This may initially seem to be counterintuitive given general sleep hygiene recommendations, but randomly generated noise may help drown out other less predictable environmental noises that can disturb sleep. One promising approach has been the introduction of noise into the sleeping environment. It could be that simpler behavior approaches may be effective on a wide scale for people like this who have not developed insomnia disorder. Maybe these people with sleep disturbance could develop insomnia disorder later. However, these digital CBT-I programs were designed for insomnia populations, yet less severe or prodromal sleep disturbance is reported by a large percentage of the population and formalized CBT-I may be therapeutically redundant for these people. This model has proved effective for triaging, delivering, and allocating resources for therapeutic providers.
Collectively, these digital CBT-I programs can be used as the “first step” in the stepped care CBT-I model. There have been a welcome plethora of digital CBT-I randomized controlled trials testing Sleepio and SHUTi but also others demonstrating clinical efficacy. These are probably the most thoroughly tested the digital insomnia therapy programs. These programs use a combination of behavioral and cognitive modules that sequentially delivers therapy over weeks, with a strong similarity to clinician-based therapy. The CBT-I programs Sleepio and SHUTi (now Somryst) were the pioneers in digital therapeutics for the chronic insomnia population. It has been over a decade since Espie first proposed the stepped care model for delivering cognitive behavioral therapy for insomnia (CBT-I) here at SLEEP with the foundational step involving self-administered therapy.
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