Summary: Digital sleep therapy can effectively treat insomnia and reduce reliance on sleeping pills.
Source: NTNU
About half a million Norwegians live with chronic sleep problems, commonly known as insomnia. Cognitive behavioural therapy for insomnia (CBT‑I) is the most well-documented, non-pharmacological treatment, but access to trained therapists is limited. A fully automated, digital version of CBT‑I offers a scalable option that appears effective for many people and can help reduce the use of sleeping medication.
A recent large-scale study published in The Lancet Digital Health evaluated a fully automated digital cognitive behavioural therapy program for insomnia (dCBT‑I). The study demonstrates that evidence-based psychological treatment delivered online can substantially improve sleep for many adults without face-to-face contact with health professionals.
“Our results show that it’s possible to provide very effective and drug-free sleep treatment on a large scale. This can be done without meeting with health personnel,” says clinical psychologist Håvard Kallestad, a researcher at St. Olav’s Hospital and the Norwegian University of Science and Technology (NTNU).
The digital program helps users identify the behavioral and cognitive factors that maintain insomnia. It addresses problematic sleep patterns, stressors, and other contributors to poor sleep, and includes sleep diaries that give patients insight into their sleep–wake patterns and progress.
The randomized controlled trial enrolled 1,721 Norwegian adults with insomnia symptoms. Participants were allocated either to the automated dCBT‑I program or to an online patient education control that provided good sleep advice and information about sleep problems. The intervention and assessments were delivered through a publicly accessible website with automated screening, informed consent, randomisation, and follow-up procedures, so participants had no direct contact with the research team during the intervention.
Results showed a clear advantage for the digital sleep therapy. Approximately 58 percent of participants who received dCBT‑I reported substantial improvement, compared with about 20 percent in the control group. After completing the program, 38 percent of the dCBT‑I group achieved scores consistent with normal sleep quality, versus 8 percent in the information-only group. The digital treatment also produced a larger average reduction in Insomnia Severity Index (ISI) scores than patient education.
“We also found that the participants who received digital sleep treatment were able to reduce their use of sleeping pills more than participants who only received sleep advice,” says Kallestad.
The therapy is fully automated and typically takes about six to eight weeks to complete. That means individuals can access evidence-based CBT‑I without scheduling clinical appointments, which improves accessibility and could ease pressure on health services. The program used in the trial was initially developed at the University of Virginia and adapted for the study.
The trial applied recommended outcome measures for insomnia and included intention-to-treat analyses. At the nine-week follow-up, participants in the dCBT‑I group showed a significantly greater reduction in insomnia severity than those who received patient education. No adverse events were reported to the trial team.
Study context and implications: This research supports the broader dissemination of digital CBT‑I as an effective, scalable, and drug-free treatment option for insomnia. It highlights the potential for automated online therapy to reach large populations and reduce reliance on sleeping medication. Future work will seek to identify which patients benefit most and how to further refine targeting and engagement.
Funding: The study was a collaboration between the Norwegian Institute of Public Health, NTNU, and St. Olav’s Hospital, and was funded by the Research Council of Norway and the Liaison Committee for Education, Research and Innovation in Central Norway.
First authorship was shared by Øystein Vedaa (Norwegian Institute of Public Health and NTNU) and Håvard Kallestad. Børge Sivertsen (Norwegian Institute of Public Health and NTNU) was the senior author.
Source:
NTNU
Contacts:
Håvard Kallestad – NTNU
Image Source:
The image is in the public domain.
Original Research (open access):
“Effects of digital cognitive behavioural therapy for insomnia on insomnia severity: a large-scale randomised controlled trial” by Øystein Vedaa, Håvard Kallestad, Jan Scott, Otto R.F. Smith, Ståle Pallesen, Gunnar Morken, Knut Langarud, Philip Gehrman, Frances P. Thorndike, Lee M. Ritterband, Allison G. Harvey, Tore Stiles, Børge Sivertsen. Lancet Digital Health. DOI: 10.1016/S2589-7500(20)30135-7
Abstract
Effects of digital cognitive behavioural therapy for insomnia on insomnia severity: a large-scale randomised controlled trial
Background
Several large trials have shown the potential of digital CBT‑I, but broader validation using recommended insomnia outcomes is needed. This study evaluated a fully automated dCBT‑I program for its effects on insomnia severity, sleep–wake patterns, sleep medication use, and daytime impairment.
Methods
A parallel-group superiority randomized controlled trial compared dCBT‑I with online patient education. Interventions were delivered via a free public website that handled screening, consent, randomisation, and outcome collection. Adults aged 18 or older with regular internet access and an Insomnia Severity Index (ISI) score of 12 or higher were eligible. Participants were randomised 1:1 to either dCBT‑I (six core interactive sessions to be completed over nine weeks) or patient education. Participants were masked to group assignment and had no contact with researchers during the intervention period. The primary outcome was change in ISI score from baseline to nine-week follow-up in the intention-to-treat population.
Findings
Between February 2016 and July 2018, 1,721 participants were randomised (868 to dCBT‑I and 853 to patient education). At nine-week follow-up, ISI completion rates were 67% in the dCBT‑I group and 63% in the patient education group. Participants receiving dCBT‑I showed a significantly larger reduction in ISI scores compared with the control group. The number needed to treat was favourable for both treatment response and remission outcomes. No adverse events were reported.
Interpretation
Fully automated digital CBT‑I effectively reduces the severity of insomnia symptoms and supports the wider dissemination of this evidence-based, accessible, and non-pharmacological treatment. Further research should identify moderators of response to improve targeting and impact.
Funding
Norwegian Research Council; Liaison Committee for Education, Research and Innovation in Central Norway.