Digital CBT for Insomnia Shows Effectiveness in Patients with Chronic Fatigue

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Digital Cognitive Behavior Therapy for Insomnia (CBT-I) is equally effective in treating insomnia in individuals with or without co-occurring chronic fatigue, according to a recent study.

Results from a recent investigation suggest that co-occurring chronic fatigue does not moderate the effectiveness of digital Cognitive Behavior Therapy for Insomnia (CBT-I) in adults with the condition.1

According to the study, the data established digital CBT-I as a promising approach for intervention when treating patients with physical and mental disorders including chronic fatigue.

CBT-I is a non-pharmacological treatment that's exhibited effectiveness in the improvement of sleep quality and reducing symptoms of insomnia.

Oftentimes, insomnia is accompanied by chronic fatigue, which is particularly complex and can have a debilitating impact on affected individuals. Those plagued by persistent fatigue can't alleviate their symptoms with rest, significantly influencing their quality of life.

Previously, it was unclear whether patients with co-existing symptoms of insomnia and chronic fatigue responded differently to CBT-I compared with those without chronic fatigue.

To futher the understanding of these relationships, a large community-based sample of adults with insomnia were evaluated by a team of investigators, including Lina Stålesen Ramfjord, Department of Mental Health, Norwegian University of Science and Technology.

Comparing CBT and Patient Education for Insomnia

The team of investigators conducted a secondary analysis of data from a community-based randomized controlled trial of digital CBT-I compared with patient education. The study included 1717 participants with self-reported insomnia, of which 592 reported symptoms of chronic fatigue while 1125 did not.

Patients with chronic fatigue reported significantly greater improvements following digital CBT-I for insomnia compared with patient education on the Insomnia Severity Index, Short Form-12 mental health, and Hospital Anxiety and Depression Scale.

However, findings showed no significant differences in the effectiveness of digital CBT-I for insomnia between patients with chronic fatigue and those without chronic fatigue on any outcome.

Impact of Co-existing Chronic Fatigue

For the analysis, linear mixed models were employed with baseline ratings of the Chalder Fatigue Questionnaire used to identify patients with more or fewer symptoms of self-reported chronic fatigue.

The main outcomes assessed in the study were the Insomnia Severity Index, Short Form-12 mental health, Short Form-12 physical health, and the Hospital Anxiety and Depression Scale.

Some limitations were noted, such as relying on self-reported measures of insomnia and chronic fatigue, and the use of a specific digital CBT-I program, which may limit the generalizability of the findings. Further research is needed to confirm these results and explore the potential benefits of digital CBT-I in individuals with other comorbid conditions.

Overall, the research demonstrated significant improvements in insomnia symptoms among the adults who reported high levels of fatigue after they participated in CBT-I.

"This has clinical implications that are relevant to the management of insomnia, as fatigue is among the most commonly reported comorbid symptoms. Moreover, this may further establish dCBT-I as an adjunctive intervention in individuals with physical and mental disorders."


  1. Ramfjord, L. S., Faaland, P., Scott, J., Saksvik, S. B., Lydersen, S., Vedaa, Ø., Kahn, N., Langsrud, K., Stiles, T. C., Ritterband, L. M., Harvey, A. G., Sivertsen, B., & Kallestad, H. (2023). Digital cognitive behaviour therapy for insomnia in individuals with self-reported insomnia and chronic fatigue: A secondary analysis of a large scale randomized controlled trial. Journal of Sleep Research, e13888.