The Effects of App-Delivered Cognitive Behavioral Therapy for Insomnia (CBT-I) on Sleep Quality, Dysfunctional Beliefs, and Sleep Hygiene

Sleep quality has been well-researched and supported as a predictor of physical and mental health (Ohayon et al., 2017). In 2016, The National Sleep Foundation provided an evidence-based set of recommendations regarding indicators of good sleep quality. Across the 277 studies included in the review, shorter sleep onset latencies, fewer awakenings, and higher sleep efficiency were indicators of good sleep quality across the lifespan (Ohayon et al., 2017). In contrast, poor sleep quality has been linked to a myriad of adverse consequences including increased stress responsivity, cognitive, memory, and performance deficits, impairment in emotion regulation, and increases in negative emotions (Medic et al., 2017; O’Leary et al., 2016). Poor sleep quality is also linked to long-term physical health difficulties including hypertension, cardiovascular disease, and weight-related issues (Medic et al., 2017). There is evidence that sleep disturbances and comorbid psychological and medical diagnoses have a cyclical influence such that sleep problems lead to greater decline in general and psychological health, which in turn worsens sleep problems (Kaplan & Harvey, 2014). Cognitive behavioral therapy for insomnia (CBT-I) is a psychological treatment comprised of sleep hygiene strategies including stimulus control, relaxation, and cognitive restructuring of dysfunctional beliefs about sleep. CBT-I posits that maladaptive beliefs about sleep are critical targets in treatment (Kaplan & Harvey, 2014). A randomized control trial conducted by Eidelman et al. (2016) found that individuals who participated in CBT-I had a significant decrease in dysfunctional beliefs about sleep and had reduced insomnia symptoms and impairment at both post-treatment and follow-up when compared to behavioral or cognitive therapy alone. A meta-analysis conducted by Geiger-Brown et al. (2015) found that CBT-I improved subjective sleep quality post-treatment, reduced sleep onset latency, improved total sleep time, and increased sleep efficiency among those with comorbid diagnoses, and treatment effects were stable at follow-up. ABSTRACT. Sleep quality is correlated with physical and mental health and is an important target for overall well-being. CBT-I is an evidence-based strategy to improve sleep quality; however, shortage of qualified providers; logistical issues such as cost, travel, and time; privacy concerns; and a desire to resolve symptoms on one’s own limit access to CBT-I. Compared to traditional face-to-face or web-based delivery of CBT-I, app-delivered CBT-I may be an efficacious alternative capitalizing on the portability, privacy, and accessibility of mobile phones. The present study examined the effectiveness of the CBT-I Coach for educating participants about the importance of healthy sleep practices and dysfunctional beliefs about sleep and targeted sleep. The use of the CBT-I Coach resulted in significant improvements in sleep quality, dysfunctional beliefs about sleep, sleep hygiene behaviors, and sleep efficiency. This study supports the use of CBT-I Coach as an effective intervention for improving sleep quality.