O035 Digital CBT-i versus digital sleep education control in an Australian community-based cohort: A randomised controlled trail.

BACKGROUND: Insomnia is a prevalent and debilitating condition in Australia. Cognitive behavioural therapy for insomnia (CBT-i) is the recommended first-line treatment, but is accessed by very few people with insomnia. We aimed to develop and test an interactive self-guided digital CBT-i program in an Australian community-based sample. METHODS: A randomised controlled trial was used to investigate the effect of digital CBT-i, versus digital sleep education control, on changes in insomnia (ISI), depression (PHQ-9) and anxiety symptoms (GAD-7) by 8-week follow-up in people with insomnia symptoms (ISI≥15). Intention-to-treat linear mixed models and complete-case chi-square analyses were used. RESULTS: Participants included 62 adults with insomnia symptoms (82% female, Age M [sd] = 52.5 [16.3]). There were no between-group differences in baseline characteristics, or rates of missing data at 8-weeks. CBT-i was associated with significantly greater improvements in the ISI (M [95%CI] reduction = 9.7 [7.8-11.6], d = 3.5) and PHQ-9 (M reduction = 4.8 [3.1-6.6], d = 1.0), but not GAD-7, compared to control (M ISI reduction = 1.6 [-0.2-3.4]; M PHQ-9 reduction = 1.0 [-0.7-2.6]; both interaction p < 0.001). Compared to control, CBT-i resulted in greater rates of insomnia improvement (ISI reduction ≥6; 7%, vs 75%), insomnia remission (ISI<8; 0%, vs 42%), and lower rates of clinically significant insomnia by 8-weeks (ISI≥15; 61%, vs 12%, all p < 0.001). CONCLUSION: This digital CBT-i program leads to large improvements in insomnia and depression symptoms adults with insomnia. Implementation programs are required to increase access to digital CBT-i in Australia.