Digital CBT for Insomnia : Can Mobile Apps Truly Cure Sleep Disorders?

Insomnia is a real problem and people living with this condition suffer a lot because not getting proper and enough sleep during the night can put them at the risk of several health issues. However, the good news is that several effective treatments are available for insomnia that can help people fall asleep faster, have uninterrupted sleep, and also feel more rested during the daytime. Cognitive behavioral therapy or CBT for insomnia is one of the effective treatments for the condition. However, with the advancement of technology, now digital cognitive behavioral therapy or digital CBT (dCBT-I) has gained popularity among patients with insomnia. Digital CBT can be beneficial in alleviating insomnia. More about digital CBT and its effectiveness can be known in the following paragraphs.

Insomnia is a common sleep issue that affects people’s health worldwide.^{(1, 2)} Cognitive behavioral therapy for treating insomnia is a short, structured, and also evidence-based treatment approach that helps in getting rid of the frustrating symptoms of insomnia. Digital CBT includes various CBT applications that can be used to combat insomnia.

Over the past decades, fully self-service digital CBT applications or apps have been developed that have been effectively treating insomnia in Western countries.^{(3, 4)} These digital CBT apps for insomnia have emerged as the recommended first-line therapy for the condition.⁽⁵⁾

A study that was published in Jama Psychiatry mentioned that an online CBT program could cure 57% of those who used it when compared with 27% of those who had standard education about insomnia.⁽⁶⁾

Various terms are used for digital CBT, such as internet CBT (iCBT), online CBT (oCBT), electronic CBT (eCBT), and computerized CBT (cCBT).

Probably yes! Insomnia can be cured by apps. Digital CBT delivers therapy for insomnia in various ways. Let us see these different ways.

1. Digital CBT as Support

This is a form of digital involvement in the treatment of insomnia and also comprises the field of telemedicine.^{(7, 8)} Here, a special therapist or health professional offers the therapy and in this process, specific digital elements are used for supporting the therapy.⁽⁹⁾

There are several approaches to using digital tools like a communication program for giving therapy, mobile apps with components like sleep diaries, and relaxation exercises for supporting the treatment. For instance, a mobile app has been developed that supports face-to-face CBT for insomnia patients in the VA system.⁽⁹⁾

Using digital CBT as support is primarily intended to enhance current conventional therapy for insomnia. Thus, this can increase the feasibility of accessing cognitive behavioral therapy in remote regions or at times preferable for patients with insomnia. But, this way of using digital CBT for insomnia is not likely to have a large effect on the scalability of cognitive behavioral therapy for insomnia.

2. Guided Digital CBT

Guided digital CBT is another category by which digital CBT can be used for insomnia. To date, the largest number of digital CBT programs described in the literature combine an automated program with clinical support.^{(10, 11, 12, 13)} Such programs offer pre-assembled course information, which are available in various modalities, across several sessions. There has been effectiveness in improving sleep-onset latency, sleep efficiency, wake-after sleep onset, and severity of insomnia through these programs.

As the name suggests, guided digital CBT requires a time investment from an expert health professional. In general, time commitments have been suggested to be somewhere between 40 minutes to 2 hours per patient per the digital CBT course.^{(14, 15)} This time is a much lower time investment than required for face-to-face cognitive behavioral therapy, thus suggesting that guided digital  CBT (dCBT) could substantially increase the scalability of cognitive behavioral therapy for insomnia.

3. Fully Automated Digital CBT

There are only three fully automated digital CBT programs that have been reported in the scientific literature.^{(16, 17)} Such programs are fully automated and function without any support from a human specialist or therapist. However, some programs might still offer support from therapists as an additional feature.

Presentation of the fully automated digital CBT programs largely differs and ranges from presenting texts with videos to virtual animated therapists. Generally, sleep diaries and questionnaires support the automatic tailoring of such fully automated dCBT programs to patients’ needs, in a way as a therapist would.

1. Sleep Cycle

iPhone rating: 4.7 stars

Android rating: 4.7 stars

Sleep Cycle app monitors your sleep patterns and provides you with detailed statistics and daily sleep graphs so that you have a better understanding of what is going on when you sleep or what might be interfering with a good night’s sleep. Sleep cycle app also features an intelligent alarm clock that is specifically designed to wake you up gently when you are in the lightest phase of your sleep cycle.

2. Nature Sounds Relax and Sleep

Android rating: 4.5 stars

This is an app developed for people suffering from insomnia and it includes six nature-based relaxing tracks. However, this runs only on Android phones.  The app helps you start your audio therapy. You can choose from animal sounds, high-quality water sounds, nature sounds, white noise, and more, all of these sounds are specially designed to help you relax and sleep well.

3. Relax Melodies: Sleep Sounds

iPhone rating: 4.8 stars

Android rating: 4.6 stars.

This is another app that can help you sleep well. Choose sounds and melodies from the list to customize and mix them on Sleep Melodies and try Sleep Moves too. These features have guided exercises with a pillow that would help you enjoy sound sleep. These guided exercises have been approved by sleep and health professionals. You will start experiencing deep sleep, better sleep, and relief from stress and anxiety through this app’s five-day programs.

4. Sleep Sounds

Android rating: 4.6 stars

This app features excellent quality soothing sounds that help you to have better and uninterrupted sleep. You can choose from twelve customizable nature sounds, and select the duration of your timer so that the app automatically turns off after you have slept.

5. Tide

iPhone rating: 4.8 stars

The Tide app helps you fall asleep quickly by giving you several tools like pre-recorded sounds, meditation practices for relaxing your body and mind, breathing exercises, and even timers. This is one of the best digital apps that can help people with insomnia to sleep soundly.

While numerous apps have been developed to aid in the treatment of insomnia, and many have shown promising results, it’s essential to approach digital cognitive behavioral therapy (dCBT) with a balanced perspective. Just as these digital interventions come with their set of benefits, there are potential pitfalls that users and healthcare providers should be aware of. Let’s delve into some of the adverse effects associated with dCBT.

Though digital CBT is usually safe, there might be some adverse effects of the same. Below are some of the adverse effects of digital CBT.

• Using digital cognitive behavioral therapy can delay people with other sleeping disorders (apart from insomnia) from seeking professional care and getting themselves treated.
• Sleep restrictions might increase daytime sleepiness and this might increase your risk of falls, accidents, and seizures. Thus, digital CBT must be used with caution, especially for people with epilepsy, sleep apnea, schizophrenia, and pregnancy.

The wave of digitalization has brought forth numerous tools and platforms that promise better health outcomes. While digital CBT apps can be an invaluable asset, they should ideally serve as a complement to traditional therapy methods rather than a complete replacement. 

• Human Touch Matters: No matter how advanced an app is, it can’t fully replace the nuanced understanding, empathy, and personalized feedback that a trained therapist can offer. Real-time conversations can lead to deeper insights into a patient’s feelings, behaviors, and experiences.
• Tailored Recommendations: Each individual’s insomnia can have distinct triggers and underlying causes. A one-size-fits-all approach might not work for everyone. Direct interactions with healthcare professionals ensure that the treatment is tailored to the individual’s unique needs.
• Safety Nets: In cases where insomnia is a symptom of a deeper psychological or health issue, immediate professional intervention might be required. Personal interactions can help in early identification and addressal of such underlying problems.
• Motivation and Assurance: Engaging in face-to-face therapy can serve as a motivation booster. Knowing there’s someone who understands and is continuously tracking progress can provide the reassurance many need to stay committed to their treatment plan.

While the digital realm offers convenience and accessibility, it’s crucial to strike a balance. For many, a combination of digital aids along with regular check-ins with a healthcare provider might be the most effective route towards managing and eventually overcoming insomnia.

Insomnia, while burdensome, is no longer an unbeatable foe. Digital CBT apps have opened a new frontier in managing this sleep disorder, bringing therapy right to one’s fingertips. They offer promising results, accessibility, and convenience. However, while they’re a boon, remember: 

• Digital Tools are Complementary: Apps should ideally be used in tandem with traditional therapy methods. The human touch, insight, and adaptability a therapist offers are unparalleled.
• Safety First: Always consult with a healthcare professional before starting or changing a treatment approach. It ensures you get care tailored to your needs and safeguards against potential underlying issues.
• Personalize Your Approach: Every individual’s experience with insomnia is unique. While apps are beneficial, find what combination of digital and traditional methods works best for you.

Armed with knowledge, the right tools, and professional guidance, a restful night’s sleep is well within reach.

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