Online insomnia treatment brings relief to overburdened caregivers

Providing care for a family member with a disabling illness can be a demanding job that leaves many people unable to sleep, but an online insomnia treatment developed at the University of Virginia School of Medicine can help, new research shows.

Not only did the SHUTi (Sleep Healthy Using the Internet) sleep intervention help caregivers get better rest, it most benefited those shouldering the greatest responsibilities in caring for their loved ones, the researchers found. 

The results suggest the online format of the program holds great promise for helping people access insomnia treatment who otherwise could not because of their demanding caregiving responsibilities, the investigators say.

"Compared to the general population, caregivers are more likely to experience insomnia but have a harder time getting help for this problem," said researcher Kelly M. Shaffer, PhD, a clinical psychologist at UVA Health who is part of UVA's Center for Behavioral Health and Technology. "Effective and accessible Internet-based interventions like SHUTi can give more caregivers meaningful relief."

Caregivers and insomnia

Approximately one in six Americans provides physical, emotional or medical care for a loved one disabled by illness. This can place a huge emotional and physical toll on caregivers. Many end up stressed and sleep-deprived but still struggle to fall asleep even when they have the opportunity.

SHUTi has helped many people overcome sleep difficulties in previous research trials. Shaffer and her fellow researchers wanted to see if this intervention, and the cognitive behavioral therapy it provides, would be helpful for caregivers.

To determine that, the researchers provided SHUTi to 100 "high-intensity" caregivers struggling with insomnia. Of those, 60 completed the program, while 22 started but did not finish it. Of the 18 who didn't use the program, most said they had not because of concerns about the time it would require and fitting it into their caregiving obligations. Overall, the verdict was very positive, with most participants who used the program finding it user-friendly and seeing benefit in the cognitive-behavioral strategies provided.

Notably, the most engagement and the best outcomes were largely seen in participants with the most challenging caregiving situations. In particular, caregivers reporting more guilt about taking time for their own well-being at the start of the study tended to show some of the greatest improvements in their sleep quality and number of awakenings through the night. Many of these caregivers appreciated that SHUTi gave them space to focus on their own health goals. 

Users also said that they liked that SHUTi helped them manage their feelings of stress, anxiety and overwhelming responsibility. This made it easier for them to stop their minds from racing as they tried to fall asleep, the researchers report.

The results suggest that SHUTi could be a useful tool for helping busy caregivers access insomnia treatment they might not be able to get in person. Further, the research suggests that the program is helpful as is, even without custom tailoring for caregivers, such as content on how to fall asleep more easily after helping a loved one during the night. Still, this tailored information may be helpful for some caregivers, and the researchers hope to study this next.

Family caregivers fill an irreplaceable role in their loved ones' healthcare teams. In turn, they deserve care for their own health concerns that is effective, affordable and practical. Our study provides hope that Internet-based interventions like SHUTi can make that a reality."

Kelly M. Shaffer, PhD, clinical psychologist at UVA Health

Findings published

The researchers have published their findings in a pair of papers in the Annals of Behavioral Medicine. The research team consisted of Shaffer, Daniel J. Buysse, Heidi Donovan, Jillian V. Glazer, Julie Klinger, Meghan K. Mattos, Kate Perepezko, Lee M. Ritterband and Wen You. The authors' disclosures are included in the papers.

The research was supported by the National Institutes of Health's National Center for Advancing Translational Sciences, grant NCATS R21TR003522.