Structured knowledge assessment to bridge big data with personalized sleep support

Poor sleep is one of the most common health problems. We don't know who responds best to which kind of treatment. By providing interventions online under supervision of experts, and meanwhile extensively assessing determinants of effectiveness, we can create a knowledge database that can guide future personally tailored effective sleep-improving interventions. This aim is made feasible by the newly established public private partnership of (1) the Sleep & Cognition group of the Netherlands Institute for Neuroscience; (2) the company 'Slaapmakend', representing the largest network of providers of face-to-face cognitive behavior treatment for insomnia (CBTI) in the Netherlands; and (3) the company Organiq, providing digital solutions for education and behavioural change by application of gamified new media.

Insomnia affects 1.7 million Dutch citizens (CBS 2018). Serious consequences for daily functioning cost about 10 billion/year due to absenteeism, reduced performance, medical expenses, etc. (Trimbos 2018). In the long term, these costs increase exponentially because insomnia increases the risk, exacerbates severity, hinders recovery and promotes relapse for almost every brain disorder. There is a strong unmet need for effective sleep-improving interventions, both to solve the acute problem and for prevention.

Although the best treatment on average is cognitive behavioural therapy for insomnia (CBTI), it is ineffective in 30%, and alleviates only half of the complaints in the others. New interventions like bright light and exercise are being proposed but effectiveness is unknown. Who responds best to CBTI and other treatments and with which health benefits, is unknown. This missing knowledge is essential for the effective roll-out of personalized treatment utilizing existing and novel interventions.

This project solved the bottleneck by creating this knowledge through a research platform for long-term monitoring of sleep, traits and health in large cohorts while offering eHealth interventions and evaluating determinants of their effectiveness.
In summary, the main conclusions of application of the built structured knowledge assessment platform were:

• Insomnia is highly present in people with any mental health issue and sleep interventions should be evaluated especially those with clinically relevant symptoms of SAD, PD, and PTSD.
• Guided online cognitive behavioral therapy for insomnia effectively reduces sleep complaints across people with any mental health issue. It moreover reduces the severity of symptoms of MDD, GAD, SAD and BPD, but is not effective enough to reduce the severity of symptoms of PTSD and PD.
• While universal implementation of guided online cognitive behavioral therapy for insomnia could provide significant benefits, adaptable content and flexible guidance may better meet individual needs.
• Limitations of current platform software implementation call for the development and implementation of a less costly and more robust and sustainable software platform.

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