Counting sheep isn’t putting you to sleep? Are stress and worries keeping you up at night?

Many people have heard the advice of unplugging from technology to help fall asleep. This means not checking your smart phone or channel surfing as you settle down for a good night’s rest.

A new program that’s been successfully piloted at the University of Iowa turns that notion on its head, instead, using technology to actually improve sleep efficiency.

The program, SHUTi, which stands for Sleep Healthy Using the Internet, is a six- to eight-week online program that is available at no cost to eligible UI employees with 50 percent or greater regular employment.

The UI Employee Assistance Program is offering the new program to help people who are experiencing trouble with sleep. People do not need a medical diagnosis of insomnia to participate.

Faculty and staff participated in a pilot of SHUTi last year. Of the estimated 55 faculty and staff who expressed an interest in participating in the pilot, 29 met criteria to be screened for the program. The majority of those who finished the pilot program reported significantly improved sleep efficiency.

Combating public health issue

Not getting enough shut-eye is recognized as a major public health issue.

“Our brain is very sophisticated, and it can keep us awake,” says Maggie Moore, director of Faculty and Staff Services/Employee Assistance Program. “We wanted to offer a program to improve sleep efficiency and help people feel better and be healthier. Our quality of sleep has a profound impact on our overall quality of life.”

The UI Integrated Health Management Advisory Group started looking at the issue seriously about five years ago. As a result, efforts are underway to improve awareness of the importance of sleep and create tools that can assist with improving sleep.

In fact, according to the Centers for Disease Control, sleep inefficiency is linked to motor vehicle crashes, industrial disasters, and medical and other occupational errors.

People experiencing sleep inefficiency are also more likely to experience chronic diseases such as hypertension, diabetes, depression, and obesity as well as cancer, increased mortality, and reduced quality of life and productivity.

How does it work?

SHUTi is a comprehensive, step-by-step self-training program that has been shown to improve sleep for adults with insomnia. It is not recommended for shift workers.

The program is based on principles of Cognitive Behavioral Treatment (CBT) for Insomnia, which has repeatedly been shown to be one of the most effective treatments for insomnia. And, in contrast to the improvements seen with medications, the beneficial effects of CBT for insomnia may last well beyond the end of treatment. The National Institutes of Health concluded in 2005 that CBT-I should be one of the first treatment choices for insomnia.

Modeled after highly successful face-to-face CBT techniques, SHUTi is organized into structured, weekly sessions. Each week a new concept is introduced, and all are completed online from the privacy and convenience of home. The program includes an introductory overview, sleep restriction, stimulus control, cognitive restructuring, sleep education, and relapse prevention.

The program starts with a tutorial to provide an overview of the program. Participants will begin with an overview session to help evaluate their own sleep problems and treatment goals.

Each session, or core, focuses on specific methods for improving the quantity and quality of people’s sleep.

Each of these cores takes about 45 to 60 minutes to complete. Once people have completed a core, they will work over the next seven days to incorporate the strategies and techniques they have learned into their daily routine. Then, a new core will be unlocked. Participants will be able to review their completed cores and print out helpful materials for the full length of their subscription.

Every day, participants will be asked to complete a short, three-minute online daily sleep diary, allowing SHUTi to make personalized recommendations. Weekly graphs will help people understand their personal sleep improvement progress.

SHUTi works by way of improving overall sleep efficiency by reducing the amount of time an individual spends in bed awake. A “sleep window” is calculated based on data gathered from the individual’s sleep diaries. The window is then expanded when efficiency improves. Prior studies suggest that approximately 73 percent of participants with clinically severe or moderately severe insomnia had no clinical insomnia after completing the program.

Benefits of SHUTi

In addition to improving sleep efficiency, SHUTi also helps people address thoughts related to poor sleep and how those thoughts can actually decrease one’s ability to sleep. 

SHUTi was developed at the University of Virginia with funding from the National Institutes of Health and has been empirically validated. 

The studies found that adults with chronic insomnia who received SHUTi:

• Decreased the severity of their insomnia
• Awoke fewer times at night
• Decreased the number of minutes they were awake during the night
• Improved the overall efficiency of their sleep, meaning they were asleep more of the time they were in bed
• Felt less tired (more rested, more energy) during the day
• Improved their overall quality of life (including feeling less depressed, less anxious)
• 73 percent of adults reported no longer having insomnia after using SHUTi

“We were very pleased with how much our pilot participants benefited from the program as well as how well our current participants are doing.”  Moore says, “The results are very similar to the results from the original research, which is quite exciting.”