who would not have web access or a smartphone should have difficulty accessing appointments via video, and due to this fact may only access CBTi via phone. With uncertainty regarding continued insurance reimbursements for telephone visits, access to CBTi could also be further limited. Additionally, CBTi shouldn't be all the time covered by medical insurance plans, and is primarily provided by practitioners who only speak English.

Resources for CBTi providers and tools

Find a CBTi provider.

Find a sleep medicine physician/center.

Cleveland Clinic CBTI App

Summer riceThe first FDA-approved digital treatment for insomnia