From the Guidelines
Telehealth is a highly effective option for treating insomnia, offering convenient access to cognitive behavioral therapy for insomnia (CBT-I), which is the first-line treatment, as supported by the most recent and highest quality study 1.
Treatment Options
The treatment of insomnia via telehealth services can include:
- Cognitive behavioral therapy for insomnia (CBT-I), a multisession, multicomponent treatment focused on sleep-specific thoughts and behaviors, which has been shown to be effective in treating chronic insomnia 1
- Brief behavioral treatment for insomnia (BBT-I), an abbreviated version of CBT-I that focuses on the behavioral components of sleep restriction, stimulus control, and sleep hygiene only 1
- Medication management, including short-term sleep aids like zolpidem, eszopiclone, or trazodone, which can be prescribed for 2-4 weeks while implementing behavioral strategies 2, 3
- Melatonin (1-5mg) taken 1-2 hours before bedtime to help regulate sleep cycles 2, 3 ### Delivery Methods Telehealth delivery platforms can include:
- Provider-directed telemedicine, which allows healthcare providers to assess sleep patterns, recommend sleep hygiene improvements, and guide patients through CBT-I techniques via video consultations 1
- Self-directed Internet-based programs, which can provide patients with access to CBT-I and other behavioral therapies for insomnia 1 ### Benefits The use of telehealth for treating insomnia can offer several benefits, including:
- Convenient access to care, which can improve treatment adherence and outcomes 1
- Reduced barriers to care, such as travel time and scheduling difficulties 1
- Ongoing monitoring and treatment adjustments, which can be enabled through sleep diaries and wearable device data 1 ### Recommendations Patients with insomnia should be treated with CBT-I as the first-line treatment, and telehealth can be a highly effective platform for delivering this treatment 1. Additionally, medication management and melatonin can be considered as adjunctive therapies, and patients should prepare for telehealth appointments by documenting sleep patterns, ensuring privacy during sessions, and having good internet connectivity.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Treatment Options for Insomnia via Telehealth Services
- Cognitive Behavioral Therapy for Insomnia (CBTi) is a recommended first-line treatment for insomnia, and telehealth services can increase access to this treatment, particularly for older adults 4.
- Internet-delivered CBTi has been shown to be effective in improving sleep efficiency, reducing insomnia severity, and decreasing symptoms of depression 5, 6.
- Telehealth-delivered CBTi has been found to be non-inferior to in-person treatment, with significant improvements in insomnia severity and other secondary outcomes 7.
- Tele-CBTi has also been shown to be feasible and effective in individuals with multiple sclerosis, with significant improvements in insomnia severity, sleep quality, and fatigue severity 8.
Key Features of Telehealth-Delivered CBTi
- Clinician-patient dashboard with user-friendly features, such as patterns of sleep data from ambulatory devices, guided relaxation resources, and reminders to complete in-home CBTi practice 4.
- Video telehealth or live video sessions with a trained CBTi provider 7, 8.
- Internet-delivered CBTi programs with multiple sessions and modules 5, 6.
Benefits of Telehealth-Delivered CBTi
- Increased access to treatment, particularly for older adults or individuals with mobility difficulties 4, 8.
- Improved sleep efficiency, reduced insomnia severity, and decreased symptoms of depression 5, 6, 7.
- Non-inferior to in-person treatment, with significant improvements in insomnia severity and other secondary outcomes 7.
- Feasible and effective in individuals with multiple sclerosis, with significant improvements in insomnia severity, sleep quality, and fatigue severity 8.