Discussion
sleep disturbance, anxiety, cognitive behavioral sleep, insomnia, Insomnia, sleep-related anxiety, depression
DISORDER, SECONDARY
This randomized-controlled trial investigated whether providing individuals with insomnia symptoms support for interpretation of recorded sensor-based sleep data improved insomnia symptom severity compared to sleep hygiene and education control. Overall, the intervention was feasible as indicated by the high satisfaction and low dropout. After the intervention, the Intervention (vs. Control) group had lower insomnia symptom severity and sleep disturbance (medium ES), and lower rates of Insomnia Disorder. However, the two groups did not meaningfully differ on all other secondary and exploratory outcomes at post-intervention, including SRI, PSA, dysfunctional beliefs and attitudes about sleep, symptoms of depression and anxiety, and sleep–wake state discrepancy metrics (TST, SOL, WASO). Within-group changes from pre- and post-intervention were more similar than different in the Intervention and Control groups: both showed improvements in some sleep and insomnia domains but not others.Group differences in post-intervention insomnia symptoms and sleep disturbance are consistent with Tang and Harvey’s [There are a few possible explanations for the modest effects of the Intervention group in this study:(1) Although sleep education and hygiene are often used as the control group in cognitive behavioral sleep interventions, it is consistently shown to have benefits to sleep [(2) The Intervention group received education and guidance on sleep–wake state discrepancy but did not receive intervention targeting known perpetuating factors of insomnia, such as systematically addressing different types of sleep-related beliefs and strategies to manage PSA. This is consistent with the little group difference in changes of DBAS and PSA in this study. In the absence of these cognitive components, receiving wearable measured sleep alone might have perpetuated sleep-related anxiety. Terms such as “orthosomnia” [Overall, there were no meaningful group differences post-intervention in any of the sleep–wake state discrepancy parameters (TST, SOL, and WASO), suggesting that providing feedback and guidance on wearable-measured sleep (i.e. directly targeting sleep–wake state discrepancy) did not alter sleep perception more than sleep education and hygiene (i.e. no content targeting sleep–wake state discrepancy). It is possible that mechanisms of sleep–wake state discrepancy not addressed in this study played an important role in its maintenance. Emerging research highlights the importance of physiological aspects such as the mixture of wake and sleep activity during sleep and the sensitivity to sleep fragmentation [