Work

Continuous sleep tracking in digital CBT-I: Efficacy and insights from a naturalistic-environment study

Year: 2025

Type: article

Abstract: Background: Insomnia is highly prevalent, yet few receive cognitive behavioral therapy for insomnia (CBT-I) due to limited treatment availability. Unguided digital CBT-I offers an accessible alternative to traditional face-to-face therapy. Research in this area often relies on either subjective sleep measurements (e.g., sleep diaries) or controlled single-night lab studies. This study examines the effectiveness of a novel app-based CBT-I program combining therapy with continuous subjective and objective sleep tracking via a heart rate (HR) sensor in a naturalistic setting. Methods: Eighty-eight participants (56.8 % female) aged 20-85 years (M = 49.9 ± 13.10) completed an 8-week app-based CBT-I intervention with continuous sleep tracking (sleep diaries and HR sensor), followed by a 2-week follow-up. Assessments at baseline, post-intervention, and follow-up included sleep related problems, psychological strain, quality of life, and dysfunctional beliefs. Results: Insomnia prevalence dropped from 92 % at pre-intervention to 67 % at follow-up. Improvements were observed in subjective sleep quality (p < .001, r = 0.59), dysfunctional beliefs (p < .001, r = 0.48), quality of life (p's < .002, r's > 0.33), psychological strain (p < .001, r = 0.43), depression (p = .010, r = 0.27), and anxiety (p = .003, r = 0.32). While sleep diary data showed improvements in various sleep parameters, objective data revealed statistical trends towards a reduced total sleep time (TST; p = .083, r = 0.19), driven by sleep restriction, and light sleep (p = .089, r = 0.18). Using continuous sleep monitoring we additionally found relevant changes during the intervention levels for subjective wake after sleep onset, sleep efficiency as well as objective TST. Conclusion: Findings support the effectiveness of app-based CBT-I and suggest that continuous objective sleep tracking over weeks can reveal previously undetected sleep and well-being improvements in real-world settings.

Source: International Journal of Clinical and Health Psychology

DOI: 10.1016/j.ijchp.2025.100646

Authors: Alexandra Hinterberger, Esther-Sevil Eigl, Aniko Szeko, Pavlos I Topalidis, Manuel Schabus

Institutions: University of Salzburg, Sigmund Freud Privatuniversität Wien

Language: English

Topic: Sleep and related disorders

Subfield: Experimental and Cognitive Psychology

Field: Psychology

Domain: Social Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $2,970