Effectiveness of internet-based CBT-I for the treatment of chronic subthreshold to moderate insomnia

Wongpitak Theppornpitak; Solaphat Hemrungrojn; Krittapas Thienwiwatnukul; Dittapol Muntham; Naricha Chirakalwasan; Puntarik Srisawart

doi:10.3389/fneur.2023.1180339

Effectiveness of internet-based CBT-I for the treatment of chronic subthreshold to moderate insomnia

Front Neurol. 2023 Jun 2:14:1180339. doi: 10.3389/fneur.2023.1180339. eCollection 2023.

Authors

Wongpitak Theppornpitak¹, Solaphat Hemrungrojn^{2

3}, Krittapas Thienwiwatnukul^{1

2}, Dittapol Muntham^{1

4}, Naricha Chirakalwasan^{1

5}, Puntarik Srisawart^{1

2}

Affiliations

¹ Excellence Center for Sleep Disorders, King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
² Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
³ Cognitive Fitness and Biopsychological Technology Research Unit, Chulalongkorn University, Bangkok, Thailand.
⁴ Section for Mathematics, Faculty of Science and Technology, Rajamangala University of Technology Suvarnabhumi, Phranakhon Si Ayutthaya, Thailand.
⁵ Division of Pulmonary and Critical Care Medicine, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.

Abstract

Study objectives: To study the effectiveness of the first internet-based cognitive behavioral therapy for insomnia (CBT-i) in Thailand, using the Nitra application, for chronic subthreshold to moderate insomnia treatment.

Methods: An interventional study without a control group was conducted between January and June 2022. Participants were adults aged 18 years old and older with subthreshold to moderate severity of chronic insomnia (insomnia severity index (ISI) of 8-21) and had mean sleep efficiency <85% from baseline sleep diaries. Baseline sleep characteristics were obtained from questionnaires and sleep diaries from the Nitra application for 2 weeks. Eligible participants continued using the Nitra application for 4 weeks during the intervention period. Interventions including sleep restriction, stimulus control, cognitive restructuring, relaxation techniques, and sleep hygiene education were implemented via the pre-programmed Nitra application. Post-intervention sleep characteristics were also obtained from questionnaires and sleep diaries from the Nitra application for another 1 week.

Results: A total of 40 participants completed the study. All participants had a baseline sleep efficiency of less than 85% with the majority of the participants having a sleep-onset insomnia problem (98%). For the primary outcome, sleep efficiency was significantly improved after using the Nitra application (p < 0.001). Self-reported total sleep time, sleep onset latency, wake after sleep onset, early morning awakening, ISI, Pittsburgh Sleep Quality Index (PSQI), and average subjective sleep quality were also significantly improved (p < 0.001 for all parameters except p = 0.017 for total sleep time and p = 0.018 for wake after sleep onset). Participants who had a low baseline ISI and went to bed and woke up within 30 minutes of a designated bedtime and wake-up time recommended by the Nitra application for ≥70% of all nights demonstrated an increased chance of achieving normal sleep efficiency after using the Nitra application.

Conclusion: This first internet-based CBT-i in Thailand, using the Nitra application, effectively improved sleep efficiency and other sleep parameters in chronic subthreshold to moderate insomnia.

Keywords: chronic insomnia; chronic subthreshold to moderate insomnia; cognitive-behavioral therapy for insomnia; internet-based CBT-I; sleep diary.