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Sleep and Productivity Benefits of Digital Cognitive Behavioral Therapy for Insomnia: A Randomized Controlled Trial Conducted in the Workplace Environment

Bostock, Sophie PhD; Luik, Annemarie I. PhD; Espie, Colin A. PhD

Journal of Occupational and Environmental Medicine: July 2016 - Volume 58 - Issue 7 - p 683–689
doi: 10.1097/JOM.0000000000000778

Objective: Evaluating digital cognitive behavioral therapy (dCBT) for insomnia in a workplace environment.

Methods: Within a randomized controlled trial in a Fortune 500 company, we randomized 270 self-identified poor sleepers [180 M/90 F: mean age 33.6 years (23 to 56 years)] to dCBT (n = 135) or waiting list (WL, n = 135). dCBT comprised six online sessions delivered by an animated therapist. Major assessments were at baseline and posttreatment.

Results: Sleep Condition Indicator (SCI) scores were significantly higher for the dCBT group [interaction term: F (1,485) = 15.63, P < 0.0001], representing Cohen's d of 1.10 following dCBT (d = 0.34 for WL). On the Work Productivity and Impairment questionnaire, “presenteeism” demonstrated significant improvements following dCBT [F(1,485) = 10.99, P = 0.001: d = 0.64 for dCBT, d = 0.09 for WL]. Effects for “abseenteeism” failed to reach statistical significance (P = 0.101).

Conclusions: dCBT is effective in improving sleep and work-based productivity in adults with insomnia.

Big Health Ltd, London (Drs Bostock, Luik, Espie); Faculty of Medicine, University of Southampton (Dr Bostock); and Sleep & Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, UK (Drs Luik, Espie).

Address correspondence to: Colin A. Espie, PhD, Sleep & Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Sir William Dunn School of Pathology, South Parks Road, OX1 3RE, UK (

The dCBT intervention ( was provided to employees of the Fortune 500 company within which this RCT was based. For commercial reasons, this company do not wished to be named, or to appear as coauthors, but have agreed to this paper being published. CE is a cofounder of and a shareholder in Big Health (Sleepio) Ltd. SB receives a salary from Big Health. AIL is employed by the University of Oxford on funds provided to the University by Big Health.

Copyright © 2016 by the American College of Occupational and Environmental Medicine