CATEGORY: SLEEP & RECOVERY
A self-guided online program teaching cognitive behavioral therapy for insomnia left 40 to 51% of older adults free of clinically significant insomnia a full year later, compared with 16% of those given online sleep education, in a randomized trial of 311 adults aged 55 to 95 published in npj Digital Medicine.1 The program ran just nine weeks, required no therapist, and its benefits were still growing at the one-year mark.
Three Groups, Nine Weeks, a Year of Follow-Up
Participants—all with insomnia, averaging about 66 years old—were assigned by chance to one of three groups, which is what lets a trial like this say the program itself made the difference. One group used SHUTi OASIS, an internet program built specifically for older adults; a second used the same program with brief human support added only when someone fell behind; a third received online patient education about sleep. Insomnia was measured with the Insomnia Severity Index, a seven-question survey scored 0 to 28, at the end of the nine weeks and again six and twelve months later. A score under 8 counts as no clinically significant insomnia—the trial’s definition of remission. The study was funded by the National Institute on Aging; several authors report equity in the company that licenses the program, a disclosure the paper carries in full.
Remission for Four to Five in Ten, Versus Fewer Than Two in Ten
At the one-year mark, 34 of 85 people (40%) in the program-only group and 40 of 79 (51%) in the program-plus-support group scored in remission, against 13 of 83 (16%) in the education group. Treatment response—a drop of more than 7 points on the insomnia scale—showed the same spread: 40% and 49% versus 18%. Picture a room of 100 longtime poor sleepers: after the online program, roughly 40 to 51 of them no longer qualify as having insomnia at all a year later; with education alone, about 16 do. The program groups also fell asleep faster, woke less during the night, and reported less fatigue across most checkpoints.
Rebuilding the Bed-Sleep Connection
Cognitive behavioral therapy for insomnia, or CBT-I, is a short, structured approach that treats chronic sleeplessness as a set of learned habits and thought patterns rather than a chemical shortage. In the trial, participants kept sleep diaries, matched their time in bed to the sleep they were actually getting, got up when wide awake rather than lying there, and worked on the racing 3 a.m. thoughts that keep wakefulness going. For many people with chronic insomnia, the bed itself has become a cue for alertness and worry—much as a kitchen can trigger hunger—and the program’s methods steadily rebuild it as a cue for sleep. CBT-I is already the recommended first-line treatment for chronic insomnia, but trained providers are scarce, which is the access gap a fully automated program is meant to close.
The Education Group Gained Ground Too
The researchers stated their expectation up front: the online program, with or without support, would outperform patient education. It did, but the education group was not standing still—its remission rate climbed from 2% right after the program to 16% a year later, a reminder that some sleepers improve with information and time alone. The two program versions finished close together, with the supported version somewhat higher. The result also does not stand alone: in a separate randomized trial of 336 US adults with diagnosed insomnia disorder, an automated CBT-I program cleared for prescription use produced higher response and remission rates than online sleep-hygiene education, with gains sustained through six months.2
Key Takeaways
- A year after a nine-week self-guided online CBT-I program, 40 to 51% of older adults were in insomnia remission, versus 16% with online sleep education.
- Because participants were assigned by chance, the trial can credit the program itself—not the kind of person who chooses it—for the difference.
- The fully automated version performed nearly as well as the version with human support added.
- A separate randomized trial of another automated CBT-I program in US adults found the same pattern, adding weight to the finding.
References
- Ritterband LM, Shaffer KM, Thorndike FP, et al. A randomized controlled trial of a digital cognitive behavioral therapy for insomnia for older adults. npj Digital Medicine. 2025;8(1):458. link
- Prather AA, Krystal AD, Emsley R, et al. The effectiveness of digital cognitive behavioral therapy to treat insomnia disorder in US adults: nationwide decentralized randomized controlled trial. JMIR Mental Health. 2025;12:e84323. link