Both computerized CBTI and sleep hygiene education significantly improved insomnia severity, daytime sleepiness, fatigue, and sleep quality in adults with epilepsy, with cCBTI additionally associated with reduced depressive symptoms and increased sleep time.
Key Findings
Results
ISI scores decreased beyond the clinically meaningful threshold of 4 points in both groups, but the between-group difference was not statistically significant.
ISI scores decreased by -9.0 points in the cCBTI group and -5.8 points in the control group
Both groups showed significant improvement from baseline (both p < 0.001)
The between-group difference did not reach statistical significance (p = 0.076)
Study enrolled 35 subjects with mean age 39.5 ± 12.6 years; 57% female
Participants had moderate-to-severe insomnia at baseline
Results
PHQ-9 depressive symptom scores improved significantly only in the cCBTI group.
PHQ-9 scores decreased by -4.5 points in the cCBTI group (p = 0.003)
The control group did not show a significant improvement in PHQ-9
This was one of two outcomes that differentiated cCBTI from sleep hygiene education alone
Results
Self-reported sleep duration increased significantly only in the cCBTI group.
Sleep duration increased by +1.07 hours in the cCBTI group (p < 0.001)
Controls did not show a significant improvement in sleep duration
This was the second outcome measure that distinguished cCBTI from sleep hygiene education alone
Results
Daytime sleepiness, fatigue, and sleep quality improved in both cCBTI and control groups.
Epworth Sleepiness Scale (ESS), Fatigue Severity Scale (FSS), and Pittsburgh Sleep Quality Index (PSQI) all improved in both groups
All patient-reported outcomes improved in the cCBTI group
Controls showed improvement in ESS, FSS, and PSQI only, but not PHQ-9 or sleep duration
Results
Seizure frequency was higher at baseline in the cCBTI group compared to controls, but groups were comparable by end of study.
Baseline seizure frequency differed significantly between groups (p = 0.028), with cCBTI having higher frequency
By end of study, seizure frequency was comparable between groups (p = 0.30)
No significant between-group difference in seizure frequency was observed overall
Authors describe the narrowing of baseline differences as suggesting 'a potential benefit of cCBTI'
This was the first study to explore the effect of cCBTI on seizure control in adults with epilepsy
Methods
The study used a randomized, single-blind, controlled trial design with the Go! To Sleep℠ computerized CBTI program compared to sleep hygiene education alone.
35 subjects were analyzed after randomization to cCBTI or sleep hygiene education control
Primary outcome was change in Insomnia Severity Index (ISI) from baseline to end of study
Secondary outcomes included ESS, FSS, PSQI, PHQ-9, self-reported sleep duration, and frequency of disabling seizures
Participants were adults with epilepsy (AWE) with moderate-to-severe insomnia
Background
Insomnia is described as a prevalent and treatable comorbidity in adults with epilepsy, but the effectiveness of CBTI in this population had not been extensively studied prior to this trial.
Cognitive Behavioral Therapy for Insomnia (CBTI) is identified as the gold standard treatment for insomnia
The study represents the first randomized controlled trial evaluating computerized CBTI in adults with epilepsy
The study also represents the first exploration of cCBTI's effect on seizure control
What This Means
This research suggests that a computerized version of Cognitive Behavioral Therapy for Insomnia (cCBTI) can meaningfully improve sleep problems in adults with epilepsy. In a randomized controlled trial of 35 adults with epilepsy and moderate-to-severe insomnia, both the cCBTI group and a control group receiving sleep hygiene education alone saw significant reductions in insomnia severity — both exceeding the threshold considered clinically meaningful (a drop of 4 or more points on the Insomnia Severity Index). Both groups also improved in daytime sleepiness, fatigue, and overall sleep quality.
However, the computerized CBTI program provided additional benefits beyond what sleep hygiene education achieved. Only the cCBTI group showed significant improvement in depressive symptoms (a decrease of 4.5 points on the PHQ-9) and a meaningful increase in total sleep time (about one additional hour per night). This suggests that cCBTI offers a broader range of benefits for this population. Regarding seizures, although cCBTI participants had higher seizure frequency at the start of the study, this difference had narrowed by the end — which the authors note may hint at a potential seizure-related benefit, though no definitive conclusion can be drawn.
This research matters because people with epilepsy frequently suffer from insomnia, and poor sleep can worsen both seizure control and mental health. The findings suggest that an accessible, computerized CBTI program could be a practical tool for improving sleep and mood in this population without the need for in-person therapy. The authors call for larger studies to confirm these findings, particularly to better evaluate whether improving sleep through cCBTI might also help with seizure management.
Ahdab J, Grigg-Damberger M, Mouchati C, Thanaviratananich S, Somboon T, Bena J, et al.. (2026). Go! to sleep SM: a randomized, controlled trial for the treatment of chronic insomnia in adults epilepsy.. Epilepsy & behavior : E&B. https://doi.org/10.1016/j.yebeh.2025.110878