Patient engagement is a significant determinant of health. To help our patients manage their chronic diseases, we must equip them with the necessary tools and resources.
Using motivational interviewing and other behaviour-change techniques, we can give them the support they need to take ownership of their health. Unfortunately, access to a behavioural therapist is not always available, but other resources – smartphone apps – are a second-line option.
Insomnia is the most common sleep disorder. It presents difficulty initiating and maintaining sleep or waking up too early without a secondary cause. Anxiety and heightened arousal in the sleep environment are often key features of insomnia. Lately, I have been asking my patients to try specific apps for behaviour change especially in areas of sleep management.
The good news is that there is a solution that doesn't involve medication. Cognitive behavioral therapy for insomnia (CBTi) is the gold-standard first-line therapy, and it is just as effective as pharmacotherapy with longer-lasting effects. However, access to trained mental health professionals who can provide CBTi has been challenging.
That's where digital CBTi platforms like the Insomnia Coach app come in. Created by the US Department of Veterans Affairs National Center for PTSD, Stanford University School of Medicine, and the Department of Defence National Center for Telehealth and Technology, Insomnia Coach is a free, phone-based app designed to provide patients with the tools they need to manage their insomnia. The app includes a five-week training plan, a sleep diary, and sleep-related educational materials.
What sets Insomnia Coach apart from other sleep apps is its focus on CBTi principles such as sleep restriction and consolidation. It includes an initial survey on insomnia symptoms, which can be repeated weekly to track progress, and daily sleep rules focusing on sleep hygiene and stimulus control. The app also includes exercises to calm down and relax before bed and a "Learning" tab that provides background information about sleep physiology and insomnia.
I was especially impressed by the app's "Progress" tab, which graphically shows the progression of sleep efficiency and enables reminder alarms to be set for all features, including bedtime, diary input and training plan review. Although the app was initially designed to complement traditional face-to-face CBTi, the app was found to be effective as a self-management tool in a small study on nurses.
Insomnia Coach provides self-motivated patients the tools they need to manage their symptoms. It may not replace formal CBTi delivered by a trained mental health professional but, as one of my patients commented, “It is still better than nothing.”
Patient self-management apps have the potential to revolutionize the way health care is delivered and to empower individuals to take control of their own health and wellness.
Editor’s note: The views, perspectives and opinions in this article are solely the author’s and do not necessarily represent those of the AMA.
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