Digital health for insomnia: Getting involved & the efficacy of such treatments

With a shortage of health professionals trained to provide F2F assistance in the insomnia space, there has been an explosion in the provision of such services over the 'net'. What is being treated and how effective are these services?

Digital CBTi to prevent mental health disorders

Epidemiological estimates suggest that 10% of adults meet the diagnostic criteria for insomnia disorder, about 33 million insomnia sufferers in the US (2020) or 2.6 million in Australia (2023). Despite being the gold standard treatment for insomnia, CBTi is often unavailable to patients seeking treatment. In the past few years, two studies have reported that the provision of CBTi via telemedicine is an effective application [1,2].

While most clinicians reading this article will be interested in the improvements gained in the management of pain and recovery/rehabilitation by using cognitive-behavioural therapy for insomnia (CBTi), it is worth being aware that providing the same program has a strong demonstration of improvement for those with mental health presentations. Large RCTs support digital CBTI as a tool that can be used to prevent the development of depression, anxiety, stress reactions, and suicidal thoughts [3-5].

The benefits of digital CBTi revolve around access and scalability. For example, in my case, from Esperance WA, I can provide a treatment program to anyone with an internet connection. While this sounds like an unlimited pool of clients, practically it means I can assist those in our rural and remote region without them needing to travel 1-2 hours each way to see me F2F. Scalability for me means that I can develop evergreen online training for clinicians, who can undertake this training in their own time, and then start assisting other clients with insomnia-related problems. By up-skilling in the provision of CBTi, you can assist clients with physical or mental conditions and on a greater geographical range.

What to deal with first? Insomnia or Anxiety

In much the same way that pain and insomnia are bidirectional factors, with research tending to indicate that dealing with insomnia is a better first choice, longitudinal studies are pointing to insomnia as being the antecedent factor in the bidirectional relationship between insomnia and anxiety. That is, if you were only able to treat one, you would address their insomnia first.

However, in the clinical world, unlike the research world, we don't need to be so rigid and can provide both insomnia and anxiety-based treatments. Interestingly in the above paper, the authors noted in the Results the following;

Crucially, at the end of treatment, the insomnia treatment was more effective in reducing symptoms of insomnia than the anxiety treatment, and equally effective in reducing symptoms of anxiety.


1. Arnedt JT, et al. . Telemedicine versus face-to-face delivery of cognitive behavioral therapy for insomnia: a randomized controlled noninferiority trial. Sleep. 2021;44. doi:10.1093/sleep/zsaa136.

2. Gehrman P, et al. . Randomized noninferiority trial of telehealth delivery of cognitive behavioral treatment of insomnia compared to in-person care. J Clin Psychiatry. 2021;82:1041–1046. doi:10.1089/tmj.2016.0032.

3. Cheng P, et al. . Depression prevention via digital cognitive behavioral therapy for insomnia: a randomized controlled trial. Sleep. 2019;42(10). doi:10.1093/sleep/zsz150

4. Felder JN, et al. . Randomized controlled trial of digital cognitive behavior therapy for prenatal insomnia symptoms: effects on postpartum insomnia and mental health. Sleep. 2022;45(2). doi:10.1093/sleep/zsab280

5. Kalmbach DA, et al. . Cognitive-behavioral therapy for insomnia prevents and alleviates suicidal ideation: insomnia remission is a suicidolytic mechanism. Sleep. 2022;45(12):zsac251. doi:10.1093/sleep/zsac251