Usability and Acceptability of Digital Cognitive Behavioural Therapy for Insomnia (Sleepio) in People with Cognitive Impairment: A Mixed-Methods Study

Insomnia and dementia are major public health issues. Although cognitive behavioural therapy for insomnia (CBT-I) is the recommended first line treatment for insomnia, few studies have examined its usability or effectiveness in people with cognitive impairment. Digital CBT-I (dCBT-I) is an effective and easily accessible alternative to CBT-I. We undertook a mixed-methods analysis of the usability and acceptability of dCBT-I (SleepioTM) in patients attending a memory clinic. Participants were community dwellers aged ≥50 years with insomnia (Sleep Condition Indicator score ≤ 16) and subjective cognitive decline (SCD), mild cognitive impairment (MCI) or dementia. The Mobile Device Proficiency Questionnaire (MDPQ) assessed digital literacy. The System Usability Score (SUS) and Usability Metric for User Experience–Lite (UMUX-Lite) assessed usability. Acceptability was assessed by analysing adherence to the intervention and subjective reports of perceived benefit. Both usability and acceptability were further explored in semi-structured interviews. Among 24 participants (median age 69; 17 females), 2 had SCD, 14 MCI, and 8 dementia. Overall response to SleepioTM was positive. Participants favoured relaxation-based aspects of the programme. Behavioural elements, such as sleep restriction, were generally less favoured. Lack of digital literacy was the main barrier to engagement, though this could be surmounted by assistance from caregivers or family members in certain instances. Regardless of cognitive status, those with above-average digital literacy (MDPQ > 20) undertook a median 6/6 sessions, while those with below-average digital literacy (MDPQ < 20) undertook a median 3/6 sessions. Among those with above-average digital literacy, median SUS and UMUX-Lite were 72.5 and 75, respectively, representing acceptable usability, while overall scores were 63.75 and 56.25, respectively, representing marginally acceptable usability. Our findings may suggest that SleepioTM is usable and acceptable for people with SCD, MCI and selected individuals with mild dementia, particularly where digital literacy is preserved. Additional caregiver support may facilitate usability among people with MCI and lower digital literacy. Usability appears limited in more advanced dementia. However, as some subgroups were small, more research is required to confirm these findings.