Discussion
napping, insomnia
MUSCLE RELAXATION
This pilot randomized clinical trial found that the smartphone-based, Chinese culture-adapted DCBT-I app reduced the severity of insomnia (measured with ISI scores) and improved sleep quality (assessed via sleep diary) compared with a sleep education control provided via the same app. The DCBT-I app has several features to adapt to Chinese culture, communication, and lifestyle. Regarding language expressions, we applied a contextually appropriate and easily understandable verbal communication style to facilitate interaction with participants and foster a better understanding of the treatment. Furthermore, the behavioral and cognitive guidance was provided in a manner congruent with the Chinese lifestyle and introduced some localized activities. For example, in the stimulus control section, some activities, such as knitting sweaters and traditional Chinese calligraphy, were added to the suggested activities to be performed by the participants outside of their beds when they could not sleep. In the relaxation section, the study app arranged the progressive muscle relaxation practices at noon instead of in the afternoon, when most people in China are accustomed to napping, since taking a nap might reduce sleep motivation at night. In the cognitive and stimulus control section, a traditional Chinese concept holds that “Zi Wu sleep” is beneficial to health. Zi Wu sleep suggests that people need to go to sleep for the night by 11 The chatbot format is another prominent feature of the app. The communication interface of the chatbot used a convenient and friendly question-and-answer format, rather than using full pages of text or completing forms. The study app presents as a virtual sleep therapist by simulating the language expressions of a real-world therapist through a chat tone, which could facilitate patients’ trust and acceptance of the intervention. The information collected for the sleep diary and all interventions are given in this kind of chatbot form.This study established a sleep education control that used the same app as the intervention group. To our knowledge, this is the first RCT in which the control group received sleep education provided using the same interface as an intervention. The use of the same app allowed this study to be single-blinded. In previous studies, content for the sleep education control was obtained from a website, which was available all at once, and a user could access the full site content at any time during the intervention.Sleep diaries are the main method for subjective sleep quality assessment. Similar to previous studies,This study had good adherence and a low rate of attrition, with 93.9% of participants completing treatment and 89.0% of participants completing the 6-month follow-up. Previous studies have reported attrition rates of 20 to 45%. For example, a 2016 study