Users of online insomnia program SHUTi reported better sleep in 25 studies, in a review led by its developers

The treatment that guidelines put first for chronic insomnia is a form of talking therapy, and for most people with insomnia it is hard to get. One answer has been to turn the therapy into software. A new review gathers the published research on one of the most-studied such programs, an online course called SHUTi.

Across 25 studies and more than 14,000 people, those given the program reported much less severe insomnia afterward, and they improved more than people given online information about sleep. The gap held for a year. The review was written by researchers who include the program’s developers, every result rests on what participants reported about their own sleep, and about a third of people did not complete a full dose of the course.

Why an online insomnia program was built

The therapy in question is cognitive behavioral therapy for insomnia, or CBT-I. It is a structured course that changes the habits and thoughts that keep insomnia going. In the United States, the American College of Physicians (ACP) put it at the top of its 2016 guideline. ACP recommends that all adult patients receive cognitive behavioral therapy for insomnia (CBT-I) as the initial treatment for chronic insomnia disorder, the guideline states.

The obstacle is supply. A 2016 trial report put it bluntly: there is a paucity of trained clinicians to deliver this much needed treatment. Paucity means shortage. An independent review the same year made the same observation, that in-person treatment is often unavailable.

SHUTi, which stands for Sleep Healthy Using the Internet, was one response. It was developed at the University of Virginia (UVA). “It’s our program that we began developing almost 20 years ago,” Lee Ritterband, a UVA professor and one of the program’s creators, said in a university interview last year. Ritterband explained the reasoning: the therapy works, but it is not widely accessible because there are not a lot of people trained to provide it.

The 2016 trial report described the program as it was then. It was a 6-week fully automated, interactive, and tailored web-based program built on the main elements of face-to-face therapy. Fully automated means no therapist is involved. In Ritterband’s description, it includes sleep restriction, stimulus control, cognitive restructuring, sleep hygiene and relapse prevention. Sleep restriction means limiting time in bed to roughly the hours a person actually sleeps, so that sleep becomes more solid. Stimulus control means using the bed only for sleep, so that bed and wakefulness stop going together. Cognitive restructuring means examining and changing unhelpful beliefs about sleep.

Users keep a daily record of their sleep, and the program uses it to set a schedule for each person.

Who reviewed the insomnia program

The review was published on October 7 in the journal Sleep. Its first author is Kelly Shaffer and its last author is Ritterband. Other authors include Frances Thorndike and Charles Morin, who also worked on the program’s main trials.

Readers weighing the result need to know that the authors are not bystanders. A UVA statement issued with the 2016 trial said the program was available through BeHealth Solutions, which it described as the company that licenses SHUTi and its software platform from UVA. It went on: Ritterband, Thorndike, Gonder-Frederick and Morin have equity ownership in BeHealth Solutions. Equity ownership means holding shares. Three of those four are authors of the new review. That disclosure is ten years old and described the position in 2016.

More recently, Ritterband told the university’s interviewer that the program had moved further into commerce. “The software has been licensed and the commercial product, Somryst, has been authorized by the FDA,” Ritterband said. The FDA is the US Food and Drug Administration.

None of this makes the pooled numbers wrong. It does mean the review is the developers’ account of their own program’s record.

How the review of the insomnia program worked

The authors describe SHUTi as among the most-studied digital Cognitive Behavioral Therapy for Insomnia programs, and set out to summarize two decades of work on it.

They searched four databases up to October 7, 2025, for English-language primary, empirical reports of the effects of SHUTi on three measures of sleep. All three are reported by the sleeper.

The first is the Insomnia Severity Index (ISI), a seven-question form about trouble sleeping and its effect on the day. A trial of the program explains that ISI scores range from 0 to 28 with the following clinical cutoffs: up to 7 means no insomnia, 8 to 14 mild symptoms below the threshold for a diagnosis, 15 to 21 moderate insomnia and 22 or more severe insomnia.

The other two come from sleep diaries, which are daily logs kept by participants. Sleep onset latency is the time it takes to fall asleep. Wake after sleep onset is the time spent awake during the night after first falling asleep.

Twenty-nine publications reported unique data from 25 studies, with 14,166 participants in total. The studies had tested the program among diverse populations from around the world. Ritterband has said that studies in Canada, Norway, Denmark and Australia have all shown the treatment meaningfully reduced insomnia.

The team then did two things. They averaged how much people given the program changed from before to after. And they ran a meta-analysis, a pooling of results from separate studies, on the 10 randomized trials that had compared the program with online education. Randomized means chance decided who received which. In the 2016 trial, for example, the education website provided nontailored and fixed online information about insomnia.

What the review found about the insomnia program

People given the program improved on every measure. From the start of a study to its follow-up points, average scores on the insomnia index fell by 8 points or more. Time to fall asleep dropped by 21 minutes or more. Time awake in the night dropped by 27 minutes or more, or 35 minutes or more when waking too early in the morning was counted.

Those are before-and-after changes. People tend to enroll in an insomnia study when their sleep is at its worst, and some improvement follows whatever they are given. The fairer test is the comparison with the education groups.

There, the program still came out ahead. Across the 10 trials with an education group, the paper says, SHUTi participants reported greater improvements from baseline through post-assessment and 6- and 12-month follow-ups. Baseline means the starting measurement, and post-assessment means the measurement at the end of the course.

The review expresses the gap as a standardized mean difference, a way of putting results from different studies on one scale by dividing each difference by how much scores vary. By convention, 0.2 counts as small, 0.5 as medium and 0.8 as large. For insomnia severity the difference ran from 0.85 to 1.03 across the time points, which is large. For time to fall asleep it was 0.32 to 0.41, and for time awake in the night 0.45 to 0.48, which are small to medium.

So the program’s clearest effect was on how people rated their insomnia overall. Its effect on the minutes recorded in their diaries was more modest.

Not everyone stayed the course. The review reports its uptake figure in one line, with 64% completing a full therapeutic dose of SHUTi. A therapeutic dose here means enough of the course to be expected to work. That leaves about one in three who did not get that far.

The authors also tested whether participant and study characteristics moderated effects, meaning whether the program worked better for some groups than others. Their conclusion is that it worked across medically, psychiatrically, and demographically diverse samples.

What single trials and other reviews of online insomnia therapy show

Individual trials show what the pooled figures mean in points.

The 2016 US trial is the one most often cited. Altogether, 303 adults with chronic insomnia self-referred to participate, and 151 were assigned to the program and 152 to online education. A year later, of the program group members who supplied data, 56.6% (69 of 122) had scores in the no-insomnia range. That share describes the program group on its own. Over the year, the trial’s comparisons of the two groups favored the program.

A large trial of this kind of program was run in Norway, with Thorndike and Ritterband among its authors. It randomized 1,721 adults to a fully automated six-session online course or to online education about sleep. After nine weeks, average scores on the insomnia index had fallen from 19.2 to 10.4 in the course group and from 19.6 to 15.2 in the education group. The difference between groups was 4.7 points, with a range from 4.1 to 5.4. Participants were masked to group assignment and had no contact with researchers during the intervention period. Masked means they were not told which version was the one under test.

A version for older adults was tested last year. In that trial 311 participants (ages 55-95) were randomized to three groups: 105 to the program alone, 102 to the program with an added support protocol and 104 to online education. Both groups given the program reported less severe insomnia than the education group for a year.

Reviews by other research groups put the benefit of internet therapy in a similar place. One team pooled 15 trials of various online programs in 2016. Internet therapy resulted in a decrease in the insomnia severity index by 4.3 points compared with control groups. A larger pooled analysis of digital programs, published this year, went wider. The analysis (73 RCTs, 14,465 participants) identified a non-linear dose-response relationship between the length of a digital course and its benefit. In plain terms, the benefit grew with total course time and then leveled off, beyond about 300 minutes. RCTs are randomized controlled trials. The largest effect it estimated was 5.77 points on the index against control.

Set beside those figures, the before-and-after drop of 8 points in the new review is larger than the gain over a comparison group that independent reviews find for digital programs. That is expected, because comparison groups improve too.

What the insomnia program review cannot show

The reviewers are the developers. The review was led from the group that built the program, and authors of it have held a financial interest in the company selling it. Its pooled results are in line with independent reviews of internet therapy in general.

Everything is self-reported. Insomnia is defined by how a person experiences sleep, so self-report is the standard measure. Still, none of the pooled outcomes was measured by a device. UVA’s 2016 statement said of that trial that the measure of effectiveness was based on experiences self-reported by study participants rather than a measurement of time spent sleeping.

The comparison was with education. The trials show the program beats reading about sleep online. They do not show how it compares with a therapist, with other apps or with sleeping pills. The 2016 review of 15 trials found no clear differences for internet-delivered versus in-person therapy with a trained therapist on the measures it pooled.

A third fell short of a full dose. The figure of 64% completing a full therapeutic dose leaves a large minority who stopped early. In the trial in older adults, 63% (n = 131) completed all six SHUTi Cores within the nine-week course period. That is 131 people, and Cores is the name for the program’s six parts.

Who took part. In the main US trial, participants referred themselves. The trial in older adults listed as a weakness its lack of diversity in terms of ethnicity, race, and education, which diminishes generalizability. Generalizability means how far results apply to other people.

English-language reports only. The search was limited to papers in English.

Whether an online program, a therapist or another approach suits a particular person with insomnia is assessed by their doctor.

Twenty years of studies show people given this program report better sleep than people given sleep education pages, on the evidence of the team that made it.