Sachin Shah, MD, MS; Sharon Schutte-Rodin, MD, DABSM, FAASM; Shalini Paruthi, M.D.; Ambrose Chiang, MD, FAASM; Makayla Cordoza, PhD, RN, CCRN-K; Kevin Gipson, MD; Evin Jerkins, DO; Eric J. Olson, MD on behalf of the AASM Emerging Technology Committee

The AASM recommends clinicians use cognitive behavioral therapy for insomnia (CBT-I) as first-line treatment for chronic insomnia in adults.1 While CBT-I delivery can vary by type, both individual/group on-site delivery and telehealth CBT-I have shown greater therapeutic effects than guided and unguided internet CBT-I.2 When CBT-I access at sleep centers is limited (e.g., no on-site or local CBT-I resource, extended wait list), administration of digital CBT-I (dCBT-I) through websites and downloadable applications (apps) followed by therapist-delivered CBT-I is suggested.3,4 This article aims to provide AASM members (1) a better understanding of the currently available dCBT-I technologies, and (2) familiarity with online insomnia programs to possibly discuss with patients.

Evidence-based, comprehensive dCBT-I programs employ combinations of sleep hygiene, sleep restriction, stimulus control, relaxation therapy/mindfulness, and cognitive therapy over several weeks. There are three main platform modalities: (1) self-guided platforms with unrestricted access to app features that may or may not provide guidance or recommendations of a course plan; (2) automated guidance platforms that unlock app features as milestones are achieved at a pre-set pace (AI may be used to tailor recommendations); (3) auxiliary platforms designed to be used in conjunction with sleep providers or therapists at their discretion, and may allow for a level of self-guidance. Table 1 highlights the components employed by various dCBT-I platforms, their duration, and how these subjects are taught.5

Limitations that providers should be familiar with include that nearly all current dCBT-I are in English and exclude: (1) children (except Night Owl and Sleep Easy); (2) patients with moderate to severe depression, bipolar disease, schizophrenia or who are pregnant (except Sleepio); (3) shift workers. Data privacy also varies among platforms. Platforms may/may not collect individual user data to tailor components of CBT-I, cross-sell internally, or be sold to other third parties.

When evaluating sleep technologies, clinicians should be aware that product claims may overstate evidence-based clinical outcomes for that specific product.5 Other than Somryst (formerly SHUTi) and Sleepio, most dCBT-I have few or no published studies, and only Somryst is currently FDA-cleared for dCBT-I. Somryst requires a physician prescription for access, and Sleepio is only available in the U.K. and select organizations.

Lastly, individual or combination components of dCBT-I treatments are marketed directly to consumers. These include relaxation apps and devices, interactive mindfulness activities via websites or apps, or sleep enhancers such as wearables and nearables. Some offer shorter, condensed brief behavioral therapy (BBT) and Acceptance and Commitment Therapy (ACT) options. Several non-specific anxiety and stress reducing online programs and apps (e.g., Headspace and Calm) claim to treat or improve insomnia. Several wearable devices (e.g., headbands, watches, rings) and nearables (e.g., light adjusting) provide consumers with sleep feedback, allowing patients to possibly improve their sleep-related behaviors. (Table 2).5 A select few dCBT-I work only in conjunction with devices, and some are simply devices that claim to improve sleep without employing dCBT-I methods.

In sum, dCBT-I can be a valuable supplementary resource when traditional CBT-I is unavailable. Additionally, consumers have access to a vast array of apps and devices purported to improve insomnia. Some of these are offered as independent self-help resources, while others are professionally or AI/ML guided, or offered as a hybrid support model. If used clinically, clinicians should familiarize themselves with costs, reimbursement, workflow integration, data access, security, and privacy policies. Providers should be cognizant of the ever evolving dCBT-I landscape as more research focusing on various patient populations, increasing patient adherence, tailoring treatments, and improving response rates is done.6 More detailed insomnia technology reviews can be found at #SleepTechnology, an online AASM member resource.5

Table 1: Examples of Digital CBT-I Platforms and Key Characteristics (Currently posted in #SleepTechnology)

Platform Operating
Type Duration
Validation RCT# CBT-I Components Media
A Mindful Way Web App Automated 6 1 SR, RT/M, CT Text, Video, Audio Guided RT/M
CBT I Coach iOS/Android Auxiliary, Self-Guided N/A 3 SH, SC, SR, CT, RT/M, PR Text, Audio, Guided RT/M
Full Sleep iOS/Android Auxiliary 6 0 SC, RT/M Text, Interactive Texting, Audio Guided RT/M
Go! To Sleep Web App Automated 6 3 SH, SC, SR, RT/M, CT, PR Text, Audio, Guided RT/M
Mayo Clinic Insomnia Web App Self-Guided 5 0 SH, SC, SR, RT/M, PR Text
Night Owl Sleep Coach iOS/Android Self-Guided 8 0 Unclear Text, Video
Pocket Kado iOS/Android Self-Guided Unclear 0 Unclear Interactive Game
Sleep Easy iOS/Android Unclear 6 1 SH, SC, CT, RT/M Text, Audio Guided RT/M
Sleepio iOS/Android Web App Automated 6 12 SH, SC, SR, RT/M, CT, PR Text, Video, Quizzes, Audio Guided RT/M
Sleep Reset iOS/Android Auxiliary 8 0 SH, SC, SR, RT/M, CT Text, Interactive Texting
Sleep School iOS/Android Web App Self-Guided Auxiliary 1-5 (Unclear) 0 ACT Audio, Video
Somnio Web App Auxiliary 8 2 SH, SC, SR, RT/M, CT Text, Video, Interactive Video
Somnus Unclear Self-Guided Unclear 0 SH, SC, SR, RT/M, CT, ACT Audio
Somryst iOS/Android Web App Automated 9 15 SH, SC, SR, CT Text, Video, Quizzes
Stellar Sleep iOS/Android Automated 2-12 (Unclear) 0 SH, SC, SR, RT/M, CT, paradoxical intention Text, Audio, Guided RT/M
VA SleepEZ Web App Self-Guided 4-6 0 SH, SC, SR, RT/M, PR Text, Video

Table Key: RCT= Randomized Control Trial, SH= sleep hygiene, SC= stimulus control, SR=sleep restriction, RT/M= relaxation therapy/mindfulness, CT= Cognitive Therapy, PR=preventing relapse, ACT= Acceptance and Commitment Therapy. # Only randomized, multi-arm RCTs were included. Note: The authors have no affiliations with these technologies.

Table 2: Other Sleep Facilitation Apps and Devices (Currently Posted in #SleepTechnology)

Type of Apps or Device
Relaxation Calm, Digipill, Dodow, Headspace, Moshi Twilight, Napflix, Pzizz, Sleep Genius, Sleepa, Sleepiest, Sleepzy, Slumber
Light Adjusting Apple Nightshift, Ayo Glasses, EyeJust, Luminette, Ocushield, ReTimer
Sleep Facilitation- Related Wearables & Nearables 2Breathe, Apollo Neuro, AlphaStim, BedJet, ChiliPAD, CES, Dawn House Bed, Dream Light Pro, DreamPad, Dreem 2 and 3, EBB Cool Drift, Homni and Terrailon Nearables, iSense SmartSleep Pillow, Ivy Kokoon Sleep Headphones, Modius (Shalini), Muse S, Nest Hub, Philips SmartSleep Deep Sleep Headband, Philips Smart Sleep and Wake up Light, Remee, Sleep as Android, Sleep Number 360 Smart Bed, Sleep Number Bed with Sleep IQ, Sleep Robot, SleepScore Max, SNOO Smart Sleeper, Somnee Headband, Somnofy, Somnox, Thim, Welt-I

Note: The authors have no affiliations with these technologies.

This article appeared in volume nine, issue one of Montage magazine.


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