**4.2. CBT-I Coach**

CBT-I Coach is a smart-device app that can be used for insomnia. The app is available for iOS and Android platforms, and as of February 2016, it has been downloaded over 80,000 times. CBT-I Coach was developed by the United States Department of Veterans Affairs to support their clinician-guided CBT-I program. One of the major components of CBT-I Coach is keeping a Sleep Diary. The app has a diary function built in to keep track of sleep behaviors. The diary function includes drop down menus and places to enter text to facilitate documentation of sleep quantity and quality. The app also includes the Insomnia Severity Index (ISI) scores so the patient can keep track of their progress without visiting their clinician. The app can plot the quantitative diary data and ISI scores graphically so the user can easily see change over time. Both the diary and ISI scores can be sent to the user's clinician to provide a more comprehensive picture of patient progress. Users can set up notifications to remind them to fill out their diary. CBT-I Coach also has extensive educational material, recommendations for sleep hygiene and stimulus control, dynamic checklists to encourage health habits and prevent relapse, audio-guided relaxation exercises, and tools for cognitive restructuring [40].

While the CBT-I program has been studied extensively and has been shown to decrease insomnia symptoms and improve sleep efficiency, fragmentation, and onset latency [41–49], there has been little formal review of the CBT-I Coach app itself. A small pilot RCT assessed the app for feasibility, acceptability, and effects on adherence and sleep outcomes. All participants found the app helpful, and greater than 50% used the educational materials and reminders in the app [50]. Another study survey CBT-I clinicians prior to releasing CBT-I Coach and again 2 years after its release. Before the release of the app, clinicians thought that the app was at least moderately likely to improve care, and most (87%) intended to use the app. 2 years after the release of the app, ~60% of clinicians reported using the app and thought it improved homework adherence and outcomes [40].
