The Economic Consequences of Improving Sleep among the Urban Poor through Cognitive Behavioral Therapy for Insomnia

Poor sleep is common among adults living and working in low-income urban settings, but there is little evidence on whether improving sleep changes health or economic outcomes in these contexts. Existing interventions have mostly tried to increase how long people sleep. This study instead evaluates a program that targets sleep quality. The program is adapted from Cognitive Behavioral Therapy for Insomnia (CBT-I), the standard non-drug treatment for insomnia in high-income countries, where it is typically delivered by trained clinicians over seven or more individual sessions. Our adaptation condenses the core content into four weekly group sessions, delivered through pre-recorded video modules and trained lay facilitators rather than health professionals, and is designed for low-cost delivery.
Working with the Busara Center for Behavioral Economics, we recruit approximately 300 adults aged 18 to 45 with insomnia symptoms, drawn primarily from informal settlements in Nairobi. Participants are randomly assigned to one of two groups. The treatment group takes part in the four-week adapted program. The control group attends sessions on the same weekly schedule and completes surveys and other activities with no sleep or health content. All participants wear a wrist-worn sleep tracker for part of the study period, with devices rotated across the sample so that objective sleep data are collected for every participant. Everyone completes surveys before and after the intervention period. We measure effects on sleep (insomnia severity and device-measured sleep quality and duration), mental health (symptoms of depression and anxiety), cognitive performance, and productivity measured through incentivized tasks administered during study visits.