digital sleep therapy for older adults with cognitive impairment

Conditions: Insomnia Type; Sleep Disorder; Cognitive Impairment

Summary: this study aims to determine the efficacy of digital behavioural therapy for insomnia (dbti) compared to online sleep health education (control) at reducing insomnia symptom severity (insomnia severity index: isi) in older adults (50+ years) with subjective cognitive impairment from baseline compared to week 8.

insomnia is a highly prevalent sleep disorder affecting up to 10% of the adult population and reports of over 40% in the older population. current insomnia treatments focus heavily on symptom management with cognitive behavioural therapy for insomnia (cbti), in both digital and face-to-face form as the recommended first-line treatment. despite the strong evidence for digital cbti, there are a lack of data related to older people and whether digital brief behavioural therapy is efficacious in this population. recent work shows that sleep plays a critical role in optimising brain function and sleep disturbance is highly prevalent in individuals with cognitive impairment. the investigators will conduct a fully online study comparing 3-weeks of digital brief behavioural therapy for insomnia (dbbti) (in addtiotion to an extra optional 3 weeks) against online sleep health education. participants will be recruited, screened and determined eligibility and consent will be conducted online. participants will be randomly allocated to either dbbti delivered via a mobile application called sleepfix or wait-listed control. the sleepfix mobile application delivers sleep restriction therapy using a 4 stage approach to improve sleep efficiency. the control will consist of 3 online sleep health education modules provided bi-weekly with information about sleep and sleep hygiene without any specific insomnia therapy. participants will be recruited using social media and directed to a website to determine eligibility and then provided access to either the dbbti (sleepfix) or the control with a link to the first online module. at baseline, all participants will complete self-reported measures of insomnia, cognition ,sleep, fatigue, sleepiness , anxiety, depression, quality of life and digital health literacy. these will be repeated at follow-up at weeks 8, 16.

Eligibility criteria:
inclusion criteria: * aged 50 years and older * insomnia severity index score ≥10 * self-reported subjective cognitive impairment as defined as moderate subjective cognitive complaints (i.e. answers yes to have cognitive concerns or thinking and memory skills are worse than same-age peers on the online screening) * english speaking * access to a smartphone and willingness/proficiency to use a mobile app for healthcare * able to give informed online consent exclusion criteria: * neurological (e.g. parkinson's, epilepsy) and major psychiatric disease (e.g. current major depression), dementia, history of cerebrovascular events (stroke, tia); history of head injury with loss of consciousness \> 30mins; * self-reported jetlag symptoms due to travel in the last 7 days; * current illicit substance use or alcohol intake suggestive of a hazardous or harmful pattern; * shift-work; * medical conditions with known effects on cognition and sleep (e.g. cancer with chemotherapy); * diagnosed obstructive sleep apnoea, or other sleep disorder including rem sleep behaviour disorder, restless legs syndrome or narcolepsy.