Digital therapy for insomnia shows how technology can be harnessed to improve sleep and mental health

Technology and screens are supposedly the enemy of health. They ruin our sleep, mental health and we're slaves to their constant need for attention. At least that's what seems to be the consensus in the news. However, the reality is much more two-sided. In fact, a new study demonstrates that our blue light emitting devices can be a force for good — by providing a novel way to deliver mental health interventions.

Problems with sleep, such as insomnia, have been shown to be associated with mental health difficulties such as depression. Although long recognised as a symptom of depression, there is growing recognition that sleep problems can also emerge before episodes of depression, but it's currently unclear whether improving sleep is protective against developing depression later on.

A recent clinical trial in Sleep by Philip Cheng and colleagues at Henry Ford Health System and the University of Oxford explored just this. They looked at whether using an established digital intervention for insomnia would not only reduce depressive symptoms but also reduce the risk of someone developing depression.

The researchers recruited individuals with insomnia and gave them one of two interventions. One group received a digital version of cognitive behavioural therapy for insomnia (dCBTi) that has already been shown to be effective in improving sleep. Specifically, dCBTi involves teaching patients techniques to positively change behaviours (e.g. avoiding naps) and thoughts (e.g. avoiding effortful attempts to sleep) to break the cycle of poor sleep. Participants had access to online modules covering these techniques for 12 weeks during which their progress was guided by a fully automated "virtual therapist". By contrast, a control group were simply given access to online sleep education including information on good sleep hygiene (e.g. how to create a bedroom optimised for sleep) and the effects of poor sleep on health via weekly emails.

A year later, the team found that those in the dCBTi group reported reduced depressive symptoms, and had a greater chance of showing remission of pre-existing depression, compared to the control group. Importantly, they also found that those who had minimal to no depressive symptoms at baseline were 50% less likely to develop depression at follow-up if they received dCBTi. Participants whose insomnia improved were most likely to show this protective effect, suggesting that improving sleep can reduce the number of people who go to experience depressive symptoms.

This isn't the first study to highlight the importance of early intervention in sleep disturbances for mental health. A study conducted in 2018 showed that improving insomnia symptoms in an otherwise healthy student population was able to reduce the symptoms of depression, anxiety and psychosis.

Digital interventions are a growing area in mental health as a way to monitor and treat symptoms and to identify triggers for relapses. Such research not only supports the role of technology in mental healthcare but also supports its use to easily and effectively help reduce sleep disturbances like insomnia.

However, one of the big issues with digital interventions is ensuring individuals complete the course. The number of people dropping out of such interventions is notoriously high. For example, in Cheng and colleagues' study under half of those randomised to the digital intervention for sleep completed the course and many did not even complete the first session. A therapy, no matter how effective, is only useful if people engage in it. This is a clear hurdle that researchers need to tackle in order to fully realise what technology has to offer.

Nonetheless, it's encouraging to see that treating sleep can help reduce the risk that some people will develop depression. Given the poor state of the nation's sleep, it's perhaps something we can all be mindful of. Despite the broad-brush that screen-use and technology are smeared with when it comes to our sleep and health, it looks as they may not be the enemy. Well, as long as we don't keep refreshing Twitter before bed anyway…

Further reading

– Depression prevention via digital cognitive behavioral therapy for insomnia: a randomized controlled trial

About the author

Post written by Dr Jack Barton (@Jack_bartonUK) for BPS Research Digest. Jack is a freelance science writer based in Manchester, UK, whose research focuses on understanding the link between sleep and mental health.