It also makes treatment flexible and scalable, as access to the internet and devices are its only limiting factor (and even that may one day be an obsolete consideration). Chiefly, DTx decouple treatment from the requirement to work directly with a mental health care professional. Internet- and smartphone-delivered treatments, termed “digital therapeutics” (DTx), are ideally situated to provide a solution for overcoming the dissemination and access barriers. Therefore, we have an urgent need to raise awareness of CBT-I and develop modes of delivery that are more accessible and easier to disseminate. Involving therapists, however efficiently, is not scalable to meet the volume of need. 6 Although telehealth delivery has been proposed as a solution, trained therapists are still required. This limitation, coupled with other barriers including stigma, a lack of CBT-I awareness among patients and providers, and the perception of insomnia treatment as a low priority, prevents widespread access to this recommended treatment. 12 This problem is magnified internationally, given that 88% of sleep specialists are based in the United States, meaning that most countries do not have any sleep specialists to deliver CBT-I. This is greater than 10 times the number of licensed psychologists in both countries combined. Colleagues once calculated that the required capacity to extend 3 hours of CBT-I to half of the 50 million individuals who use sleep medication in the United States and United Kingdom would be about 2 million clinicians. Unfortunately, the need for CBT-I far exceeds the capacity of our health care systems. 8 As a result, the American Academy of Sleep Medicine, American College of Physicians, British Association for Psychopharmacology, the European Sleep Research Society, and other international bodies recommend CBT-I as first-line therapy for insomnia. 6,7 Importantly, patients prefer CBT-I to medication for the long-term management of their sleep difficulties. 5 Decades of research show that CBT-I is effective in a range of populations, including those with psychiatric and medical comorbidities. Medication is the most widely available treatment, despite CBT-I’s sustained sleep improvements and fewer side effects than pharmacotherapy. 5Ĭognitive behavioral therapy for insomnia (CBT-I see Table) and medication are 2 approaches to insomnia treatment. 2-4 It is not surprising, then, that the burden of insomnia is significant and individuals with insomnia report a lower quality of life than their healthy-sleeping counterparts. 1 Beyond sleep difficulties and associated daytime complaints, individuals with insomnia are at increased risk of developing mental disorders (eg, depression, anxiety, substance use disorders) and physical health conditions (eg, type 2 diabetes, cardiovascular disease, and hypertension). Additionally, approximately 10% of adults meet DSM-5 diagnostic criteria for insomnia disorder, which is characterized by difficulties falling or staying asleep at least 3 days per week for at least 3 months, along with impairment in daytime functioning or well-being. According to some estimates, close to one-third of adults in Western countries regularly experience difficulties with sleep.
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