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Lee M. Ritterband, PhD; Frances P. Thorndike, PhD; Linda A. Gonder-Frederick, PhD; Joshua C. Magee, MA; Elaine T. Bailey, PhD; Drew K. Saylor, BA; Charles M. Morin, PhD

Arch Gen Psychiatry. 2009;66(7):692-698.

Context  Insomnia is a major health problem with significant psychological, health, and economic consequences. However, availability of one of the most effective insomnia treatments, cognitive behavioral therapy, is significantly limited. The Internet may be a key conduit for delivering this intervention.

Objective  To evaluate the efficacy of a structured behavioral Internet intervention for adults with insomnia.

Design, Setting, and Participants  Forty-five adults were randomly assigned to an Internet intervention (n = 22) or wait-list control group (n = 23). Forty-four eligible participants (mean [SD] age, 44.86 [11.03] years; 34 women) who had a history of sleep difficulties longer than 10 years on average (mean [SD], 10.59 [8.89] years) were included in the analyses.

Intervention  The Internet intervention is based on well-established face-to-face cognitive behavioral therapy incorporating the primary components of sleep restriction, stimulus control, sleep hygiene, cognitive restructuring, and relapse prevention.

Main Outcome Measures  The Insomnia Severity Index and daily sleep diary data were used to determine changes in insomnia severity and the main sleep variables, including wake after sleep onset and sleep efficiency.

Results  Intention-to-treat analyses showed that scores on the Insomnia Severity Index significantly improved from 15.73 (95% confidence interval [CI], 14.07 to 17.39) to 6.59 (95% CI, 4.73 to 8.45) for the Internet group but did not change for the control group (16.27 [95% CI, 14.61 to 17.94] to 15.50 [95% CI, 13.64 to 17.36]) (F_1,42 = 29.64; P < .001). The Internet group maintained their gains at the 6-month follow-up. Internet participants also achieved significant decreases in wake after sleep onset (55% [95% CI, 34% to 76%]) and increases in sleep efficiency (16% [95% CI, 9% to 22%]) compared with the nonsignificant control group changes of wake after sleep onset (8% [95% CI, –17% to 33%) and sleep efficiency (3%; 95% CI, –4% to 9%).

Conclusions  Participants who received the Internet intervention for insomnia significantly improved their sleep, whereas the control group did not have a significant change. The Internet appears to have considerable potential in delivering a structured behavioral program for insomnia.

Trial Registration  clinicaltrials.gov Identifier: NCT00328250

Author Affiliations: Behavioral Health and Technology (Drs Ritterband, Thorndike, and Bailey, Mr Magee, and Ms Saylor) and Center for Behavioral Medicine Research (Dr Gonder-Frederick), Department of Psychiatry and Neurobehavioral Sciences, University of Virginia Health System, Charlottesville; and Department of Psychology, Université Laval, Ville de Québec, Québec, Canada (Dr Morin).

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