Web-Based Cognitive Behavioral Therapy (CBT) for Insomnia: An Analysis of its Effectiveness and Applicability to the Hospital Setting

Abstract

Background: Insomnia is an underrepresented and growing problem in society. About half of society is affected by sleep disturbances occasionally. Especially hospital employees require further attention due to the increased risk of sleep disturbances. The risk of being affected by poor sleep quality is almost twice as high for nurses working in rotating shifts and almost three times as high in night shift nurses compared to day and evening shift working nurses. As there is a lack of professionals who can treat the increasing number of affected people, web-based Cognitive Behavioral Therapy for insomnia (CBT-I) can provide a feasible and easily available treatment to change sleep behavior. Using a self-induced program, light to severe sleep impairments can be reduced. Aim: The following thesis examines the effectiveness of web-based CBT-I on sleep-related outcomes considering currently available randomized controlled trials. In addition, a SWOT-Analysis assesses the applicability of such web-based CBT-I approaches for the target group of hospital employees. Methods: A systematic literature research was conducted in the databases PubMed, Cochrane Library, Ebsco and Google Scholar as well as a free search in previous articles. Predefined inclusion and exclusion criteria enabled the inclusion of 15 randomized controlled trials (RCT). To assess the applicability for hospital employees, a SWOT-Analysis was executed to consider strengths, weaknesses, opportunities and threats of web-based CBT-I for the target group of hospital personnel. Results: The literature review identifies improvements through web-based CBT-I in outcomes like insomnia severity, sleep efficiency and sleep quality. Other sleep-related outcomes and secondary outcomes reveal inconsistent results. Face-to-face CBT-I shows either equal or higher effectiveness than web-based approaches. Analysis of the applicability to hospital employees identifies requirements for adaptation, as the coverage of a high number of participants, automated reminders and support by the employer. Conclusion: As an overall result, there is a clearly given effectiveness in decreasing the severity of insomnia and increasing sleep efficiency and sleep quality but inconsistent results regarding other outcomes. Web-based CBT-I is applicable to hospital employees with a few adaptations to address this target group. Further research is required to assess the effectiveness of web-based CBT-I for this particular target group.