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An online course developed by Macquarie University psychologists that has been proven to help even people with long-term insomnia and other health conditions is now available free Australia-wide.

About 1 in 3 Australians has trouble sleeping, whether they struggle to fall asleep or are waking during the night and unable to go back to sleep.

Designed to help change behaviors that are having a negative impact on our lives, cognitive behavioral therapy (CBT) is the gold standard treatment for a range of mental health conditions, including depression, anxiety and obsessive-compulsive disorder (OCD).

CBT-i is a targeted version of the therapy, developed specifically to combat insomnia, and it has been shown to be highly effective.

However, while a number of psychologists offer some level of support for insomnia, the Sleep Health Foundation has estimated that only about 30 full-time psychologists in the country are trained to deliver CBT-i.

To help meet the shortfall, Macquarie University psychologists have developed the Sleep Course, which is now being offered by the University's digital mental health service, MindSpot.

In an eight-week, self-paced course, participants work through a series of lessons, with the option of weekly check-ins with a therapist.

Help for everyone

Clinical psychologist and researcher Dr. Amelia Scott is the lead course developer and led the clinical trial to examine its effectiveness.

"Something that was important to us was ensuring the course could help a sample of real people who might present to GPs with insomnia, not just people who meet the relatively narrow criteria to be allowed into a clinical trial, " Dr. Scott says.

"Many clinical trials for insomnia treatment exclude people on the grounds that they might not have had a severe enough score when they were screened, or they might have other mental or physical health conditions, or other sleep conditions like sleep apnea. They might be shift-workers, or they could be taking some type of prescribed sleep medication.

"We didn't exclude anyone from our trial, and we found that everyone benefitted, on average reporting their sleep quality had improved by 40%.

"We found the group of people who were taking sleeping medications during the treatment showed less improvement than other participants, but they did still benefit from the course.

"Our oldest participant was an 85-year-old lady who she said she had gone from decades of insomnia to getting a consolidated, seven-hour block of sleep each night."

While the total amount of sleep participants got did not change dramatically, the big difference was that they were sleeping in longer blocks and spending less time awake in bed.

Another key benefit was a 35% improvement in symptoms of depression and a 23% improvement in symptoms of anxiety across the trial group—an important finding, as sleep disturbance is common among people with depression and anxiety.

About 40% of trial participants also opted to receive telephone support with a psychologist alongside the course.

Building a different relationship with sleep

Dr. Scott says the course encourages people to look at their sleep differently: less in terms of the number of hours they are getting, but how much of their time in bed is spent sleeping.

One of the key ingredients of CBT-I is sleep restriction therapy, which involves temporarily shortening the amount of time someone allows themselves to sleep.

This might involve waiting until midnight to go to bed and getting up at 6am on the dot the next morning.

While it sounds tough, it is an effective process, Dr. Scott says. The brain learns to fill a smaller window of time with more continuous and better-quality sleep, and importantly, it results in less time spent in bed awake.

Once it has worked, you gradually give yourself a larger sleep window.

"People with insomnia often find themselves lying awake for hours, trying hard to fall asleep and becoming increasingly frustrated or anxious, " Dr. Scott says.

"We know that putting effort into falling sleep has the opposite effect. The course helps people shift how they think about this time, so it's no longer a battleground, but something they can respond to more calmly and constructively.

"Many people believe they need eight uninterrupted hours every night, but most of us don't sleep that way, and don't need to. We all wake up many times overnight.

"What matters more is how you respond to those wakeful moments. I think the course helps people feel less panicked and more in control."

Tips for a better night's sleep

The Sleep Course is now available free of charge at MindSpot. MindSpot offers digital mental health assistance for a range of conditions, including depression, anxiety, OCD and chronic pain.

This content was originally published on The Macquarie University Lighthouse.