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  • Updated 07.14.2023
  • Released 07.14.2023
  • Expires For CME 07.14.2026

Telehealth and cognitive behavioral therapy for insomnia (CBT-I0)



Chronic insomnia is a sleep disorder characterized by a long-term pattern of difficulty with sleep initiation or maintenance and perceived daytime impairment or distress as a result of poor sleep quality. Worldwide estimates suggest that approximately 30% of the population reports one or more symptoms of chronic insomnia (46). Current medical guidelines recommend cognitive-behavioral therapy for insomnia (CBT-I) as a first-line treatment for chronic insomnia based on a strong body of research (11). CBT-I is a multi-component treatment that both addresses psychological, behavioral, and physiological factors that perpetuate insomnia and focuses on establishing more effective patterns of behavior and thinking to optimize sleep quality. Despite being the treatment of choice for chronic insomnia, CBT-I availability is limited due to several barriers. These barriers include the absence of clinicians trained in CBT-I; lack of awareness by clinicians to screen for insomnia or to refer for CBT-I; patient issues, including lack of awareness or engagement; as well as systems issues associated with access and economic burden (ie, locations of clinics, insurance reimbursement, missing work to attend appointments) (30). In addition, integration of mental health services in medical settings, where sleep patients are seen, faces structural and financial barriers that currently limit widespread application of this evidence-based approach. These access barriers are accentuated for minorities and the underserved.

Efforts to overcome such barriers in both medical and mental health settings involve the use of sleep telemedicine. Over the past 2 decades, there has been a growing body of research examining the potential benefits of teletherapy and, specifically, cognitive-behavioral therapy delivered via telehealth (22; 15). The rapid and widespread adoption of telehealth at the beginning of the COVID-19 pandemic has accelerated this research and demonstrated effectiveness as well as patient acceptability (06). These efforts have extended to the treatment of insomnia, and studies have demonstrated the effectiveness of an “ehealth” approach to CBT-I as a patient-centered alternative to face-to-face treatment, with the benefit of being able to reach a larger portion of the patient population that might not otherwise benefit from this treatment.

Key points

• Cognitive-behavioral therapy for insomnia (CBT-I) is a first-line treatment for insomnia.

• Access to personnel trained in CBT-I is limited for several reasons.

• Telehealth offers a promising alternative modality for delivering CBT-I and expanding access.

• CBT-I delivered via telehealth broadly has strong empirical support. Future research is needed to determine how to best triage and personalize these innovative and promising modalities that expand access to care and optimize sleep health.

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