A qualitative examination of the usability of a digital cognitive behavioral therapy for insomnia program after stroke.
Tom Smejka, Alasdair L Henry, Catherine Wheatley and 3 others
PMID 35108134WHAT IT FOUND
People with stroke found the digital sleep program engaging but often unsafe or impractical.
Advice to leave bed or stop napping conflicted with fatigue and mobility issues, while cognitive barriers required partner support. Standard CBT-I protocols need adaptation before being recommended for this population.
Key findings
01Participants reported that standard CBT-I advice, such as getting out of bed when unable to sleep, was unsafe due to mobility issues and fall risks.
02Advice to avoid daytime naps was frequently impractical because post-stroke fatigue made napping necessary for many participants.
03Three participants required a partner to help them use the program due to cognitive difficulties, suggesting digital interventions may exclude those without support.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
The study included participants with varying levels of insomnia severity, including those with sub-clinical symptoms, which may have reduced motivation to engage with challenging techniques. All participants were in the chronic phase of stroke (>3 months), so findings may not apply to those in early rehabilitation. Researchers provided weekly contact and support, which is not part of the standard Sleepio protocol, potentially inflating completion rates and usability compared to real-world independent use. The sample was small (n=11) and recruited from user groups, which may introduce selection bias toward more motivated or digitally literate individuals.
Declared interests
The study was funded by the Wellcome Trust and the National Institute for Health Research (NIHR) Oxford Biomedical Research Centre. The authors declared no conflicts of interest related to the commercial product Sleepio, and the researcher explicitly stated he was not affiliated with the company.
The easy way to misread this
Do not interpret the high completion rate as evidence that Sleepio is usable independently for all stroke survivors. The researchers provided weekly support and prompts, and three participants required a partner to use the program, indicating that standard automated delivery may fail for those with cognitive or navigation difficulties.