O025 Efficacy of digital behavioural therapy for insomnia in older adults: RCT

Introduction Sleep restriction is among the most effective components of cognitive behavioural therapy for insomnia (CBTi), yet its efficacy in older adults remains unclear. We investigated the effects of a digital behavioural therapy for insomnia (dBTi) combined with a sleep tracker, compared to digital sleep education, on insomnia symptoms in older adults. Methods In this single-blind, two-arm randomised controlled trial, participants aged ≥60 years with ISI ≥10 were randomised to dBTi or control. The dBTi group received 3 weeks of app-based sleep restriction therapy (with an optional additional 3 weeks) synchronised with a wearable sleep tracker. The control group completed three bi-weekly online sleep hygiene modules. The primary outcome was ISI at 8 weeks, with follow-up at 16 and 26 weeks. Secondary outcomes included sleep quality, fatigue, sleepiness, and symptoms of anxiety and depression. Results A total of 273 participants were randomised (dBTi: n = 136; control: n = 137) between September 2022 and November 2023 (mean age 67.9 ± 5.6 years; 81.7% female; baseline ISI 17.2 ± 4.4). At 8 weeks, mean ISI scores were significantly lower in the dBTi group vs control (10.5 [9.2–11.9] vs 14.1 [13.1–14.9]; p<.001). Reductions persisted at 16 and 26 weeks (week 26: 8.6 [7.1–10.2] vs 13.7 [12.9–15.4]; p<.001). Secondary outcomes also significantly improved in the dBTi group. Discussions Digital sleep restriction therapy combined with a sleep tracker significantly improved insomnia symptoms in older adults. Digital therapeutics may enhance scalability and accessibility and should be evaluated in future stepped-care models.