That's where the Internet comes in. Data from two recent small studies—one described in the Archives of General Psychiatry, another in the journal Sleep—suggest that interactive Web-based programs, based on the components of face-to-face CBT therapy, can help people improve their sleep. The lead authors of both studies say they plan to make their programs commercially available in the future. Jacobs already runs a program called Conquering Insomnia, which "replicates" a CBT treatment program he developed and tested in roughly 10,000 patients (www.cbtforinsomnia.com, $24.95). HealthMedia's Overcoming Insomnia is available at no cost through many employers and health plans such as Kaiser Permanente and Aetna, according to a company spokesperson, and it's also being tested for sale to consumers (healthcoach.myselfhelp.com, $19.95).
Internet-based treatments "have tremendous capacity for reaching a very large number of patients," says Michael Sateia, a professor of psychiatry and chief of sleep medicine at Dartmouth-Hitchcock Medical Center. But Sateia, who wasn't involved in the latest studies, cautions that more research is needed to evaluate the treatments' effectiveness. Same goes for the CBT-for-insomnia self-help books that are multiplying, experts say. It's not clear which insomniacs would benefit most from self-help measures and which need face-time with a therapist; insomnia can be the byproduct of a physical or mental health problem, experts say. "We have to be careful," says Morin. "Not everyone will do well with reading a book or [using] the Internet."
Some say self-help is better than no help. Trevor Semotok, a 29-year-old from Canada, has been struggling with insomnia for almost two years. Though it takes him nearly 45 minutes to fall asleep most nights, his real problem is that he wakes up two to three hours before his 6:30 a.m. alarm blares and is unable to return to sleep. "It's hard to maintain a productivity level when you're constantly fighting dropping eyelids in the afternoon," he says. Semotok sought help at a local sleep clinic, but an "extensive" waiting list prevented him from being seen. Further frustration came when he agreed to participate in a study testing an online cognitive behavioral therapy treatment—the study recently published in Sleep—but was assigned to the control group and thus went without the treatment. Once the study ended, however, he tried it. "While it has not solved the problem, a healthier attitude towards sleep has improved both the number of sleepless nights as well as how I deal with them when they occur," says Semotok. One thing he's learned: His anxiety over lying awake can be addressed by getting bedroom clocks out of sight.
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