How does online sleep therapy help with sleep disorders?

Interview

How does online sleep therapy work? We asked co-developer Alexander Rötger how their therapy functions and who it is designed for.

How did you come up with the idea of developing online sleep therapy?

About one third of the population today complains of occasional sleep problems, and one in ten people suffer from chronic sleep disorders. This corresponds to over 10 million people in German-speaking countries. These figures made a strong impression on us during our psychology studies, especially because only a few people actually consult a sleep specialist or undergo therapy. And this despite the fact that there are many effective, science-based techniques for treating sleep disorders. For us, the only solution was to create a digital offering to make effective techniques available to as many people as possible.

How does sleep therapy work?

Participants follow six sessions with a virtual coach. The coach shares facts about sleep and gives participants personalised instructions on sleep and relaxation exercises to improve their sleep behaviour. In addition, throughout the therapy programme a sleep diary is kept and analysed.

How can sleep therapy work without a sleep analysis conducted in a specialised laboratory?

In the case of organically induced sleep disorders such as sleep apnoea or restless leg syndrome, it is essential to visit a sleep laboratory in order to diagnose the disorder and begin therapy with a sleep mask.

However, in the case of psychological sleep disorders, by far the most common category, an examination in a sleep laboratory isn't absolutely necessary. What is more important is the way in which the person assesses their sleep themselves. The subjective information and data provided by the diary enable tailor-made advice to be drawn up, giving participants the opportunity to change their behaviour in order to improve their sleep over the long term.

How is a sleep disorder analysed? Does the cause need to be identified?

The diary consists of one entry made in the morning and one in the evening. Participants record the length of their sleep, time spent lying in bed, how often they wake up, as well as mood and behavioural data. This data serves as the basis for certain elements of the therapy, such as shortening the time spent in bed. With this method, the time participants have actually slept is used to calculate a new time window and then adjusted step by step until the optimum sleeping time has been found.

The causes of psychological sleep problems depend on each individual and may be linked to stress at work, financial worries, relationship difficulties, etc. These factors can indeed trigger sleep problems, but after a certain period of time, they generally no longer play a role. The disorders end up becoming chronic and therefore persist even without their original trigger. The result is a vicious circle of negative thoughts and counterproductive behaviour, giving rise to an unfavourable pattern that perpetuates the sleep problems. The aim of online therapy is therefore not to identify the precise origin of the disorder, but to put an end to the vicious circle in which these people are trapped.

How is this programme different from other online therapy programmes and sleep apps?

Unfortunately, most applications and therapies aren't based on scientific criteria. We wanted to set ourselves apart from these products, which is why we invested a lot of time in medically based development and scientific research. In developing our therapy, we referred to the recommendations of the German Sleep Society (DGSM) and, before entering the market, conducted a clinical study in collaboration with the University of Zurich to enable us to prove the effectiveness of our product.

Is a sleep tracker absolutely necessary?

No, using a sleep tracker is optional. But it helps participants with their diary because it records key sleep data automatically.

Who is sleep therapy designed for? Are there any exclusions?

The therapy is designed for all adults with internet access who have difficulty falling asleep or staying asleep or who wake up too early in the morning and therefore feel tired during the day. There are no exclusion criteria before starting the programme. However, we also recommend consulting a doctor, especially if there are indications that the sleep problems could be organically generated.

How effective is this type of therapy?

The effectiveness of online sleep therapy was evaluated in a clinical study. Significant improvements were achieved in many areas. In a follow-up survey, it was also shown that the effects were sustained over the long term, even after the programme was completed. In particular, participants felt more productive during the day. And, results also showed that, on average, participants:

• fell asleep 20 minutes earlier.
• reduced time spent awake at night by 50 minutes.