Accepted for/Published in: JMIR Mental Health
Date Submitted: May 30, 2022
Date Accepted: Sep 30, 2022
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Effectiveness of an app-based short intervention to improve quality of sleep: Randomized Controlled Trial
ABSTRACT
Background:
A growing body of evidence for digital interventions to improve sleep quality shows promising effects. The interventions investigated so far have been primarily web-based, while app-based interventions that may reach a wider audience and be more suitable for daily use.
Objective:
The aim of this study is to evaluate the intervention effects, adherence and acceptance of an unguided app-based intervention for individuals who wish to improve their sleep.
Methods:
In a randomized controlled trial, we evaluated the effects of an app-based short intervention (Refresh) to improve sleep quality compared to a waitlist condition. Refresh is an eight-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 as self-assessed by the Regensburg Insomnia Scale (RIS). Secondary outcomes were depression (PHQ-9 score) and perceived sleep-related impairment.
Results:
We included 371 participants, of which 245 reported poor sleep quality at baseline. About one in three participants who were allocated to the intervention group never accessed the intervention. Active participants completed on average four out of eight chapters. Retention rates were 67% (n=250) at post-intervention and 56% (n=214) at six-month follow-up. At post-intervention, sleep quality in the intervention group had improved more than in the waitlist group, with a small effect (d=.26) in the whole sample and a medium effect (d=.45) in the subgroup with poor sleep quality. Effects in the intervention were maintained at follow-up, while in the waitlist group sleep quality continued to improve during the follow-up period. Perceived sleep-related impairment also improved from pre- to post-assessment. No significant intervention effect on depression was detected. Working alliance and acceptance were moderate to good.
Conclusions:
An app-based, unguided intervention is a feasible and effective option to scale up CBT-I based treatment. Intervention uptake and adherence need to be addressed in future studies. Clinical Trial: ISRCTN53553517
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