Cognitive Behavioral Therapy Using a Mobile Application Synchronizable With Wearable Devices for Insomnia Treatment: A Pilot Study

Abstract

Study objectives: The use of telemedicine with a mobile application (MA) and a wearable device (WD) for the management of sleep disorders has recently received considerable attention. We designed an MA synchronizable with a WD for insomnia treatment. Our pilot study determined the efficacy of simplified group cognitive behavioral therapy for insomnia (CBT-I) delivered using our MA and assessed participant adherence to and satisfaction with the device.

Methods: The efficacy of the CBT-I using MA (CBT-I-MA) was assessed by comparing sleep variables (sleep efficiency [SE], Insomnia Severity Index [ISI], and Pittsburgh Sleep Quality Inventory [PSQI] scores) before and after a 4-week treatment protocol in 19 patients with insomnia disorder patients. SE was assessed using a sleep diary, actigraphy, and the PSQI.

Results: The intervention significantly improved all three measures of SE (P < .05), and the response rate to treatment was high (94.7%). Total ISI and PSQI scores and sleep latency, as measured by the sleep diary, improved significantly. Participants showed relatively good adherence to our MA, and sleep diary entries were made on 24.3 ± 3.8 of 28 days. Moreover, 94.7% of the participants reported that our MA was effective for treating insomnia.

Conclusions: Our pilot study suggested the clinical usefulness of a CBT-I-MA. We expect that our findings will lead to further development and replication studies of CBT-I-MA.

Keywords: cognitive behavioral therapy; insomnia; mobile application; telemedicine; wearable device.

© 2017 American Academy of Sleep Medicine

Figures

Figure 1. Improvement in sleep efficiency after cognitive behavioral therapy for insomnia using a mobile application.

Data are mean and standard error of the mean. The SE when using the sleep logs and actigraphy is the average values during the first, second, and fourth weeks. PSQI = Pittsburgh Sleep Quality Index, SE = sleep efficiency, W0 = baseline, W1 = week 1, W2 = week 2; W4 = week 4.

Figure 2. Improvement in Insomnia Severity Index and Pittsburgh Sleep Quality Index total score after the intervention.

Data are mean and standard error of the mean. (A) Improvement in ISI total score after the intervention. (B) Improvement in PSQI total score after the intervention. ISI = Insomnia Severity Index, PSQI = Pittsburgh Sleep Quality Index, W0 = baseline, W2 = week 2, W4 = week 4.