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Comparing the Efficacy of Telemedicine to In-Person Treatment for Insomnia: A Closer Look at Cognitive Behavioral Therapy

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Exploring the Effectiveness of Telemedicine in Cognitive Behavioral Therapy for Insomnia


Chronic insomnia affects a significant portion of the US population, with approximately 10% to 15% of adults experiencing dissatisfaction with sleep quality or duration. Cognitive behavioral therapy for insomnia (CBTi) is recognized as the first-line treatment for addressing this condition. Often misunderstood as talk therapy or sleep hygiene, CBTi combines behavioral and cognitive therapy techniques to effectively manage insomnia. Unlike common internet advice or suggestions from friends and family, CBTi delves deeper into behavioral components such as reducing total time spent in bed, adhering to consistent sleep and wake times, and getting out of bed when unable to sleep. It may also incorporate relaxation strategies and mindfulness techniques.

The Challenge of Accessing CBTi Treatment

While research has established the efficacy of CBTi and medical guidelines recommend it as the primary treatment, access to specialty-trained clinicians offering this therapy remains limited. Moreover, self-guided approaches, including the use of books, have proven to be less effective. Traditionally, CBTi has been delivered in person. However, with the widespread adoption of telemedicine during the global pandemic, remote delivery of CBTi has become increasingly common.

Investigating the Effectiveness of Telemedicine in CBTi

To evaluate whether telemedicine is as effective as in-person treatment for insomnia patients, Dr. J. Todd Arnedt and his team conducted a recent study at the University of Michigan. The study involved 65 adults with chronic insomnia who were randomly assigned to receive six individual sessions of CBTi either in person or via telemedicine. The main objective was to determine if telemedicine-delivered CBTi could reduce the severity of insomnia symptoms to a similar extent as in-person treatment. The researchers also assessed additional factors such as daytime functioning and patient satisfaction with the respective treatments.

The Results

At two different time points—immediately after completing CBTi and three months later—the study found that the effectiveness of telemedicine-delivered CBTi was not inferior to in-person treatment. In simpler terms, the telemedicine group demonstrated comparable improvements to the in-person group. Furthermore, telemedicine did not produce inferior outcomes in terms of response rates, daytime functioning, and patient satisfaction.

Implications and Benefits

These findings provide crucial evidence supporting the efficacy of CBTi delivered via telemedicine. It indicates that the expected response to this treatment approach is not diminished compared to in-person therapy. Particularly during the ongoing pandemic, the rapid adoption of telemedicine has greatly improved accessibility to CBTi for more patients. By eliminating the need for travel and reducing the geographic distance between practitioners and patients, remote CBTi offers a dependable and accessible solution for managing insomnia.

Remaining Challenges and Recommendations

However, certain barriers continue to hinder access for some patients. Individuals without internet access or smartphones may struggle to attend video-based appointments, limiting their options to telephone-based CBTi. Uncertainties regarding insurance coverage for telephone visits may further restrict CBTi accessibility. Additionally, CBTi is not universally covered by health insurance plans, and its availability predominantly relies on English-speaking practitioners.

Resources for CBTi Providers and Patients

For healthcare providers and individuals seeking CBTi resources, the following options are available:

- Find a CBTi provider
- Locate a sleep medicine physician or center
- Cleveland Clinic CBTi app
- Somryst, the first FDA-approved digital therapeutic for insomnia

William H. McDaniel, MD

Dr. Robert H. Shmerling is the former clinical chief of the division of rheumatology at Beth Israel Deaconess Medical Center (BIDMC), and is a current member of the corresponding faculty in medicine at Harvard Medical School.

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