Effectiveness of Information and Communication Technology-Based Cognitive Behavioral Therapy Using the Smart Sleep App on Insomnia in Older Adults: Randomized Controlled Trial.

Abstract

Background: Insomnia is a common sleep disorder, especially among older adults, with a significant impact on the quality of life (QoL) and is associated with various comorbidities. Traditional pharmacotherapy for insomnia is often unsuitable for older adults because of potential drug interactions and side effects, making nonpharmacological interventions such as cognitive behavioral therapy for insomnia (CBT-I) more appropriate. However, delivering CBT-I in a traditional face-to-face setting poses challenges including accessibility and adherence, particularly for older adults.

Objective: This study aimed to evaluate the effectiveness of an information and communication technology (ICT)-based CBT-I program, "Smart Sleep," specifically designed to improve insomnia among community-dwelling older persons.

Methods: A single-blind randomized controlled trial was conducted with 59 older participants from Incheon, South Korea. Participants were divided into an intervention group, which used the Smart Sleep mobile app, and a control group. The intervention group received 8 weeks of non-face-to-face CBT-I through the app, which included sleep diaries, relaxation exercises, and real-time consultations. Outcomes were measured at baseline, week 4, and week 8, with a focus on insomnia severity, sleep quality, sleep efficiency, dysfunctional beliefs about sleep, depression, and QoL.

Results: The intervention group showed significant improvements in insomnia severity, sleep quality, sleep efficiency, and dysfunctional beliefs about sleep compared to the control group. However, there was no significant difference in the QoL between the 2 groups (F_2,114=0.998, P=.37). Participation rates in the Smart Sleep program were high, with a 94% completion rate for sleep diary tasks and 100% participation in real-time consultations. In addition, subgroup analysis based on sleep medication use showed significant improvements in insomnia severity for both medicated and nonmedicated participants.

Conclusions: The ICT-based CBT-I program "Smart Sleep" effectively improved sleep-related outcomes among older participants, demonstrating the potential of non-face-to-face interventions in managing insomnia in this population. The program is user-friendly, and ICT-based coaching contributed to high engagement. To ensure broader access for older adults, distribution through community welfare or public health centers is recommended.

Trial registration: Clinical Research Information Service KCT0007287; https://cris.nih.go.kr/cris/search/detailSearch.do?seq=23344.