Seoul National University Hospital Proves Effectiveness of Mobile App-Based Cognitive Behavioral Therapy for Insomnia

Somzz App Improves Insomnia Severity, Sleep Efficiency, Depression... Effective for Chronic Insomnia Treatment
Multicenter, Single-Blind, Randomized Clinical Trial by Seoul National University, Samsung Seoul, and Korea University Anam Hospital

Professors Lee Yujin of Seoul National University Hospital, Kim Seokju of Samsung Seoul Hospital, and Lee Heonjeong of Korea University Anam Hospital, Department of Psychiatry.
[Image source=Seoul National University Hospital]

A joint research team of psychiatry professors including Yoojin Lee from Seoul National University Hospital, Seokjoo Kim from Samsung Seoul Hospital, and Heonjeong Lee from Korea University Anam Hospital (first author: Jiyoon Shin, professor at Uijeongbu Eulji University Hospital) has demonstrated the effectiveness of mobile cognitive behavioral therapy for insomnia (MCBTi) using Somzz, the first digital therapeutic device app in Korea. According to the study, Somzz app-based MCBTi, which provides real-time personalized feedback, improved insomnia severity, sleep efficiency, wake after sleep onset, sleep satisfaction, depressive symptoms, and quality of life, confirming its effectiveness in treating chronic insomnia.

Insomnia is a common sleep disorder with a prevalence of about 10% in the general population. It negatively affects physical and mental health, making its treatment important. Cognitive behavioral therapy for insomnia (CBTi) is the primary treatment for chronic insomnia, but accessibility is limited due to time constraints of face-to-face therapy and a shortage of skilled professionals. Mobile app-based cognitive behavioral therapy developed as a solution offers the advantage of providing treatment easily to more patients.

Until now, studies evaluating the effectiveness of cognitive behavioral therapy via mobile apps have been rare, and few have rigorously verified it through multicenter, single-blind, randomized controlled trials.

This study was conducted with a total of 98 participants recruited from Seoul National University Hospital, Samsung Seoul Hospital, and Korea University Anam Hospital. The participants were adults diagnosed with chronic insomnia, randomly assigned to a group using the Somzz app (49 people) and a control group using a simple sleep habit education app (49 people). Both groups underwent six sessions over six weeks, followed by a four-month follow-up.

The Somzz group received real-time feedback on sleep behaviors and sleep restriction therapy that set personalized bedtimes and wake times. They also received stimulus control therapy, relaxation therapy, sleep hygiene education, and relapse prevention education. The control group received basic sleep education through sleep hygiene education and audiovisual materials and were able to keep daily sleep diaries.

The primary evaluation measure was the Insomnia Severity Index (ISI), with secondary measures including sleep diaries and self-reported mental health questionnaires.

Results showed that the Somzz group had significantly lower ISI scores after treatment and at the three-month follow-up. Post-intervention, the Somzz group’s ISI score was 9.0, significantly lower than the control group’s 12.8. At the three-month follow-up, the Somzz group’s ISI score was 11.3, lower than the control group’s 14.7, confirming the sustained treatment effect. This demonstrates that cognitive behavioral therapy for insomnia via the Somzz app more effectively reduces insomnia severity.

Notably, the Somzz group’s remission rate of insomnia (ISI score below 8) was 45%, and the treatment response rate (ISI score reduction of 7 or more) was 57%, proving its effectiveness in improving insomnia treatment outcomes and symptom reduction.

Additionally, the Somzz group’s sleep efficiency was 78.3%, higher than the control group’s 70.6%. Wake after sleep onset (WASO), measuring time awake after sleep onset, was shorter in the Somzz group at 53.0 minutes compared to 65.3 minutes in the control group, indicating improved sleep quality.

The Somzz group also showed superior results in mental health indicators. The depression score (PHQ-9) was 6.6 in the Somzz group, lower than 8.7 in the control group. The quality of life score (SF-36) was 72.4 in the Somzz group, higher than 63.5 in the control group.

The dropout rate during treatment in the Somzz group was low at 12.2% (6 out of 49), lower than the dropout rate of up to 40% in face-to-face cognitive behavioral therapy for insomnia, demonstrating high adherence to digital therapeutic devices like Somzz.

The research team emphasized the significance of this study as the first multicenter, single-blind, randomized clinical trial investigating not only sleep-related indicators but also the effects on mental health.

Professor Yoojin Lee, the principal investigator of this clinical trial, stated, "This study shows that cognitive behavioral therapy through Somzz, Korea’s first digital therapeutic device, is very effective in treating insomnia. Especially since meaningful improvements were observed in insomnia severity, sleep efficiency, wake after sleep onset, sleep satisfaction, and mental health, it suggests that Somzz can be used as an efficient and accessible treatment for insomnia."

The study results were published in the latest issue of JMIR (Journal of Medical Internet Research), an international journal in the field of digital health and medical informatics.