CBT-i Coach: An effective supplementary treatment for insomnia
CBT-i Coach teaches people to recognize how their thoughts and behaviors affect their sleep patterns. App-users are provided with education about how sleep works. They are also guided on how to adjust both their sleep routines and their approach to sleep in order to enhance sleep quality and duration. CBT-i Coach is intended to augment face-to-face care with a healthcare professional.
Sleep problems such as insomnia are a common symptom of many mental illnesses, including anxiety, depression, schizophrenia, bipolar disorder and attention deficit hyperactivity disorder (ADHD). The relationship between insomnia and mental illness is bidirectional: about 50% of adults with insomnia have a mental health problem, while up to 90% of adults with depression experience sleep problems. Post-secondary students are at particular risk for sleep problems as they often have a constantly changing sleep-wake cycle due to classwork, exams, social issues, and environmental factors. The number of university students with insomnia is more than double that of the general population.
The CBT-i Coach app provides:
Psychoeducation: Information regarding the purpose of sleep and stages of sleep provide a helpful review of information that the clinician provides in early sessions. A simple overview of sleep regulation is also included in a way that is relatively simple to understand.
Relaxation skills: This app provides suggestions on how to “wind down” before bed, suggestions to schedule worry time and some light cognitive restructuring techniques. It includes a brief progressive muscle relaxation exercise as well as several guided imagery exercises.
Sleep Diary: This app includes a sleep diary, calculates sleep efficiency and has a handy reminder option to make sure that the user completes the assigned sleep diary task.
Assessment: It allows the user to take the Insomnia Severity Index (ISI), schedule assessments at regular intervals and review ISI scores over time. This app also includes the Sleep Need questionnaire so that the healthcare provider can make better informed decisions about changes in sleep prescription.
Reminders: Many reminders are available including: prescribed bed time, prescribed wake time, assessment reminders and sleep diary data entry. It should also be noted that when total sleep falls below 5 hours, the user is reminded to speak with their provider about improving sleep and getting assistance.
A randomized control trial with the app has shown significantly improved sleep outcomes, and a study using surveys conducted with clinicians trained in CBT for insomnia show a majority of clinicians reported using it with patients and had favorable impressions of its impact on homework adherence and outcomes.
It should be noted that any data logged in the app are only as secure as the phone itself. Use the security features on the device if you are concerned about the privacy of information. Users are free to share data, but as the self-monitoring data belong to each user HIPAA concerns do not apply while the data is stored or shared. If the user were to share data with a healthcare provider, the provider must then comply with HIPAA rules.
CBT-i Coach is based on the therapy manual, Cognitive Behavioral Therapy for Insomnia in Veterans and has been shown to be efficacious for insomnia for both veterans and civilians CBT-i Coach is a collaborative effort between VA’s National Center for PTSD, Stanford School of Medicine, and DoD’s National Center for Telehealth and Technology.
For more information about CBT-i Coach, please visit the U.S. Department of Veterans Affairs website.