Effectiveness of an App-Based Short Intervention to Improve Sleep: Randomized Controlled Trial

• Published in: JMIR mental health Vol. 10; p. e39052
• Main Authors: Vollert, Bianka, Müller, Luise, Jacobi, Corinna, Trockel, Mickey, Beintner, Ina
• Format: Journal Article
• Language: English
• Published: Canada JMIR Publications 21.03.2023
• Subjects: Automation; Behavior; Clinical trials; College students; Health risk assessment; Health risks; Insomnia; Internet access; Intervention; Mental depression; Mental disorders; Original Paper; Quality of life; Self help; Sleep; Social networks; sleep; cognitive behavioral treatment for insomnia; eHealth; mobile app; insomnia
• ISSN: 2368-7959; 2368-7959
• DOI: 10.2196/39052

A growing body of evidence for digital interventions to improve sleep shows promising effects. The interventions investigated so far have been primarily web-based; however, app-based interventions may reach a wider audience and be more suitable for daily use. This study aims to evaluate the intervention effects, adherence, and acceptance of an unguided app-based intervention for individuals who wish to improve their sleep. In a randomized controlled trial, we evaluated the effects of an app-based short intervention (Refresh) to improve sleep compared with a waitlist condition. Refresh is an 8-week unguided intervention covering the principles of cognitive behavioral therapy for insomnia (CBT-I) and including a sleep diary. The primary outcome was sleep quality (insomnia symptoms) as self-assessed by the Regensburg Insomnia Scale (RIS). The secondary outcomes were depression (9-item Patient Health Questionnaire [PHQ-9] score) and perceived insomnia-related impairment. We included 371 participants, of which 245 reported poor sleep at baseline. About 1 in 3 participants who were allocated to the intervention group never accessed the intervention. Active participants completed on average 4 out of 8 chapters. Retention rates were 67.4% (n=250) at postassessment and 57.7% (n=214) at the 6-month follow-up. At postintervention, insomnia symptoms in the intervention group had improved more than those in the waitlist group, with a small effect (d=0.26) in the whole sample and a medium effect (d=0.45) in the subgroup with poor sleep. Effects in the intervention group were maintained at follow-up. Perceived insomnia-related impairment also improved from pre- to postassessment. No significant intervention effect on depression was detected. Working alliance and acceptance were moderate to good. An app-based, unguided intervention is a feasible and effective option to scale-up CBT-I-based treatment, but intervention uptake and adherence need to be carefully addressed. ISRCTN Registry ISRCTN53553517; https://www.isrctn.com/ISRCTN53553517.