Photo Credit: Stefanamer

A voice-interactive in-home cognitive behavioral therapy program significantly improved insomnia in breast cancer survivors compared with controls.

Breast cancer survivors experienced marked improvements in insomnia symptoms after using a daily in-home voice-interactive program that delivers cognitive behavioral therapy for insomnia (CBT-I), according to study results published in JAMA Network Open.

“These findings support a novel method for addressing insomnia symptoms that presents new avenues for scalability and engagement,” the researchers wrote.

An estimated 30% to 50% of US breast cancer survivors report insomnia symptoms, the study team continued. Although CBT-I has been shown to help, the intervention can be difficult to access due to the scarcity of practitioners.

The trial tested the impact of a 6-week, in-home, daily CBT-I program that uses smart speakers compared with web-based educational content, which was used as a control. Breast cancer survivors randomly assigned to the CBT-I intervention entered information about sleep concerns, sleep patterns, sleep behaviors, exercise, and use of sleep aids via a smartphone app.

After study intake, participants activated the program by speaking to a smart speaker. The program collected sleep diaries and provided tailored recommendations on CBT-I fundamentals such as sleep restrictions, modifications to sleep schedule, stimulus control, and sleep hygiene.  The program also offered relaxation content.

Breast cancer survivors randomly assigned to the control intervention received access to a website with generalized information about CBT-I, sleep, and cancer survivorship.

Improvements Across Multiple Sleep Parameters

Of the 76 women enrolled in the study, 38 were randomly assigned to each of the groups. The mean age of participants was 61.2 years, and the mean time from diagnosis was 9.6 years. Participants had experienced insomnia for an average of 10.3 years.

Between baseline and 6-week follow-up, Insomnia Severity Index scores (ISI) decreased by a mean 8.4 points in the intervention group and 2.6 in the control group. Experts consider an 8-point decrease as marked improvement and a 7-point decrease as moderate improvement, according to the study.

Sleep diary data also signaled significant gains in the intervention group for sleep quality, wake after sleep onset, sleep onset latency, and sleep efficiency compared with the control group, the study found. Improvements in total sleep time did not differ between the groups, a finding that did not surprise researchers because CBT-I focuses on sleep initiation and continuity rather than total sleep time.

“Cancer centers may consider programs such as this to reach more breast cancer survivors with insomnia,” they wrote.