JMIR Publications

ABSTRACT

Background:

Sleep disturbance and its daytime sequelae is a pervasive problem in adolescents and young adults (AYA), associated with negative mental health and academic outcomes. The sleep problems of AYA are complex and transdiagnostic, including delayed sleep phase issues, insomnia, hypersomnia and hypersomnolence. Effective interventions must be both evidence-based and tailored to the individual. AYAs have a preference for both self-management and digital approaches, and leveraging these preferences is helpful given the dearth of AYA treatment providers trained in behavioural sleep medicine. We involved AYA stakeholders in the co-design of a behavioural, self-management, transdiagnostic sleep app called Delivering Online Zzz’s with Empirical support (DOZE).

Objective:

The primary objective was to test the feasibility and acceptability of DOZE in a community AYA sample aged 15 to 24 years. A secondary objective was to evaluate sleep and related outcomes in this nonclinical sample.

Methods:

Participants (n=51) used DOZE for a period of 4 weeks in which they completed sleep diaries, received feedback on their sleep, set goals in identified target areas, and accessed tips to help them achieve their goals. Participants completed measures of acceptability and satisfaction at baseline and endpoint. Google Analytics data were used to understand patterns of app usage to assess feasibility. Participants completed questionnaires assessing fatigue, sleepiness, chronotype, depression, anxiety, and health-related quality of life at baseline and endpoint to evaluate changes in these clinical outcomes.

Results:

The app was appraised as highly acceptable on the items “easy to use”, “easy to understand”, “time commitment”, and “overall satisfaction,” and was rated as highly credible at pre- and post-test (i.e., treatment was “logical”; “confident treatment approach would work”, “confident recommending app to a friend”). Google Analytics supported that AYAs logged on frequently and completed the diary within 2 hours of waking and tracked most days in each 14-day period (Ms=10.52 and 9.81, respectively). The most common goals set were: decreasing schedule variability (41.0%), naps (20.5%) and lingering in bed in the morning (13.3%). The most frequent tips accessed were: how to wind-down before bed, how to help with being a night owl, and how to get up regularly in the P=morning. There were statistically significant improvements on indices of sleep disturbance including lingering in bed in the morning (P=.030), total time awake (P=.022), sleep efficiency (P=.002), and total sleep time (P = .031), as well as self-reported insomnia severity (P=.001), anxiety (P=.002), depression (P=.004), and energy/fatigue (P=.011).

Conclusions:

These results support the feasibility, acceptability and preliminary efficacy of DOZE, a free self-management, transdiagnostic sleep app. AYAs are able to set and achieve goals based on tailored feedback on their sleep habits, consistent with research suggesting that AYAs prefer autonomy in their healthcare choices and produce good results when given the tools to support their autonomy. Clinical Trial: NCT03960294