A randomized controlled trial of a digital cognitive behavioral therapy for insomnia for older adults
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Abstract
Older adults with insomnia face considerable challenges accessing treatment given limited availability to first-line therapy (Cognitive-Behavioral Therapy for Insomnia, CBT-I). This study evaluated the efficacy of Sleep Healthy Using the Internet for Older Adults Suffering with Insomnia and Sleeplessness (SHUTi OASIS), a tailored CBT-I internet intervention for older adults with insomnia, in a 3-arm randomized controlled trial (SHUTi OASIS alone, SHUTi OASIS + stepped support, online patient education [PE]). 311 participants (ages 55-95) were randomized to receive SHUTi OASIS (alone n = 105; with stepped support n = 102), with both conditions reporting significant improvements across post, 6-month, and 12-month follow-ups in insomnia severity compared to those receiving PE (n = 104). Clinically meaningful indices of insomnia response and remission were also higher among those receiving SHUTi OASIS. Those who received SHUTi OASIS also significantly outperformed those receiving PE on secondary outcomes, including sleep onset latency, wake after sleep onset, sleep efficiency, number of awakenings, sleep quality, and fatigue, across most timepoints. Results indicate that digital CBT-I provides important benefits for older adults, offering strong potential to expand access to insomnia treatment for this underserved population.
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Education on the biological mechanisms underlying sleep onset anxiety empowers individuals to identify symptoms, apply coping strategies, and reduce maladaptive responses to pre-sleep worry.
“Education on the biological mechanisms underlying sleep onset anxiety, including both cognitive and physiological aspects, empowers individuals to identify symptoms, apply coping strategies, and reduce maladaptive responses to pre-sleep worry [70].”
From Pre-Sleep Anxiety: Mechanisms and Therapeutic Approaches in Clinical Practice. (2026) · cites this paper as [70]
The Methods (Interventions; page not provided) describe general insomnia education and a CBT-I program, but do not say the education covers the biological mechanisms of sleep-onset anxiety. Searches for pre-sleep worry, physiological arousal, symptom identification, and coping strategies found no passage linking such education to the claimed benefits. (LLM, conf=0.73)
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“Therefore, the observed positive association of age in our naturalistic cohort may reflect selection and context (e.g., clinic-based follow-up and structured app use) rather than a universally higher efficacy of online CBT-I in older adults (Hughes, 2024; Ritterband et al., 2025).”
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“Telehealth platforms are particularly important because CBT-I scale programs and remotely supervised neuromodulation trials have shown both scalability and clinical impact when rigorous training, competency testing, and video oversight are incorporated (Ritterband 2025; Woodham et al. 2025).”
Breitinger-Blatt, D., Lee, J., Pereira, S. I. R., Smith, C., Gavriloff, D., & Sekaran, S. (2026) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd016349
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Liu, M., Li, Y., Lin, Y., Niu, Y., Ma, Y., & Zhu, Z. (2026) · International Journal of Behavioral Medicine · doi:10.1007/s12529-026-10486-y
Tong, Z., Ye, G., Fan, S., Li, Y., Zhang, J., Zhang, H., Chen, Q., Wang, H., Li, H., & Wang, J. (2026) · BMC Medicine · doi:10.1186/s12916-026-05129-8
Population-Specific Applications of Digital CBT-I: Evidence, Adaptations, and Emerging Directions
Lee, R. M., & Garland, S. N. (2026) · Current Sleep Medicine Reports · doi:10.1007/s40675-026-00400-z
“In the internet-delivered SHUTi OASIS program, 311 older adults were randomized to dCBT-I with or without stepped support, compared to an online education control group [49].”
Jones, B., Smith-Mason, C. E., Medalie, L., Minnick, A. M., & Gozal, D. (2026) · Family Practice · doi:10.1093/fampra/cmag080
- Authors
- Ritterband, L. M., Shaffer, K. M., Thorndike, F. P., Chow, P. I., Gonder-Frederick, L., Ingersoll, K. S., Cohn, W. F., Frederick, C., MacDonnell, K., Glazer, J. V., Mattos, M. K., Hilgart, M. M., Quigg, M. S., Bashir, M., & Morin, C. M.
- Affiliations
- University of Virginia (US)
- Université Laval (CA)
- Corresponding author
- Ritterband, Lee M.
- ORCID
- Venue
- npj Digital Medicine
- Published
- 2025-07-19
- Volume
- 8
- Issue
- 1
- Pages
- 458-458
- ISSN
- 2398-6352 (ISSN-L)
- PMC
- PMC12274496
- OpenAlex
- W4412521323
- Cited by
- 18
- References
- 57
- Citations by year
- 2026: 15 · 2025: 3
- FWCI
- 18.75
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- npj Digital Medicine (publishedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- OSF Preprints (OSF Preprints) (submittedVersion, cc-by)
- Funders
- National Institute of Aging (R01AG047885)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Health Sciences › Medicine › Physiology › Obstructive Sleep Apnea Research
- Keywords
- insomnia, older adults, cognitive behavioral therapy for insomnia, digital interventions, online therapy, online patient education, sleep quality, treatment access, fatigue
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