Does online insomnia treatment reduce depressive symptoms? A randomized controlled trial in individuals with both insomnia and depressive symptoms

Background. Insomnia is effectively treated with online Cognitive Behavioral Therapy for Insomnia (CBT-I). Previous research has suggested the effects might not be limited to sleep and insomnia severity, but also apply to depressive symptoms. Results, however, are mixed. Methods. In this randomized controlled trial (RCT) we investigated the effects of guided online CBT-I on depression and insomnia in people suffering from symptoms of both. Participants (n = 104) with clinical insomnia and at least subclinical depression levels were randomized to 1) guided online CBT-I and sleep diary monitoring (i-Sleep) or 2) control group (sleep diary monitoring only). The primary outcome was the severity of depressive symptoms (Patient Health Questionnaire-9 without sleep item; PHQ-WS). Secondary outcomes were insomnia severity, sleep diary parameters, fatigue, daytime consequences of insomnia, anxiety and perseverative thinking. Results. At post-test, participants in the i-Sleep condition reported significantly less depressive symptoms (PHQ-WS) compared to participants in the sleep-diary condition (d = 0.76). Large significant effects were also observed for insomnia severity (d = 2.36), most sleep diary parameters, daytime consequences of insomnia, anxiety and perseverative thinking. Effects were maintained at three and six month follow-up. We did not find significant post-test effects on fatigue or total sleep time. Conclusions. Findings indicate that guided online CBT-I is not only effective for insomnia complaints but also for depressive symptoms. The effects are large and comparable to those of depression therapy. Clinical trial registration number: NTR6049 (Netherlands Trial Register).