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Computerized cognitive behavioral therapy for insomnia reduces subjective overreporting of sleep onset latency in veterans with moderate-to-severe traumatic brain injury

In 36 veterans with insomnia and moderate-to-severe TBI, cCBT-I (SleepEZ program) decreased the discrepancy between subjective and objective sleep onset latency, driven by improvements in subjective but not objective sleep measures. Sleep efficiency discrepancies grew larger post-intervention due to subjective improvements without corresponding objective changes.

Last updated: Jul 23, 2026•1 RCTs•📖 Read as article →

Evidence Score

Evidence Score42/100
Human RCT★★☆☆☆
Meta-analysis☆☆☆☆☆
Mechanism★★★★★
Safety★★★★☆
Confidencelow

Study Evidence

Study 1. Changes in Subjective-Objective Sleep Discrepancies Among Participants With Post-acute Moderate-to-Severe Traumatic Brain Injury Following Computerized Cognitive Behavioral Therapy for Insomnia.

observational

Reis DJ, Sullan MJ, Kinney AR, Mingils SM, Stearns-Yoder KA, Brenner LA · The Journal of head trauma rehabilitation (2026)

Participants: N/A
Duration: 8 weeks
Intervention: Computerized cognitive behavioral therapy for insomnia (cCBT-I) via the SleepEZ program, primarily self-guided with adjunctive clinician assistance
Outcome: Subjective-objective sleep discrepancies for total sleep time, sleep onset latency, waking after sleep onset, early morning awakening, and sleep efficiency
Effect Size: N/A
Population: United States veterans aged 18-60 years with current insomnia and a history of moderate-to-severe traumatic brain injury (N=36)

Result:

PubMed: 42441739DOI: 10.1097/HTR.0000000000001196

Mechanism Graph

cCBT-I improves subjective sleep perception
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Subjective sleep onset latency overreporting decreases
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Objective sleep measures do not improve correspondingly
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Result: Sleep efficiency discrepancy increases

Limitations

  • ⚠Secondary analysis of intervention-arm data only, no control group comparison
  • ⚠Small sample size (N=36) limits generalizability
  • ⚠Actigraphy collected only during initial and final weeks, not throughout entire intervention

Frequently Asked Questions

What is the SleepEZ program?▼

SleepEZ is an online, primarily self-guided computerized cognitive behavioral therapy for insomnia program, with adjunctive assistance from a study clinician.

Did cCBT-I improve objective sleep measures in TBI patients?▼

No, objective sleep measures (actigraphy) did not show corresponding improvements, leading to larger discrepancies in sleep efficiency.

What sleep parameters showed the largest discrepancies at baseline?▼

At baseline, participants overreported sleep onset latency and early morning awakening, but greatly underreported waking after sleep onset, resulting in higher total sleep time on diaries compared to actigraphy.

Why is concurrent use of subjective and objective measures recommended?▼

Because subjective and objective sleep measures often disagree; using both provides a more complete picture of sleep health, especially after moderate-to-severe TBI.

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References

  1. 1.Reis DJ, Sullan MJ, Kinney AR, Mingils SM, Stearns-Yoder KA, Brenner LA. "Changes in Subjective-Objective Sleep Discrepancies Among Participants With Post-acute Moderate-to-Severe Traumatic Brain Injury Following Computerized Cognitive Behavioral Therapy for Insomnia.." The Journal of head trauma rehabilitation, 2026. PMID: 42441739 DOI: 10.1097/HTR.0000000000001196
Disclaimer: This content is for educational purposes only and is not medical advice. Evidence scores reflect the quality and quantity of available research, not clinical recommendations. Always consult a healthcare professional before starting any supplement or intervention.