At the darkest points of his 20-year battle with insomnia, Allan Cahill would go to bed at 7.30pm, take half a sleeping pill and spend the next 10 hours hoping for the best.
“It was consuming my life, and lying there just became more and more frustrating,” he said. “I was getting to a stage in my life that I was thinking this was never, ever going to be sorted.”
Allan Cahill’s life has changed since going through a five-week online therapy course to treat his chronic insomnia. Credit: Wolter Peeters
But when Cahill signed up to a study trialling an online therapy course, he was told to do something seemingly counterintuitive: hold off going to bed until 1am.
“I was dubious at the beginning, but the impact on the body really turned the whole situation around,” he said. “Now it takes me 10 minutes to get to sleep.”
Bedtime restriction therapy, where the patient exhausts themselves by spending less time in bed before gradually increasing it, is one of the techniques introduced to participants across the free five-week program developed by researchers at Flinders University in Adelaide.
Two-thirds of participants had better clinical sleep scores eight weeks after completing the program, and 40 per cent experienced complete remission after two months.
Dr Alexander Sweetman, a clinical sleep technician and lead author on the study, said cognitive behavioural therapy (CBT) was regarded as the first line of treatment for insomnia, but few psychologists and doctors in Australia were trained to deliver it, often leaving patients to wait months and pay hundreds of dollars to see a specialist.
“Part of our motivation for doing this study was to develop a more accessible program,” Sweetman said.
Three-quarters of the trial’s 62 participants had used sleeping pills in the past year and more than 80 per cent were female. Sweetman said other studies had suggested insomnia was slightly more prevalent in women, but that might be due to women being more likely to seek treatment than men.
Participants with depression recorded a 46 per cent improvement by eight weeks, compared with 10 per cent in the control group.
“By treating the insomnia and improving sleep, the logic follows that there should be this improvement in mental health, daytime symptoms [and] fatigue,” Sweetman said.
While the study did not observe a noticeable impact on anxiety symptoms, Cahill is no longer taking his anxiety medication to address his insomnia.
“I’m just so happy to be off them because I was never an anxious person,” he said.
Dr Amelia Scott, a clinical psychologist and researcher at Macquarie University who has trialled a similar virtual program, said the study was further evidence that CBT could be delivered effectively online.
“The next step is to develop strong pathways where GPs who are seeing people with sleep problems know they can access timely and cost-effective treatment,” she said.
Sweetman’s team is continuing to trial their program, called Bedtime Window, recruiting across Australia.
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