LAUSR

Insomnia prevalence increases across the lifespan with rates reported as high as 40% in the over 65 yo population. Although cognitive behavioral therapy (CBT) for insomnia is the first-line recommended treatment, low accessibility leaves many older adults with less effective treatment options including medication and sleep hygiene. Medication is not recommended due to side effects, which may be more probable in older individuals. Digital CBT (dCBT) for insomnia permits access to first-line treatment; however, little is known about its effectiveness in older adults. We evaluated the effects of fully-automated dCBT on symptoms of insomnia, anxiety, and depression in adults aged 65 and older. Individual participant data from prior randomized controlled trials of dCBT for insomnia (Sleepio) were combined for those aged 65+ (range=65-92yo) with insomnia disorder (N=486). Participants received access to dCBT or a control. As the insomnia, anxiety, and depression outcomes were assessed differently across studies, scores were standardized into z-scores. Mixed-effects models estimated the effect of treatment on the combined sleep, depression and anxiety outcomes at post-treatment and follow-up. For studies using the SCI-8, chi-squared tests evaluated insomnia remission rates between groups at post-treatment. Digital CBT led to significantly greater improvements at post-treatment and follow-up relative to control for the combined sleep (ds≤-1.34, ps<.001) and depression (ds≤-0.35, ps≤.001) outcomes. For the combined anxiety outcome, dCBT led to significantly greater improvements at post-treatment (d=-0.30, p=.004). Those randomized to dCBT were more likely to achieve remission of insomnia (60% vs. 16%, p<.001) at post-treatment. Fully-automated dCBT for insomnia is effective at improving symptoms of insomnia, anxiety, and depression in adults aged 65+. Digital CBT may therefore serve as a first-line treatment option for older adults with insomnia to improve sleep and broader mental health. Importantly, dCBT may serve as an accessible means for older adults to receive guideline concordant treatment at scale. This work was supported in part by the National Institute for Health Research (NIHR) Oxford Biomedical Research Centre (BRC). The views expressed are those of the author(s) and not necessarily those of the NHS, NIHR, or Department of Health and Social Care.