Digital Cognitive Behavioral Therapy for Insomnia Improves Pain-Related Functioning

In individuals diagnosed with insomnia disorder, digital cognitive-behavioral therapy for insomnia (dCBT-I) leads to significant improvements in pain-related functioning, according to findings published in Behavioral Sleep Medicine.

Researchers conducted a secondary analysis of data from 2 randomized controlled trials to evaluate whether treating insomnia with a digital CBT-I program could reduce or prevent pain interference (the extent to which pain disrupts daily activities).

Participants were randomly assigned to receive either dCBT-I through Sleepio, a fully automated digital platform, or an online sleep education program. The analysis included a total of 1320 adults meeting DSM-5 criteria for insomnia disorder, with 697 assigned to the dCBT-I group and 623 to sleep education.

Baseline characteristics were comparable between groups. The mean age for both groups was 51 years of age, with women making up the majority of participants (75%). At baseline, 25.9% of participants reported moderate-to-severe pain interference.

Primary outcomes included:

1) Whether reductions in insomnia severity through dCBT-I would result in reduced pain interference among patients with moderate-to-severe symptoms at baseline, and

2) Whether dCBT-I would prevent the development of clinically significant pain interference in those with minimal symptoms at baseline. Pain interference was measured using the Bodily Pain subscale of the 12-Item Short Form Health Survey, while insomnia severity was evaluated with the Insomnia Severity Index (ISI).

Compared with the control group, participants with moderate-to-severe baseline pain interference demonstrated a 17% increase in odds of reduced pain interference in the dCBT-I group with each 1-point reduction in ISI score (odds ratio [OR], 1.17; 95% CI, 1.01-1.35; P =.036). A post-hoc analysis identified a 7-point ISI reduction as the threshold most predictive of clinically meaningful change.

Compared with the control group, participants with little-to-no pain interference at baseline (n=977) receiving dCBT-I had a 32% lower risk of progressing to moderate-to-severe interference (OR, 0.68; 95% CI, 0.51-0.90; P =.008). The number needed to treat to prevent 1 case of functional pain interference was calculated as 14.

“Given its expandability, dCBT-I could be a valuable intervention for providers treating pain conditions, especially those without readily available behavioral sleep clinicians,” the study authors concluded.

Study limitations include its secondary analysis design, lack of recruitment based on pain as a primary complaint, use of a single-item measure for pain interference, and lack of differentiation between acute and chronic pain states.

One study author declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.

This article originally appeared on Psychiatry Advisor