Discussion
sleep disturbance, sleep disorder, anxiety, reductions in sleep disturbance, attention or learning new skills., insomnia, depression, active learning or behavior, sleep-related impairment
DISORDER
Many individuals without a diagnosed disorder experience poor sleep, and this can have serious health and economic consequences. Recently, there has been surge in use of smartphone-based audio tools to aid sleep by the general public, yet little is known about the effectiveness of such tools. This study reports on the feasibility and preliminary efficacy of two categories of audio-based tools for sleep, featured on the We were able to rapidly recruit a large sample of participants from the public who self-reported poor sleep at baseline using a validated screening measure. Participants self-reported significantly higher sleep disturbance and sleep-related impairment than population norms at baseline, including 40% impaired productivity whilst working due to poor sleep, despite not having a diagnosed sleep disorder. Participant retention and adherence were largely consistent with or higher than comparable studies. For example, only 6% of participants were lost at Post-intervention feedback ratings were largely positive, with 82.1% of participants reporting they were either “satisfied” or “very satisfied” with their allocated intervention, and 84.3% rating the quality of their intervention as either “good” or “excellent.” Ratings were similarly positive in the pragmatic waitlist group (who were given access to both interventions later). This is largely consistent with previous interventions evaluated on the Unmind MHapp [Despite being encouraged to engage with the interventions each night over 4 weeks, participants completed an average of 12.7 separate sessions (with substantial variability across participants), and 44% completed the predefined threshold for per protocol engagement (12 sessions). As expected, engagement was lower in the pragmatic waitlist group, who were not given specific instructions and were free to engage as little or as often as desired. Unfortunately, we were unable to gather meaningful feedback in this study from participants in the waitlist group who chose not to use Preliminary efficacy findings suggest that both interventions are associated with reductions in sleep disturbance and sleep-related impairment, with scores dropping from approximately 1 SD above population norms to normative levels, and between-group Hedge’s In addition to improvements in sleep, the interventions also had a significant beneficial impact on self-reported symptoms of depression and anxiety, work- and activity-related impairment, and mental well-being, with effect sizes in the medium range. This is consistent with a recent meta-analysis reporting that interventions that improve sleep quality also result in medium-sized improvements across several mental health outcomes, such as depression, anxiety, stress, and composite measures of mental health [The audio tools evaluated in this study may have more widespread application and fewer barriers to adoption than more structured interventions, and may be helpful for individuals low in motivation (e.g. due to comorbid symptoms of depression or anxiety) since they do not require focused attention or learning new skills. Previous research suggests that the core active components of CBT for insomnia (which include sleep restriction therapy and stimulus control therapy) can be challenging, resulting in suboptimal adherence and reduced potential for treatment gains [While this study did not explore the mechanisms via which the interventions improve sleep, it provides some preliminary support for the idea that listening to the tools might specifically shift attention away from inhibitory presleep cognitive processes (such as worrying about sleep, monitoring, or focusing on threat cues). This is because most participants reported using the tools as a means to fall asleep, and were more likely to engage with the tools on nights when they were feeling stressed or experiencing racing thoughts. However, this study did not directly investigate underlying mechanisms of action, and future research should aim to address this if we are to fully understand the potential impact and application of such tools.To the best of our knowledge, this is the first study to demonstrate both feasibility and preliminary efficacy of app-based tools designed to aid sleep in a nonclinical sample. If these findings are replicated in a definitive trial, they could have widespread financial and public health implications for policymakers and employers. App-based audio tools such as those evaluated in this study are safe, affordable, widely accessible, and easy to use compared to structured interventions that require active learning or behavior change. Their wide availability means they may also be useful as an early intervention, preventing mild problems from becoming disordered, though further research is needed to test this hypothesis.