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This article was written by Hannah Arem, MD, and Claire Starling.
MedStar Health Research Institute investigators are investigating whether cognitive behavioral therapy delivered on an in-home smart speaker can help breast cancer survivors with insomnia get better sleep.
Following the rigors of breast cancer treatment, an estimated 23% to 61% of patients struggle with sleep disturbances such as insomnia—inability to achieve restful sleep. While medications can help, they are only a short-term solution with side effects, and many patients understandably prefer a non-pharmaceutical option. Cognitive behavioral therapy (CBT-I) is the most effective treatment for insomnia. Still, it can be difficult for patients to identify a trained provider or complete the course of therapy.
Smart speakers are increasing in popularity, with 35% of U.S. households owning a device such as an Amazon Alexa or Google Home. These speakers provide a novel way to reach individuals at home to collect information about sleep patterns and provide real-time feedback.
A new study at MedStar Health Research Institute aims to determine whether delivering cognitive behavioral therapy for insomnia (CBT-I) through an in-home smart speaker can help breast cancer survivors reduce insomnia symptoms.
After surviving breast cancer, getting adequate sleep is particularly important because it helps strengthen the immune system, supports overall mental and physical health, and improves the quality of life. Insomnia can be debilitating. Long-term impacts include:
- Decreased job performance and increased absenteeism
- Depression and anxiety
- Difficulty concentrating
- Increased risk of falls
- Medical disorders like irritable bowel syndrome, fibromyalgia, asthma, and more
- Memory problems
- Reduced immune system function
CBT-I produces results similar to medication in effectiveness, without side effects and fewer relapses, with participants reporting they fell asleep faster and stayed asleep longer.
By studying the efficacy of automated CBT-I at home delivered by this popular technology, we hope to identify how we can help more patients complete their therapy, restore beneficial sleep, and improve their quality of life.
Improving digital CBT-I with smart speaker delivery.
CBT-I is a psychological treatment that combines three approaches to relieve insomnia:
- Cognitive restructuring: Changing inaccurate or unhelpful thoughts about sleep.
- Behavioral change: Relaxation training, learning to control stimuli, and practicing techniques to build healthy sleep habits, often called sleep restriction therapy.
- Psychoeducational information: Learning about the connection between thoughts, feelings, behaviors, and sleep.
Typically, patients learn CBT-I techniques in-person from a provider in a clinical setting. But many patients have difficulty completing the six-week therapy due to logistical and scheduling challenges, and there aren’t enough trained providers to meet the need.
Digital CBT-I (dCBT-I) can make it easier for patients to participate in the therapy on their schedule, get personalized information, and track their progress. Studies have shown that many people who visit dCBT-I websites do not complete the program, often because there is little guidance and the websites are either not intuitive or do offer enough support for users.
Personalized dCBT-I delivered via an in-home smart speaker like the Alexa Echo Dot could eliminate some of these disadvantages. Patients would not need to log in to a website or use screens before bedtime, which is contraindicated in CBT-I. Using the speaker allows for ongoing interaction and feedback—like integrating information about their progress and preferences. We anticipate that digital CBT-I (dCBT-I), delivered via an in-home smart speaker, will provide a more engaging experience patients might be more likely to stick with, thereby helping to restore restful sleep following breast cancer treatment.
If our research demonstrates that dCBT-I delivery via smart speaker is successful, we’ll look to further develop the program and distribute it for insomnia treatment in other types of cancer.
Our goal is simple: to help improve the quality of life for cancer survivors. If you’re having trouble sleeping and finished breast cancer treatment more than three months ago, you could be a candidate for this trial. Please talk with your doctor or contact us to find out more.