Digital CBT for Insomnia in Healthcare Workers

(HCW-CBTi Trial)

Recruiting at 1 trial location

Overseen By Abdel Basit Al Hawwari, MSN, RN

Age: Any Age

Sex: Any

Trial Phase: Academic

Sponsor: University Health Network, Toronto

Disqualifiers: Sleep apnea, Restless legs, Cancer, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Approved in 3 Jurisdictions This treatment is already approved in other countries

Compensation: Varies

Number of Visits: Unknown

Duration: 12 weeks

366 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial tests a digital therapy program designed to help healthcare workers struggling with sleep due to job stress during the COVID-19 pandemic. The program, called digital Cognitive Behavioral Therapy for insomnia (CBTi), is delivered through an app to improve sleep, mental health, and overall well-being. Participants will either begin the digital therapy immediately or after 12 weeks of using sleep education resources. Healthcare workers involved in frontline patient care who have trouble sleeping and internet access are ideal candidates for the trial. As an unphased trial, this study offers healthcare workers the chance to explore innovative digital solutions for better sleep and well-being.

Will I have to stop taking my current medications?

The trial protocol does not specify whether you need to stop taking your current medications. However, if you are participating in other psychological treatments or drug trials, you would not be eligible for this study.

What prior data suggests that digital CBTi is safe for healthcare workers?

Research has shown that digital Cognitive Behavioral Therapy for Insomnia (dCBTi) is generally safe for most people. Studies have found that dCBTi not only improves sleep but also enhances overall mental health. For instance, users of digital CBT have reported better sleep quality and longer sleep duration.

Importantly, dCBTi is non-invasive, meaning it doesn't involve surgery or medications, which reduces the risk of side effects. Clinical evidence suggests that dCBTi often surpasses medication in treating insomnia, offering long-term benefits with fewer side effects.

In summary, current research supports that dCBTi is well-tolerated, with few reported negative effects. This makes it a safe option for many people seeking to improve their sleep. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about Digital Cognitive Behavioral Therapy for Insomnia (dCBTi) because it offers a modern, accessible approach to managing insomnia, especially for healthcare workers. Unlike traditional therapies that might involve face-to-face sessions or medication, dCBTi leverages the Sleepio™ app and website to deliver therapy through a convenient digital platform. This method allows users to access therapy on their own schedule, making it flexible and potentially more engaging. Moreover, it eliminates the need for medication, reducing the risk of side effects and dependency.

What evidence suggests that digital CBTi is effective for improving sleep health in healthcare workers?

Research has shown that Digital Cognitive Behavioral Therapy for Insomnia (dCBTi) improves sleep. Studies have found that dCBTi can reduce insomnia symptoms and enhance sleep quality for many people. For example, one study discovered that digital therapy effectively treated insomnia without sleep medication. Another study noted that dCBTi was especially beneficial for older adults by making insomnia treatment more accessible. In this trial, participants in the intervention arm will receive dCBTi through the Sleepio™ app, which uses proven CBTi techniques and offers a flexible way to address sleep problems. This approach is a promising option for those struggling with insomnia, such as healthcare workers facing stress from the pandemic. ^{1 6 7 8 9}

Who Is on the Research Team?

Mandeep Singh, MD, FRCPC

Principal Investigator

Associate Professor, Department of Anesthesiology and Pain Medicine, Toronto Western Hospital, UHN

Are You a Good Fit for This Trial?

This trial is for frontline healthcare workers experiencing insomnia, with a score of 16 or lower on the Sleep Condition Indicator. They must be actively involved in patient care during the COVID-19 pandemic and have access to a mobile phone or computer with internet. Those with urgent CBT needs, recent CBT treatment, additional sleep disorders like apnea or restless legs syndrome, severe medical/psychiatric conditions, or participating in other treatments/drug trials are excluded.

Inclusion Criteria

Self-identify as being involved in frontline management of patients

Access to a mobile phone or a computer with Internet access

Health care workers with probable insomnia disorder, as indicated by a score of 16 or lower on the Sleep Condition Indicator (SCI)

Exclusion Criteria

I do not have any life-threatening conditions, severe neurological issues, or severe mental health problems.

My doctor says I urgently need cognitive behavioral therapy.

I have undergone cognitive behavioral therapy in the last 3 months.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants in the intervention arm receive digital CBTi via the Sleepio app over 6 to 12 weeks, while the control group accesses sleep diary and education material for 12 weeks.

12 weeks

Follow-up

Participants are monitored for changes in sleep health, mental health, and overall quality of life after the treatment phase.

12 weeks

What Are the Treatments Tested in This Trial?

Interventions

• Digital Cognitive Behavioral Therapy for Insomnia (dCBTi)

Trial Overview The study tests if digital Cognitive Behavioral Therapy for Insomnia (dCBTi) can improve sleep health, mental well-being, and quality of life among healthcare workers caring for COVID-19 patients. It's a Canada-wide randomized controlled trial comparing dCBTi's effectiveness against usual care practices.

How Is the Trial Designed?

Group I: Attention Control arm Active Control 1 Intervention

Participants in the control group will have access to online the sleep diary and sleep education material for 12 weeks, without the CBTi intervention by the Sleepio™ app (Big Health Ltd., London, UK). They will start the digital cognitive behavioral therapy for insomnia (dCBTi) intervention 12 weeks after the initial enrollment.

Group II: Intervention arm Active Control 1 Intervention

Digital CBTi will be offered using the SleepioTM website and supporting Sleepio™ app (Big Health Ltd., London, UK) via 6 sessions training program (spanning 6 to 12 weeks), lasting an average of 20 minutes each, unlocked weekly. The participant will receive the Sleepio intervention as soon as they become assigned.

Digital Cognitive Behavioral Therapy for Insomnia (dCBTi) is already approved in Canada, United States, European Union for the following indications:

Approved in Canada as Cognitive Behavioral Therapy for Insomnia for:

• Insomnia

Approved in United States as Cognitive Behavioral Therapy for Insomnia for:

• Insomnia

Approved in European Union as Cognitive Behavioral Therapy for Insomnia for:

• Insomnia

Who Is Running the Clinical Trial?

University Health Network, Toronto

Lead Sponsor

Trials

1,555

Recruited

526,000+

Published Research Related to This Trial

Digital cognitive behavioral therapy (dCBT) significantly improves functional health, psychological well-being, and sleep-related quality of life in individuals with insomnia, based on a study of 1711 participants over 24 weeks.

The reduction in insomnia symptoms was a key factor mediating these improvements, highlighting that dCBT effectively addresses both daytime and nighttime issues related to poor sleep.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effect of Digital Cognitive Behavioral Therapy for Insomnia on Health, Psychological Well-being, and Sleep-Related Quality of Life: A Randomized Clinical Trial. Espie, CA., Emsley, R., Kyle, SD., et al.[2023]

Digital cognitive behavioral therapy (dCBT) significantly improves functional health, psychological well-being, and sleep-related quality of life in adults with chronic insomnia, with these benefits sustained up to 48 weeks after treatment.

dCBT also reduces the use of both prescription and non-prescription sleep medications compared to sleep hygiene education, indicating its effectiveness in managing insomnia without relying heavily on medication.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Long-term benefits of digital cognitive behavioural therapy for insomnia: Follow-up report from a randomized clinical trial. Luik, AI., Marsden, A., Emsley, R., et al.[2021]

Digital cognitive behavior therapy for insomnia (dCBT-I) significantly improves sleep quality in patients with insomnia, particularly in those with anxiety disorders, as shown in a study of 6,002 patients over a 12-week period.

Patients receiving dCBT-I monotherapy and those with combined therapy showed notable improvements in sleep quality, with the most significant changes observed in the anxiety group, indicating that dCBT-I is a practical and effective treatment option.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Digital cognitive behavior therapy for insomnia improving sleep quality: a real-world study. Liang, S., Mao, H., Yang, J., et al.[2022]

A smartphone-based, culturally adapted digital cognitive behavioral therapy for insomnia (DCBT-I) significantly reduced insomnia severity compared to sleep education in a randomized trial with 82 participants over 6 weeks.

Participants in the DCBT-I group experienced greater improvements in total sleep time and sleep efficiency at both 3 and 6 months follow-up, indicating its efficacy in enhancing sleep quality.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Digital Cognitive Behavioral Therapy for Insomnia Using a Smartphone Application in China: A Pilot Randomized Clinical Trial. Zhang, C., Liu, Y., Guo, X., et al.[2023]

In a study involving 1720 adults with insomnia, digital cognitive behavioral therapy for insomnia (dCBT-I) significantly reduced intraindividual variability in sleep metrics, particularly in sleep onset latency, which is crucial for improving sleep quality.

The reduction in variability in sleep metrics was found to mediate significant improvements in both insomnia severity and psychological distress, highlighting the effectiveness of dCBT-I as a therapeutic intervention.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The effect of sleep-wake intraindividual variability in digital cognitive behavioral therapy for insomnia: a mediation analysis of a large-scale RCT. Vestergaard, CL., Vedaa, Ø., Simpson, MR., et al.[2021]

Digital cognitive behavioral therapy for chronic insomnia (D-CBT-I) is effective, with 46.4% of 414 participants achieving remission after a 6-week treatment, making it a strong first-line option for chronic insomnia.

Factors such as longer early morning awakening times and higher baseline insomnia severity negatively impacted treatment outcomes, suggesting that patients with milder insomnia and more severe depressive symptoms may benefit more from D-CBT-I.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Factors influencing the effectiveness of digital cognitive behavioural therapy for chronic insomnia in clinical practice. Shi, Y., Ren, R., Zhang, Y., et al.[2023]

Digital cognitive behavioral therapy for insomnia (dCBT-I) was found to be more effective than medication alone in reducing insomnia symptoms, with significant improvements in Pittsburgh Sleep Quality Index scores over 6 months for dCBT-I and combination therapy.

While dCBT-I showed comparable effectiveness to combination therapy, its benefits were less stable over time, indicating that while it is a strong treatment option, further research is needed to understand its long-term reliability in different patient groups.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Comparative Effectiveness of Digital Cognitive Behavioral Therapy vs Medication Therapy Among Patients With Insomnia. Lu, M., Zhang, Y., Zhang, J., et al.[2023]

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC5427093/

Digital Cognitive Behavioral Therapy (dCBT) for Insomnia Consistent evidence has been published on the effectiveness of dCBT to address insomnia disorder, in a variety of populations, with effects extending into well ...

2. sciencedirect.com sciencedirect.com/science/article/pii/S2667343623000069

Effectiveness of digital cognitive-behavioral therapy for ... The findings of this study demonstrate that digital therapy, combined or not with sleep medication, is effective for the treatment of insomnia. Our findings ...

3. humanfactors.jmir.org humanfactors.jmir.org/2025/1/e70193

Innovative Digital Cognitive Behavioral Treatment for ... Methods: The program was constructed based on validated CBT-i theory and practice, incorporating the latest scientific data on CBT for insomnia.

4. jamanetwork.com jamanetwork.com/journals/jamainternalmedicine/fullarticle/2823423

Nurse-Supported Self-Directed Cognitive Behavioral ... This randomized clinical trial examines the effectiveness of a nurse-supported, self-directed behavioral insomnia intervention for ...

5. nature.com nature.com/articles/s41746-025-01847-0

A randomized controlled trial of a digital cognitive ... Results indicate that digital CBT-I provides important benefits for older adults, offering strong potential to expand access to insomnia ...

6. mental.jmir.org mental.jmir.org/2024/1/e51716

Assessing the Short-Term Efficacy of Digital Cognitive ... This study examines whether adding chatbot-based and human coaching would improve the treatment efficacy of, and adherence to, dCBTi.

7. jamanetwork.com jamanetwork.com/journals/jamanetworkopen/fullarticle/2803668

Digital Cognitive Behavioral Therapy vs Medication ... In this study, clinical evidence suggested that combination therapy was optimal, and dCBT-I was more effective than medication therapy, with long-term benefits ...

8. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC11596998/

Digital cognitive behavioural therapy for insomnia reduces ... The existing literature indicates that digital CBT and CBT‐I can improve clinical outcomes in mental health in general as well as in insomnia disorder, ...

9. sciencedirect.com sciencedirect.com/science/article/pii/S2590142725000205

Internet-delivered Cognitive Behavioral Therapy for Insomnia confirmed that eCBT-I significantly improves insomnia severity, sleep efficiency, sleep quality, latency, and total sleep time, achieving ...