LAUSR

Cognitive behavioral therapy for insomnia (CBT-I) remains the first line treatment for insomnia. CBT-I in comparison with sedative-hypnotics has similar efficacy, but with treatment durability and almost no adverse effects. Despite CBT-I being recognized as the best insomnia treatment, access remains limited. Digital CBT-I hopes to address the problem of scale, so as to deliver therapy to the masses. There are now multiple mobile applications available both on smartphone app stores, which claim to deliver evidence based CBT-i. These applications largely come at a cost and patients have to pay to access their services. The goal of this study is to review CBT-i smartphone applications to see if they are indeed validated. We performed a search on the two most popular smartphone application platforms: Google Play and Apple Store. We used search terms: sleep, insomnia and CBT-I. We then searched for validation studies for those smartphone applications on Google Scholar. We included studies conducted in the past 10 years. Our second search consisted of reviewing PubMed and Google Scholar for validation studies for CBT-I applications. Our search terms consisted of CBT-I and smartphone, CBT-I and application and CBT-I and digital. Of the 9 validation studies that we initially found, 6 met our inclusion criteria. 3 were excluded as they did not solely use CBT-I in their applications. All 6 applications reported significant improvement in important sleep quality metrics such as sleep onset latency and total sleep time. 4 studies also reported on a subjective improvement in quality of sleep. 2 studies looked at populations with comorbidities including cannabis use disorder and epilepsy. Both studied again found improvement in sleep quality in those specific populations. There were concerning patterns of bias found amongst the reviewed studies. 3/6 investigators had direct relationships with companies which designed and marketed the applications. dCBT-I offers an opportunity to increase accessibility to therapy. There are only a limited number of studies which have examined the effectiveness of the applications on the market. There remains serious concerns about the risk of bias and the quality of validation studies which claim to confirm the effectiveness of these applications.