Targeting hyperarousal to improve sleep: A network intervention analysis of a digital intervention for insomnia

Abstract

Objective: Digital cognitive behavioral therapy for insomnia (CBT-I) is an effective and scalable treatment for chronic insomnia. However, treatment outcomes are typically evaluated using aggregated symptom scores, which obscure differential effects on individual symptoms and limit insights into underlying mechanisms. This study applied network intervention analysis (NIA) to investigate how somnovia, a self-guided digital CBT-I intervention, is associated with changes in individual symptoms of insomnia, depression, and anxiety over time. Method: This secondary analysis used data from a randomized controlled trial including 290 adults with chronic insomnia who were randomized to somnovia plus treatment as usual or treatment as usual alone. Using item-level data from the Insomnia Severity Index (ISI), Patient Health Questionnaire–9 (PHQ-9), and Generalized Anxiety Disorder–7 (GAD-7) collected at baseline, 3 months, and 6 months, NIA was conducted to identify direct and indirect associations between treatment assignment and individual symptoms. Results: At 3 months, somnovia was primarily associated with reductions in sleep-related worry, dissatisfaction with sleep, and difficulties relaxing, indicating early effects on cognitive and physiological arousal processes. Improvements in other symptoms appeared to occur indirectly through these core arousal-related processes. By 6 months, treatment-related associations were more broadly distributed across the symptom network, consistent with generalized improvements extending beyond sleep-specific complaints. Conclusion: Together, these findings suggest that somnovia exerts its clinical effects by reducing hyperarousal as a central transdiagnostic process, through which improvements in insomnia may contribute to sustained benefits in broader mental health outcomes, including symptoms of depression and anxiety. Trial registration: ClinicalTrials.gov (NCT05558865).