O025 Efficacy of digital behavioural therapy for insomnia in older adults: RCT

Abstract Introduction Sleep restriction is among the most effective components of cognitive behavioural therapy for insomnia (CBTi), yet its efficacy in older adults remains unclear. We investigated the effects of a digital behavioural therapy for insomnia (dBTi) combined with a sleep tracker, compared to digital sleep education, on insomnia symptoms in older adults. Methods In this single-blind, two-arm randomised controlled trial, participants aged ≥60 years with ISI ≥10 were randomised to dBTi or control. The dBTi group received 3 weeks of app-based sleep restriction therapy (with an optional additional 3 weeks) synchronised with a wearable sleep tracker. The control group completed three bi-weekly online sleep hygiene modules. The primary outcome was ISI at 8 weeks, with follow-up at 16 and 26 weeks. Secondary outcomes included sleep quality, fatigue, sleepiness, and symptoms of anxiety and depression. Results A total of 273 participants were randomised (dBTi: n = 136; control: n = 137) between September 2022 and November 2023 (mean age 67.9 ± 5.6 years; 81.7% female; baseline ISI 17.2 ± 4.4). At 8 weeks, mean ISI scores were significantly lower in the dBTi group vs control (10.5 [9.2–11.9] vs 14.1 [13.1–14.9]; p<.001). Reductions persisted at 16 and 26 weeks (week 26: 8.6 [7.1–10.2] vs 13.7 [12.9–15.4]; p<.001). Secondary outcomes also significantly improved in the dBTi group. Discussions Digital sleep restriction therapy combined with a sleep tracker significantly improved insomnia symptoms in older adults. Digital therapeutics may enhance scalability and accessibility and should be evaluated in future stepped-care models.