An Online Insomnia Program’s Edge Was Still There Years Later

CATEGORY: SLEEP & RECOVERY

The program ran for nine weeks, fully automated, with no therapist anywhere in it. More than two years later, the people who got it were still sleeping better than the people who didn’t. In a Norwegian trial of 1,720 adults with insomnia, those given an online course of cognitive behavioral therapy for insomnia scored about three points lower on a 28-point insomnia severity scale than those given online sleep education, averaging 10.7 against 13.4.¹ Entry to the trial required a score of 12 or more. Two years on, the treated group sat below that line. The comparison group didn’t.

A coin flip, then two years of waiting

Everyone in the study referred themselves, so these were people actively looking for help. Software then randomly split them: 867 to the automated therapy, which teaches the standard insomnia treatment through interactive online sessions, and 853 to ordinary sleep education online. CBT for insomnia works on the habits and beliefs that keep poor sleep going, things like time in bed and the dread of another bad night. Researchers checked back at nine weeks. Then they just kept watching. The final follow-up landed a median of 28 months after the start.

The gap shrank, and most people stopped answering

Honesty requires two caveats, and the authors state both. The advantage faded with time. It was larger at nine weeks than at two years, where the adjusted difference worked out to about 1.8 points. And only 587 people, roughly one in three, filled in the final questionnaire, which leaves real uncertainty about everyone who didn’t. Even so, the direction never flipped, no harms were reported, and the program also looked like good value: treated participants gained slightly more quality-adjusted life time, a standard measure that weighs both how long and how well people live, at no extra overall cost.

Key Takeaways

• A nine-week automated online insomnia program left users with meaningfully lower insomnia scores more than two years later, though the advantage was smaller than it had been right after treatment.
• Only about a third of participants completed the final follow-up, so the long-term estimate carries real uncertainty even in a trial this large.

References

1. Vethe D, Khan Z, Vestergaard CL, et al. Long-term clinical and cost-effectiveness of a fully automated digital cognitive behavioural therapy for insomnia: 2-year follow-up of a single-blind, superiority, randomised controlled trial. The Lancet Regional Health – Europe. 2026;66:101691. link