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

Psychol Med. 2019 Feb;49(3):501-509. doi: 10.1017/S0033291718001149. Epub 2018 May 11.


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 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 with 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 3 and 6 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 with those of depression therapy.

Clinical trial registration number: NTR6049 (Netherlands Trial Register).

Keywords: CBT; depression; insomnia; online treatment; randomized controlled trial.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Aged
  • Cognitive Behavioral Therapy / methods*
  • Depression / prevention & control*
  • Depression / therapy*
  • Female
  • Health Status Indicators
  • Humans
  • Internet
  • Male
  • Middle Aged
  • Netherlands
  • Regression Analysis
  • Sleep Initiation and Maintenance Disorders / prevention & control*
  • Sleep Initiation and Maintenance Disorders / therapy*
  • Telemedicine / methods*
  • Treatment Adherence and Compliance
  • Treatment Outcome

Associated data

  • NTR/NTR6049