In-Person CBT Noninferior to Telemedicine-Delivered Therapy for Insomnia

man who can't sleep
man who can’t sleep
Both in-person and telemedicine-delivered cognitive behavioral therapy are effective treatments for chronic insomnia.

Telemedicine-delivered cognitive behavioral therapy (CBT) is not inferior to face-to-face treatment for chronic insomnia. These findings, from a randomized, controlled, non-inferiority trial were published in Sleep.

Adults with chronic insomnia (n=65) were randomly assigned 1:1 to receive CBT either face-to-face (n=32) or online via the AASM SleepTM platform (n=33). Insomnia was determined using information from a 2-week sleep diary, indicating insomnia symptoms at least 3 nights per week. CBT was delivered in 6 weekly sessions by the same clinician with identical content. Participants were asked to keep a sleep diary and were assessed by both the Insomnia Severity Index (ISI) and daytime functionality measures. A response to treatment was defined as a >7-point change on the ISI scale, and remission was defined as an ISI score of ≤7.

Participants were majority women (n=46) with a mean age of 47.2±16.3 years. At baseline, the treatment groups differed significantly in their marital status (P =.024), employment status (P =.060), and income levels (P =.014).

After adjusting for significant confounders, telemedicine was noninferior to face-to-face CBT (β, 0.54; 95% CI, -1.64 to 2.72). No significant difference was seen at 3 months post-treatment (β, 0.34; 95% CI, -1.83 to 2.53).

Overall, most participants reported a response to treatment at the study conclusion (60.6% telemedicine vs 65.6% face-to-face), which was maintained for 3 months after the treatment ended (57.8% telemedicine vs 62.5% face-to-face). A similar pattern was observed for participants reporting remission at the study end (42.4% telemedicine vs 50.0% face-to-face), which was also maintained for 3 months (42.4% telemedicine vs 46.9% face-to-face).

Daytime functioning measures were significantly improved from baseline after CBT but did not differ between treatment cohorts, specifically the General Fatigue subscale of the Multidimensional Fatigue Inventory (F-value, 53.21; P <.001), the Patient Health Questionnaire 9-item scale (F-value, 68.65; P <.001), the Generalized Anxiety Disorder 7-item scale (F-value, 27.11; P <.001), and the Work and Social Adjustment Scale (F, 32.87; P <.001).

One limitation of this study was the lack of demographic diversity among study participants; however, the study authors asserted that these patients reflect the demographic makeup of people who are seeking care for insomnia.

Investigators concluded that CBT for insomnia among adults was similarly effective whether the therapist met in person or via an online portal. Due to the noninferiority of telemedicine in this setting, the study authors emphasized that online consultations would allow for more access and may be a better delivery method for treatment, but further study of telemedicine is warranted.

Disclosure: One author declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.


Arnedt JT, Conroy DA, Mooney A, Furgal A, Sen A, Eisenberg D. Telemedicine versus face-to-face delivery of cognitive behavioral therapy for insomnia: A randomized controlled non-inferiority trial [published online July 13, 2020]. Sleep. doi: 10.1093/sleep/zsaa136