Combining objective sleep feedback with dCBT-I – new approaches to insomnia treatment
MSc. Alexandra Hinterberger
I obtained my Bachelor’s and Master’s degree in Psychology from the University of Salzburg, Austria and I am currently doing my PhD at the Laboratory for Sleep, Cognition and Consciousness Research at the University of Salzburg. In my PhD, I focus on insomnia and digital CBT-I, and further investigate the role of objective sleep measurement in insomnia and whether providing feedback on sleep might enhance therapy-related improvements regarding sleep and well-being. More on ORCID.
Does combining objective sleep tracking and feedback on sleep with insomnia therapy work?
Sleep problems like insomnia affect a rising number of people, which makes low-threshold and easily accessible treatment options highly necessary. While digital cognitive behavioural therapy for insomnia (CBT-I) is usually only combined with a sleep diary to assess the subjective perception of a person’s sleep, objective measurement of sleep is usually disregarded.
Our research group, led by Prof. Dr. Manuel Schabus, follows a different and new approach to digital CBT-I: A smartphone app provides a CBT-I–based sleep training program as well as subjective sleep monitoring by means of a sleep diary, as known from previous digital CBT-I programs. Additionally, however, the app further includes validated continuous objective sleep measurement based on heart rate variability (HRV), and sleep feedback based on objective sleep measures. This allows for daily objective sleep analyses and individualized feedback for users. As this combination is a novel approach to digital insomnia therapy, our objective was to assess the efficacy of the app-program on subjective and objective measures of sleep by conducting a randomized controlled trial (RCT). We compared an experimental group (EG; n = 28) with access to the full app-program to a waitlist control group (CG; n = 29).
We found substantial and clinically relevant improvements in subjective sleep quality (PSQI) and insomnia severity (ISI) for the EG, which were driven by the app-training. Objective findings, as measured with PSG, were less conclusive.
However, as we continuously measured both subjective (i.e., sleep diary) and objective (i.e., HRV-based measurement) sleep, we were able to analyse changes in the discrepancy between a person’s perception of their sleep and objectively measured sleep, a well-known phenomenon in insomnia. Indeed, we found improvements regarding the discrepancy in all investigated parameters, and mostly only for the EG. Overall, our results indicate that the combination of objective sleep measurement plus feedback on sleep and digital CBT-I yields desired effects, while simultaneously enabling a more detailed insight into a person’s sleep over the course of therapy. However, more well-controlled studies are needed to detangle the complex relationship between program elements and effects on the individual, and thus fully understand the impact on insomnia in general.
Recent publications from ESRS members
- Åkerstedt et al (2024). A life of research on everyday sleep(iness). Sleep Adv.
- Tam J. et al (2024). Sex-specific changes in sleep quality with aging: Insights from wearable device analysis. J Sleep Res.
- Dumas D. et al (2024). COMISA : comorbidité insomnie et apnées du sommeil. Rev Med Suisse.
- Naushad S. et al (2024). Chronic intermittent hypoxia triggers cardiac fibrosis: Role of epididymal white adipose tissue senescent remodeling. Acta Physiol (Oxf).
- Rösler L. et al (2024). Hyperarousal dynamics reveal an overnight increase boosted by insomnia. J Psychiatr Res.
- Spaargaren KL. et al (2024). Protocol of a randomized controlled trial into guided internet-delivered cognitive behavioral therapy for insomnia in autistic adults (i-Sleep Autism). Contemp Clin Trials.