Digital CBT Tools Offer a Scalable Solution to Geriatric Insomnia

As the U.S. healthcare system contends with rising demand from an aging population, digital behavioral health interventions are stepping into gaps that traditional delivery systems cannot easily fill. A recent clinical trial of SHUTi OASIS, a fully automated, online cognitive behavioral therapy (CBT) program for insomnia tailored to adults over age 55, demonstrates the promise of digital therapeutics for chronic sleep disorders in older adults.

Developed by researchers at the University of Virginia School of Medicine, SHUTi OASIS (Sleep Healthy Using the Internet for Older Adults Suffering with Insomnia and Sleeplessness) showed clinically meaningful results across multiple endpoints. Trial participants using the tool reported improved sleep quality, reduced nighttime wakefulness, and higher remission rates when compared with those who received standard online sleep education. These improvements were sustained not only at the end of the trial, but at 6- and 12-month follow-ups.

At a time when access to licensed behavioral sleep specialists is constrained by geography and cost, SHUTi OASIS offers a pathway to scale a previously inaccessible standard of care.

Digital Access to Behavioral Sleep Interventions

Cognitive behavioral therapy for insomnia (CBT-I) is considered the gold standard of non-pharmacological treatment, supported by decades of research and endorsed by the American College of Physicians. Yet access remains uneven. Many primary care settings lack behavioral health integration, and in rural or under-resourced regions, board-certified sleep clinicians are rare.

SHUTi OASIS attempts to bridge this gap by delivering CBT-I in a self-guided, online format. According to the trial, which enrolled more than 300 adults between the ages of 55 and 95, the program succeeded in reducing both the subjective and objective markers of insomnia, without requiring in-person support or ongoing clinical supervision.

The significance here is not just clinical but infrastructural. Programs like SHUTi can serve large populations without drawing on scarce provider time. This distinction is critical in the context of aging demographics, where the volume of need routinely outpaces workforce growth.

Adapting CBT-I for Older Populations

Geriatric insomnia often resists simple treatment. For many older adults, disrupted sleep is chronic and intertwined with comorbidities such as depression, arthritis, or neurological decline. It also carries higher stakes. Poor sleep is associated with increased risk of falls, cognitive impairment, and cardiovascular events in older adults.

Tailoring CBT-I to this population requires more than just slower pacing or larger font sizes. It demands adaptations in content tone, pacing, cognitive load, and device usability. The SHUTi OASIS team, led by Dr. Lee Ritterband at UVA’s Center for Behavioral Health & Technology, explicitly designed the program with these age-related needs in mind.

Their success is measurable. Nearly one-third of trial participants were age 70 or older, and most required little to no technical assistance to complete the intervention. This challenges prevailing assumptions that older adults are less able to engage with digital therapeutics, especially when the interface is thoughtfully constructed.

Cost Efficiency Without Clinical Compromise

Digital therapeutics are often framed as tradeoffs, lower cost, wider reach, but potentially less precision. SHUTi OASIS complicates that narrative by delivering outcomes comparable to in-person care. Prior versions of SHUTi have been validated in adult populations; this study marks the first rigorous evidence base for its geriatric-specific adaptation.

As sleep medications remain widely prescribed, despite long-term risks for dependency and cognitive impairment, digitally delivered CBT-I could offer health systems a safer, more sustainable alternative. This is especially relevant in Medicare Advantage populations, where quality measures increasingly reflect behavioral health integration.

From a financial perspective, the ability to deliver a complete CBT-I protocol without therapist involvement could dramatically reduce per-patient treatment costs. According to a RAND analysis, the average cost of face-to-face CBT for insomnia ranges from $400 to $1,200 per patient, depending on the setting and number of sessions. SHUTi OASIS offers a scalable alternative, particularly for health systems or payers seeking to expand sleep care access without adding FTEs.

Implications for Digital Therapeutics Policy

As digital health solutions move from novelty to infrastructure, their regulatory and reimbursement status is under increasing scrutiny. SHUTi OASIS, like other evidence-based digital therapeutics, may eventually seek FDA clearance under the Software as a Medical Device (SaMD) framework. Meanwhile, its utility in public health strategy could inform future policy decisions around Medicare coverage or quality reporting.

The clinical validation of SHUTi OASIS also reinforces the importance of differentiating between consumer wellness apps and formally studied digital interventions. While the app marketplace is saturated with sleep trackers and meditation tools, few have undergone randomized clinical trials or achieved sustained outcomes in aging populations.

The distinction is vital for payer adoption. As CMS explores value-based models for behavioral health, programs like SHUTi offer a template for low-cost, high-impact interventions that meet the dual test of evidence and accessibility.

Reframing Insomnia as a Scalable Public Health Target

Sleep is often marginalized in the larger conversation around geriatric care. It is treated as a symptom to be endured, rather than a modifiable risk factor. SHUTi OASIS reframes that assumption, positioning insomnia as both a legitimate target for intervention and a solvable problem through digital scale.

As the population ages and demand for non-pharmacologic solutions grows, scalable tools like SHUTi will become essential infrastructure for behavioral health strategy. The burden of insomnia is measurable. Now, so is the relief.