Case Study

Intelligent cognitive behavioral therapy for insomnia

2023/08/17
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This project aims to develop an intelligent cognitive behavioral therapy for insomnia (CBT-i) on mobile devices for insomnia disorder patients. This project aims to develop a solution that, combined with smart wearables, provides dynamic quantitative monitoring and personalized intervention of sleep, cognitive functions, and behavior.

Submitted by

Digital Health Team, Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University on September 2, 2022

Context

According to a report published by the China Sleep Research Society in 2022, more than 300 million people in Chinese have insomnia. This disorder has become an important physical and mental health issue affecting large numbers of people across many age groups. 80% of brain diseases, such as Parkinson’s disease, dementia, and depression, are associated with sleep quality, duration, and changes in sleep duration and circadian rhythms. Cardiovascular and cerebrovascular health and immunity are also associated with the aforementioned factors.

CBT-i is an intervention method for insomnia recommended by international experts (Espie et al., 2019). CBT-i includes cognitive interventions, behavioral interventions, sleep hygiene education, and relaxation training. It can generate lasting impacts but is slow to take effect. Patients find it difficult to adhere to it, and the therapy compliance is low. Currently, CBT-i is usually carried out through outpatient interviews and inpatient treatment, which have time and space constraints that hinder treatment for large numbers of patients.

In recent years, as Internet technologies develop, digital CBT-i on intelligent mobile devices has garnered more attention. This type of digital therapy is built on traditional CBT-i. Video courses, online consultations, and electronic sleep logs are used to provide digital CBT-i. This assists doctors by making remote intervention and remote patient management possible. However, digital CBT-i, which lasts 6–8 weeks, has a fairly high dropout rate (about 36% in 4 weeks and more than 50% in 8 weeks), because the therapy is long, takes effect slowly, and there is no offline intervention. In addition, digital CBT-i intelligently adjusts the traditional 6–8 week therapies according to the doctor’s prescription, but it cannot trace dynamic cognitive behavioral data such as that related to an individual’s circadian rhythm, nor can it be effectively combined with quantitative assessment methods of cognitive functions, psychology, and behavior. Therefore, digital CBT-i cannot be provided to large-scale populations in a personalized manner. The key to overcoming the constraints of remote treatment of insomnia is to develop intelligent CBT-i based on individual digital profiles and personalized insomnia interventions suitable for large-scale populations.

Benefits

According to an epidemiological survey by the Ministry of Health in 2018, 38% of China’s population suffers from sleep disorders, higher than the world average of 27%. More than 500 million people in China have sleep problems such as difficulty falling asleep, poor sleep quality, and sleep rhythm disorders. Sleep disorders have a serious impact on public health and quality of life, and threaten workplace safety

Sleep disorders affect 45.5% of people over 60 and 56.7% of people over 80. In recent years, sleep problems have also become increasingly prevalent in younger populations. Young people’s sleep disorders result from mood fluctuations such as anxiety and irritability caused by stress from work and life. According to the 2020 China Sleep Index Report and the 2021 Exercise and Sleep White Paper released recently by the China Sleep Research Association, 69.3% of young people have sleep problems such as difficulty falling asleep and sleep procrastination. The number of people with insomnia increases year by year. This figure increased from 24.9% in 2018 to 36.1% in 2019. Less than 25.8% of people born in the 1970s and 1980s have deep sleep.

According to the China Sleep-health Market Analysis and Investment Prospect Research Report 2018–2023, the sleep-health industry in China was valued at about CNY279.7 billion in 2017, of which sleep supplements was valued at CNY12.8 billion, sleep medications CNY13.4 billion, sleep devices and supplies CNY250 billion, and sleep services CNY3.5 billion. At present, beddings, supplements, and intelligent wristbands account for the majority of China’s sleep aids market. Sleep and circadian rhythms are directly controlled by the brain, and there is a huge gap in the market regarding solutions leveraging the brain’s neural regulation of sleep. This project aims to develop a method that integrates cognitive, behavioral, and emotional regulation based on monitoring data collected from intelligent wristbands on sleep states, behavior, cognitive changes, and physiological indicators in real-time, in order to create a personalized intelligent therapy which is quantitative, long-term stable, and suitable for large numbers of people.

Sleep is essential to a healthy life. Addressing sleep problems has become a common need. The Fifth Plenary Session of the 18th CPC Central Committee made ”Healthy China” a national strategy. The 19th CPC National Congress set forth comprehensive measures to implement the Healthy China strategy, and pointed out that “the health of the people is a hallmark of the strength and prosperity of the nation.”

This project researches on how to use wearables for long-duration sleep monitoring, and how to leverage artificial intelligence algorithms and statistical models to assess sleep quality and predict the relationship between sleep and other chronic diseases such as cognitive decline, so as to develop intelligent sleep management solutions and intervention methods for improving sleep and cognitive health, and reducing the prevalence of cognitive impairment and other diseases caused by sleep disorders. This is essential for China in addressing the challenges to public health, socioeconomic development, and productivity improvement posed by an aging population.

Potential derived products include multi-dimensional databases of sleep states, behavior, cognitive changes, and physiological data of large numbers of people collected by intelligent wristbands; sleep state recognition and related disease prediction models based on big data mining; and brain-function-driven sleep intervention solutions based on cognitive and behavioral interventions. With previous R&D efforts and collected user data, this project aims to use artificial intelligence to develop an online, quantitative, and long-term stable “digital medication” for sleep disorders.

Solution or innovation detail

This project aims to develop the intelligent CBT-i. The R&D is built on a comprehensive method for evaluating circadian rhythm based on customized and dynamic monitoring by intelligent wristbands on behavior, cognition, and emotions. Using the multi-dimensional data, we aim to develop sleep profiles and personalized digital intervention solutions, realizing intelligent, quantitative, and stable sleep management and interventions.

(1) On top of traditional cognitive-behavioural therapies, we strive to develop a hierarchical intervention theory covering cognition, behaviour, and emotions for circadian rhythm regulation, and accumulate sleep-related quantitative data of physiological signals, motion signals, cognition, and behaviour to lay a theoretical and data foundation for the development of personalized intelligent intervention solutions.

(2) Based on the behavioral and physiological data during long sleep monitored by wearables, and the clinical cognitive evaluation data, we are developing artificial intelligence algorithms to create digital profiles for individuals that can describe the interactions between sleep abnormalities and cognitive, behavioral, and emotional functions. Based on these profiles, we are developing intelligent intervention solutions.

With the previous research efforts, the project team had completed the R&D of the following aspects.

(1) The theory and solution covering cognitive, behavioral, and emotional intervention;

(2) A digital therapy application that can be used together with intelligent wearables;

(3) A randomized controlled trial, which collected more than 350 subjects’ sleep-related

cognitive, behavioral, and emotional data over five weeks.

Intelligent comprehensive intervention system

Ecosystem

Digital sensing and intervention platform

This project focuses on a digital system for brain health supported by digital intervention, intelligent brain regulation, wearable-based quantitative monitoring, and big data modeling technologies. The project starts with the application of the digital CBT-i, and builds theory-and data-driven digital solutions for brain health to address functional brain disorders such as depression, cognitive impairment, and Parkinson’s disease. Following that, we aim to develop solutions for remote intelligent management, diagnosis, and treatment for brain health for large-scale populations.