title: Internet-Delivered Cognitive Behavioral Therapy to Treat Insomnia: A Systematic Review and Meta-Analysis.
abstract: BACKGROUND
  Insomnia is of major public health importance. While cognitive behavioral therapy is beneficial, in-person treatment is often unavailable. We assessed the effectiveness of internet-delivered cognitive behavioral therapy for insomnia.
  
  
  OBJECTIVE
  The primary objectives were to determine whether online cognitive behavioral therapy for insomnia could improve sleep efficiency and reduce the severity of insomnia in adults. Secondary outcomes included sleep quality, total sleep time, time in bed, sleep onset latency, wake time after sleep onset, and number of nocturnal awakenings.
  
  
  METHODS
  We searched PubMed/MEDLINE, the Cumulative Index to Nursing and Allied Health Literature, PsycInfo, Cochrane Library, Embase, and the Web of Science for randomized trials.
  
  
  METHODS
  Studies were eligible if they were randomized controlled trials in adults that reported application of cognitive behavioral therapy for insomnia via internet delivery. Mean differences in improvement in sleep measures were calculated using the Hartung-Knapp-Sidik-Jonkman method for random effects meta-analysis.
  
  
  RESULTS
  We found 15 trials, all utilizing a pretest-posttest randomized control group design. Sleep efficiency was 72% at baseline and improved by 7.2% (95% CI: 5.1%, 9.3%; p<0.001) with internet-delivered cognitive behavioral therapy versus control. Internet-delivered cognitive behavioral therapy resulted in a decrease in the insomnia severity index by 4.3 points (95% CI: -7.1, -1.5; p = 0.017) compared to control. Total sleep time averaged 5.7 hours at baseline and increased by 20 minutes with internet-delivered therapy versus control (95% CI: 9, 31; p = 0.004). The severity of depression decreased by 2.3 points (95% CI: -2.9, -1.7; p = 0.013) in individuals who received internet-delivered cognitive behavioral therapy compared to control. Improvements in sleep efficiency, the insomnia severity index and depression scores with internet-delivered cognitive behavioral therapy were maintained from 4 to 48 weeks after post-treatment assessment. There were no statistically significant differences between sleep efficiency, total sleep time, and insomnia severity index for internet-delivered versus in-person therapy with a trained therapist.
  
  
  CONCLUSIONS
  In conclusion, internet-delivered cognitive behavioral therapy is effective in improving sleep in adults with insomnia. Efforts should be made to educate the public and expand access to this therapy. Registration Number, Prospero: CRD42015017622.
authors: Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, United States of America.|Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, United States of America.|Robert Wood Johnson Clinical Scholars Program, University of Michigan, Ann Arbor, Michigan, United States of America.
authors: Michael
authors: M
authors: Seyffert
authors: Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, United States of America.|Robert Wood Johnson Clinical Scholars Program, University of Michigan, Ann Arbor, Michigan, United States of America.
authors: Pooja
authors: P
authors: Lagisetty
authors: Robert Wood Johnson Clinical Scholars Program, University of Michigan, Ann Arbor, Michigan, United States of America.
authors: Jessica
authors: J
authors: Landgraf
authors: Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, United States of America.|Veterans Administration Center for Clinical Management Research, Veterans Administration Ann Arbor Healthcare System, Ann Arbor, Michigan, United States of America.
authors: Vineet
authors: V
authors: Chopra
authors: Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, United States of America.|Veterans Administration Center for Clinical Management Research, Veterans Administration Ann Arbor Healthcare System, Ann Arbor, Michigan, United States of America.
authors: Paul N
authors: PN
authors: Pfeiffer
authors: Health Sciences Library, University of Michigan, Ann Arbor, Michigan, United States of America.
authors: Marisa L
authors: ML
authors: Conte
authors: Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, United States of America.
authors: Mary A M
authors: MA
authors: Rogers
mesh_terms: D000328:Adult; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003863:Depression / Q000628:therapy; D005260:Female; D006801:Humans; D020407:Internet; D008297:Male; D016032:Randomized Controlled Trials as Topic; D012044:Regression Analysis; D012890:Sleep; D007319:Sleep Initiation and Maintenance Disorders / Q000628:therapy*; D017216:Telemedicine / Q000379:methods*; D013813:Therapy, Computer-Assisted / Q000379:methods; D016896:Treatment Outcome