- mHealth therapy can help treat insomnia and mental health disorders arising from sleeplessness, according to a UK-based study.
The study of some 3,755 college students between March 2015 and February 2016, detailed in The Lancet, found that Internet-based cognitive behavioral therapy (CBT) is cheaper and easier to access than traditional, office-based treatment and medication. Clinically, the mHealth platform offered similar results in treating insomnia, paranoia and hallucinations, with small to moderate improvements in conditions like depression and anxiety.
“[T]he evidence on the effectiveness of online CBT to reduce insomnia in students suggests that treatment of insomnia has potential in the improvement of their overall mental health and wellbeing, and online therapy is an effective strategy in reaching wide numbers of participants,” a corresponding editorial written by Tea Lallukka, of the Finnish Institute of Occupational Health, and Borge Sivertson, of the Bergen, Norway-based Uni Research Health’s Regional Centre for Child and Youth Mental Health and Child Welfare concluded.
The study adds to the growing body of research in the US that mHealth and telehealth can be used to analyze and treat sleep disorders – especially those leading to more serious mental health issues, such as in veterans with PTSD.
“It’s an underappreciated topic,” said Kyu Rhee, MD, MPP, chief health officer for IBM’s Watson Health division, which partnered with the American Sleep Apnea Association in 2016 to launch the SleepHealth app and SleepHealth Mobile Study on Apple’s ResearchKit platform. “’How’s your sleep?’ is something that doctors and their patients typically pass over.”
“From restless nights to obstructive sleep apnea (OSA), sleep disorders of varying degrees have become a common occurrence across many patient and consumer populations,” Mark Aloia, MD, senior director of Global Clinical Research for Philips Respironics, said in a 2016 press release highlighting the company’s Dream Family suite of sleep therapy technology solutions, designed to help clinicians collaborate with patients at home, rather than in a clinic or hospital. “With so many options in sleep therapy, technology can now offer solutions to help monitor and support healthy sleep.”
This, actually, was a byproduct of the so-called OASIS study.
Conducted by a team of 42 researchers led by Daniel Freeman, PhD, of Oxford University’s Warneford Hospital and the Oxford Health National Health Service Foundation Trust, the 22-week study targeted students in 26 UK universities. Students with insomnia or certain mental health issues were randomly assigned either typical treatment of mHealth-based CBT treatment.
According to Freeman and his colleagues, the study – thought to be the largest of its kind – “shows very clearly that treatment of insomnia in students leads to a reduction in psychotic experiences.”
As an aside, it offered proof that mHealth therapy can help a population that is often reluctant to seek help.
“The focus on a sleep intervention in a young adult population is important,” the study noted. “Young people with incipient disorders might be very reluctant to seek help for psychiatric problems. Trouble sleeping is a common complaint with little stigma. Hence, it provides a much more acceptable focus for a first step in a care pathway. The digital sleep treatment gave added benefits. Depression in particular, but also anxiety, psychological wellbeing, nightmares, and perceived functioning all improved.”
“Although not the primary objective of the study, the trial does indicate that the provision of Internet-delivered CBT for insomnia to university students is likely to lead to reductions overall in insomnia, and smaller reductions in a number of other mental health symptoms, with benefits for positive psychological wellbeing too,” Freeman and his colleagues concluded.
The study did note one particular drawback common to mHealth programs: Problems with patient engagement.
According to the study, 70 percent of the students using the mHealth platform logged on for at least one session, but that number dropped to 50 percent for at least two sessions, 36 percent for at least three sessions, 26 percent for at least four sessions, 21 percent for at least five sessions and 18 percent for all six sessions.
“Although the dropout in the study was large, it corresponds with an earlier, similar, albeit smaller study,” Lallukka and Sivertsen wrote in their editorial. “In studies in which no direct contact or support are provided by a therapist or group, such as online self-help treatment, high dropout is expected. Moreover, the authors provided compelling analyses assessing the potential effects of dropout and selectiveness, and importantly, outcomes were not associated with” that dropout rate.
Freeman and his colleagues said the research supports the notion that sleep problems lead to mental health issues, and that mHealth and telehealth tools can be brought to bear on the issue.
“[A] gap exists in mental health services regarding intervention for early, relatively non-specific presentations, and proper sleep treatment might provide a sensible first response,” they reported. “Overall, this trial indicates the importance of sleep difficulties for mental health in the general population and the need for a reconsideration in clinical services of the priority given to improving sleep.”