Online self-help intervention improves acute insomnia severity

1. In patients with acute insomnia, an online behavioral self-help intervention was effective in reducing insomnia severity within one week.

2. Patients with acute insomnia provided with a two-page PDF self-help leaflet reported reduced insomnia severity index (ISI) scores from baseline at one-week, one-month, and three-month follow-up periods.

Evidence Rating Level: 1 (Excellent)

Insomnia is a highly prevalent sleep disorder associated with negative physical and psychological health outcomes. Pharmacological treatments for insomnia such as benzodiazepines are associated with negative side effects. Cognitive behavioral therapy (CBT) is an effective first-line treatment, but limited by a lack of qualified providers. An online self-help leaflet enables large-scale intervention delivery. However, the effectiveness of such an intervention for individuals with acute insomnia is unknown.

This stratified randomized controlled trial tested the effectiveness of a self-help leaflet on insomnia severity. 344 participants entered into the study, including 103 good sleepers and 241 acute insomnia participants as defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Healthy good sleepers were defined as not having any current sleep problems. Individuals were not eligible to participate if they self-reported chronic sleep problems persisting >3 months, actively using another treatment for their sleep disorder, or reported a history of head injury, diagnosis of schizophrenia, epilepsy, or personality disorder. Acute insomnia participants were randomized into an intervention or waitlist group, and good sleepers were randomized into an intervention or no intervention group. Complete baseline ISI data was obtained for 277 participants (82 good sleepers and 195 acute insomnia). The intervention involved a self-help leaflet that explained the principles of stimulus control, cognitive control, and imagery distraction techniques that were broken down into the “three D’s:” Detect, Detach, and Distract. Complete ISI follow-up data was obtained at one week, one month, and three months. The primary outcome measured was ISI scores.

The study showed that acute insomnia participants who received the online self-help intervention had a significantly reduced insomnia severity between baseline and all follow-up time points. Furthermore, the intervention was shown to improve anxiety and depression levels in the short term. No beneficial effects on sleep were recorded in good sleepers. A limitation of the study is the lack of an active control group, which may allow the placebo effect to influence results. Nonetheless, this study still shows promising preliminary results on the effectiveness of an online self-help intervention in rapidly reducing acute insomnia.

Click here to read this study in Sleep.

Image: PD

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