Internet-based therapy shows promise for insomnia

CHICAGO, 07 july 2009 – Sleepless people sometimes use the Internet to get through the night. Now a small study shows promising results for insomniacs with nine weeks of Internet-based therapy.

No human therapist is involved. The Internet software gives advice, even specific bedtimes, based on users' sleep diaries. Patients learn better sleep habits — like avoiding daytime naps — through stories, quizzes and games.

"This is a very interactive, tailored, personalized program," said study co-author Frances Thorndike of the University of Virginia Health System, who helped design the software, called Sleep Healthy Using the Internet, or SHUTi.

Such software could one day be a low-cost alternative for some patients, Thorndike said. And it could be the only non-drug option for people who live in areas without trained specialists, she said.

Prior research has shown face-to-face cognitive behavioral therapy can have long-lasting results for insomniacs without the side effects of medication. The SHUTi program is based on that style of therapy, which helps patients change thinking patterns that contribute to poor sleep.

In the new study, released Monday in Archives of General Psychiatry, the researchers recruited 45 adults with moderate insomnia and randomly assigned 22 of them to try the Internet program.

The group who got the treatment woke up fewer times and spent fewer minutes awake during the night. The control group's scores didn't change. Even after six months, the Internet group's scores remained improved.

The response was "fairly impressive and comparable to what you see with more intensive sorts of interventions," said Jack Edinger, a sleep disorder specialist at Duke University Medical Center in Durham, N.C., who wasn't involved in the study.

Participants were highly educated and had no sleep apnea or psychiatric problems. Testing the approach on a larger, more diverse group could determine which patients benefit most, Edinger said.

Shelby Harris, a sleep specialist at New York's Montefiore Medical Center, said something valuable is lost in an Internet-based approach. A trained therapist can help patients stay motivated and identify anxieties keeping patients awake at night.

"There will certainly be people who prefer the face-to-face contact or do better with that type of therapy," Thorndike said. "This will free up those limited resources for face-to-face therapy for the people who need it, benefit from it or would prefer it."

The study was funded by a grant from the National Institute of Mental Health.