Integrating digital behavioural therapy for insomnia into primary care: A feasibility mixed-methods study

Christopher J Gordon; Janet M Y Cheung; Zoe Menzel Schrire; Matthew Rahimi; Melissa Aji; Helena Salomon; Iliana Doggett; Nick Glozier; Keith K H Wong; Nathaniel S Marshall; Delwyn J Bartlett; Ron R Grunstein

doi:10.1111/jsr.14401

Integrating digital behavioural therapy for insomnia into primary care: A feasibility mixed-methods study

J Sleep Res. 2024 Nov 12:e14401. doi: 10.1111/jsr.14401. Online ahead of print.

Authors

Christopher J Gordon^{1

2}, Janet M Y Cheung³, Zoe Menzel Schrire⁴, Matthew Rahimi², Melissa Aji^{2

5}, Helena Salomon², Iliana Doggett², Nick Glozier⁶, Keith K H Wong^{2

6}, Nathaniel S Marshall^{1

2}, Delwyn J Bartlett², Ron R Grunstein^{2

7}

Affiliations

¹ Department of Health Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia.
² CIRUS Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Sydney, New South Wales, Australia.
³ School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.
⁴ Healthy Brain Ageing Program, School of Psychology, The University of Sydney, Sydney, New South Wales, Australia.
⁵ Black Dog Institute, University of New South Wales, Sydney, New South Wales, Australia.
⁶ Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.
⁷ Macquarie Medical School, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia.

PMID: 39533507
DOI: 10.1111/jsr.14401

Abstract

Digital cognitive behavioural therapy for insomnia has been developed to increase capacity and scalability for patients with insomnia, but implementation in primary care remains limited. The aim of the trial was to evaluate the implementation of digital insomnia therapy into primary care practice for patients with insomnia. We conducted a single-arm feasibility trial of digital behavioural therapy for insomnia (SleepFix) providing sleep restriction therapy with insomnia patients in primary care. Healthcare professionals (comprising General Practitioners, community pharmacists and nurses) were enrolled into the trial and, when deemed clinically appropriate, prescribed SleepFix to patients with insomnia. The primary outcome was uptake assessed by the number of downloads of SleepFix. Interviews with primary care healthcare professionals explored their attitudes towards implementing/using insomnia digital therapeutics in clinical practice, and patients about their experiences with SleepFix. Insomnia symptoms, mood and sleep quality were measured before and after the trial. This trial was prospectively registered (ACTRN12620000055909). Thirty healthcare professionals and 105 patients were enrolled into the trial. Fourteen healthcare professionals administered at least one insomnia digital therapeutic prescription between November 2021 and March 2022. Fifty patients downloaded and used SleepFix (47.6% uptake). In post-trial interviews, healthcare professionals felt they could incorporate digital sleep health into clinical practice and patients found SleepFix acceptable. There were significant improvements in insomnia symptoms, mood and sleep quality at week 6 (all p < 0.05). This trial shows a real-world implementation of a digital insomnia therapy into primary care that could provide a framework for prescribing digital sleep interventions.

Keywords: Insomnia Severity Index; brief behavioural intervention; qualitative research.

Grants and funding

Department of Health and Aged Care, Australian Government, MRFF Rapid Applied Research Translation Grant