Mobile Devices and Insomnia: Understanding Risks and Benefits

Non-guided, mobile, CBT-I-based sleep intervention in War-torn Ukraine: A feasibility study

BACKGROUND

War conditions can severely impact sleep and mental health at the population level, especially in the conflicts of such tremendous scale as in Ukraine. The aim of this research was to study whether a mobile, unguided Cognitive Behavioral Therapy-based Intervention for sleep problems, Sleep2, is feasible, acceptable, and potentially able to reduce mental health/sleep problems symptoms.

METHODS

A single-arm, open-label, uncontrolled pre-post evaluation study was conducted with 487 registered participants: 283 started, 160 (56.55%) finished, out of which 95 completed without an ambulatory heart rate (HR) sensor and 65 with. Assessments were conducted through online questionnaires and objective measurements via HR sensors. Besides feasibility and acceptability, outcome measures included symptoms in several mental health domains alongside self-reported and objectively reported sleep parameter.

RESULTS

Engagement with the Sleep2 app was high, achieving an 80.72% compliance rate, alongside high levels of feasibility and acceptance. Participants reported significant pre-post reductions in the severity of symptoms, with sleep problems decreasing by 22.60% (Cohen's d = 0.53), insomnia by 35.08% (d = 0.69), fear of sleep by 32.43% (d = 0.25), anxiety by 27.72% (d = 0.48), depression by 28.67% (d = 0.52), PTSD by 32.41% (d = 0.51), somatic symptoms by 24.52% (d = 0.51), and perceived stress by 17.90% (d = 0.39). Objective sleep measurements showed a significant reduction in sleep onset latency only.

CONCLUSION

The 'Sleep2Ukraine' program demonstrated high feasibility and acceptance, with significant improvements in subjective sleep and mental health measures among participants. However, given the study's uncontrolled design and reliance on self-selected participants, these findings should be considered preliminary. Randomized controlled trials are needed to establish efficacy. Nonetheless, the results highlight the potential of culturally adapted, scalable, mobile-based CBT-I interventions to address sleep and mental health needs in war-affected populations.

Decisional style, sleepiness, and online responsiveness

As sleep problems can impair quality of work, an online questionnaire was used to examine relationships between sleepiness and decision making while obtaining unobtrusive indices of performance. Participants (N = 344) completed the Insomnia Severity Index, Epworth Sleepiness Scale, and the Melbourne Decision Making Questionnaire in a Qualtrics survey while reporting mobile phone use. Qualtrics recorded the time and the number of clicks required to complete each page of the survey. Multiple regression indicated that insomnia was associated with daytime sleepiness and Hypervigilance, and mobile phone use before bed. Participants with moderate sleepiness required a greater number of clicks to complete the questionnaire. Greater sleepiness was associated with longer times to complete these self-assessment tasks. Clinically significant sleepiness produces changes in performance that can be detected from online responsivity. As sleepy individuals can be appreciably and quantitatively slower in performing subjective self-assessment tasks, this argues for objective measures of sleepiness and automated interventions and the design of systems that allow better quality sleep.Practitioner summary: Work can require processing of electronic messages, but 24/7 accessibility increases workload, causes fatigue and potentially creates security risks. Although most studies use people's self-reports, this study monitors time and clicks required to complete self-assessment rating scales. Sleepiness affected online responsivity, decreasing online accuracy and increasing response times and hypervigilance.

Investigating the subjective and objective efficacy of a cognitive behavioural therapy for insomnia (CBT-I)-based smartphone app on sleep: A randomised controlled trial

Due to insufficient treatment options for insomnia, effective solutions are urgently needed. We evaluated the effects of a CBT-I-based app combining sleep training with subjective and objective sleep monitoring on (i) sleep and (ii) subjective-objective sleep discrepancies (SOSD). Fifty-seven volunteers (20-76 years; MAge = 45.67 ± 16.38; 39 female) suffering from sleep problems were randomly assigned to an experimental group (EG, n = 28) or a waitlist control group (CG, n = 29). During the 6-week app phase, the EG used the CBT-I-based programme and a heart rate sensor for daily sleep monitoring and -feedback, while the CG used sleep monitoring only. Sleep was measured (i) subjectively via questionnaires (Insomnia Severity Index, ISI; Pittsburgh Sleep Quality Index, PSQI), (ii) objectively via ambulatory polysomnography (PSG), and (iii) continuously via heart-rate sensor and sleep diaries. Data revealed interactions for ISI (p = 0.003, ƞ2 part = 0.11) and PSQI (p = 0.050, ƞ2 part = 0.05), indicating training-specific improvements in EG, yet not in CG. While PSG-derived outcomes appear to be less training-specific, a tendential reduction in wake after sleep onset (WASO) was found in EG (p = 0.061, d = 0.55). Regarding changes in SOSD, the results indicate improvements during the app phase (EG) for sleep efficiency, sleep onset latency, and WASO (p ≤ 0.022, d ≥ 0.46); for total sleep time both groups showed a SOSD reduction. The findings indicate beneficial effects of a novel smartphone app on sleep and SOSD. More scientific evaluation of such digital programmes is needed to ultimately help in reducing the gap in non-pharmacological insomnia treatment.

A nationwide study on sleep complaints and associated factors in older adults: ELSI-Brazil

Sleep problems, such as difficulty falling asleep, staying asleep, early awakening with failure to continue sleep, and altered sleep-wake cycle, are common in the general population. This cross-sectional study with 6,929 older adults (≥ 60 years) aimed to estimate the prevalence of different types of sleep problems, their associated factors, and the population-attributable fraction of associated factors among older adults. The outcome variables consisted of self-reported sleep problems: insomnia (initial, intermediate, late, and any type of insomnia), poor sleep quality, and daytime sleepiness. The independent variables were sociodemographic and behavioral characteristics and health conditions. The prevalence proportions were initial insomnia (49.1%), intermediate insomnia (49.2%), late insomnia (45.9%), any type of insomnia (58.6%), poor sleep quality (15.6%), and daytime sleepiness (38.4%). Female sex, presence of two or more chronic diseases, not eating the recommended amount of fruits and vegetables, and regular and bad/very bad self-rated health were positively associated with the sleep problems investigated. Consuming alcohol once a month or more was inversely associated with initial insomnia. Population attributable fraction estimates ranged from 3% to 19% considering two or more chronic diseases, not eating the recommended amount of fruits and vegetables, and regular and bad/very bad self-rated health. High prevalence of self-reported sleep problems was evinced in older adults. These results can be useful to guide public health services in the creation of informational, evaluative, and screening strategies for sleep problems in older Brazilian adults.

Insomnia and depression levels among Malaysian undergraduate students in the Faculty of Medicine and Health Sciences (FMHS), Universiti Putra Malaysia (UPM) during Movement Control Order (MCO)

Rapid outbreak of coronavirus disease 2019 has caused the implementation of the movement control order (MCO) which aimed to reduce the spread in Covid-19 infections. While some may find it easy to adjust to the new norm, others found it difficult to switch from their normal routines and habits as according to the MCO SOP. This resulted in a more frequent insomnia and depression that subsequently impacted their mental health. Insomnia and depression levels are examined in this study as they relate to the Covid-19 Pandemic and the MCO among Malaysian undergraduate health sciences students at the Faculty of Medicine and Health Sciences, UPM. Random sampling methods were utilised with consideration of inclusion and exclusion criteria. The Patient Health Questionnaire-9 (PHQ-9) and the Insomnia Severity Index (ISI) were the instrument packages used in this investigation. An internet platform was used to distribute the questionnaire. Based on the results, it is concluded that depression and insomnia are significantly correlated, with a p-value of 0.05. This study also revealed the link between the severity of insomnia and the severity of depression among UPM students studying health sciences. The percentage of students with depression and insomnia was rather high (54.9% and 33.9%, respectively), and this occurred during the second wave of Covid-19 cases in Malaysia.

Impact of pre-sleep habits on adolescent sleep: an Italian population-based study

OBJECTIVE

Several evidences demonstrate that pre-sleep habits may negatively impact adolescent sleep, yet few data exist on Italian population. This study aimed to investigate the relationship between pre-sleep habits, use of technology/activity and sleep in Italian adolescents.

METHODS

Self-report questionnaires including Italian version of School Sleep Habits Survey and use of technology/activity (eg smartphone, PC) at bedtime were administered to 972 adolescents (13-19 years) from Lombardia. We stratified the sample in five groups according to the age: Group I (13-14 years), Group II (15 years), Group III (16 years), Group IV (17 years), Group V (18-19 years).

RESULTS

Our descriptive analysis reveals a different sleep profile across age-groups: Group III showed highest percentage of bad sleep (26.7%) and frequent nocturnal awakenings (24.1%), Group V had the highest percentage of insufficient sleep (40,4%) and difficulty falling asleep (42.7%) and Group IV presented an elevated difficulty in waking up in the morning (70.1%). A significant negative correlation was found in total group between use of smartphone, internet and studying/doing homework and total sleep time. The use of smartphone, internet videogames, listening to music and studying/doing homework was positively associated with delayed bedtime.

CONCLUSIONS

This study confirms the great impact of pre-sleep habits, and in particular the use of technology on adolescent sleep. Our results demonstrate that sleep is strongly altered among Italian adolescents using electronic devices in evening. The type of technology may be related to specific sleep profile, emphasizing the importance of stratification analyses to identify associated factors to sleep problems.

Mobile device use among emergency department healthcare professionals: prevalence, utilization and attitudes

Mobile devices are increasingly permeating healthcare and are being regularly used by healthcare providers. We examined the prevalence and frequency of mobile device use, and perceptions around clinical and personal usage, among healthcare providers (attending physicians, residents, and nurses) in the Emergency Department (ED) of a large academic medical center in Lebanon. Half of the target population (N = 236) completed the cross-sectional electronic questionnaire. Mobile device usage for personal matters was uniform across all providers, with the highest usage reported by medical students (81.3%) and lowest by attendings (75.0%). Medical formulary/drug referencing applications were the most common application used by providers followed by disease diagnosis/management applications, 84.4% and 69.5% respectively. Most respondents agreed that mobile devices enabled better-coordinated care among providers and were beneficial to patient care. Most respondents also agreed that mobile device use assisted in quickly resolving personal issues and reduced their feeling of stress, yet the majority did not feel that personal usage improved performance at work. Study findings revealed that although healthcare providers value mobile devices' positive impact on coordination of care, the reverse spillover effect of personal issues into the workplace enabled by mobile devices might have some negative impact on performance of staff at work.

Sleep apps: current limitations and challenges

Sleep app ownership is increasing exponentially, due to their accessibility and ease-of-use. However, there are several concerns regarding the use of sleep apps. Few sleep apps demonstrate empirical evidence to support their claims, and if they do, this evidence can be based on significant methodological limitations. In addition, there are data privacy concerns with regards to sleep apps, which share sensitive user data with business and marketing partners, unbeknownst to their users. Moreover, sleep apps may increase engagement with healthcare professionals, which may place additional strain on under-pressure sleep services. This would be compounded by the fact that some sleep apps produce many false positives, and clinicians would need more time to analyze the data provided by these apps. In the future, sleep apps must undergo rigorous validation studies and grant more autonomy to their users over how their data is shared.

Psychological risk factors associated with internet and smartphone addiction among students of an Indian dental institute

Background

The internet and smartphones have a strong potential for addiction. Excessive use of these technologies can have adverse effects on psychological well-being of the users.

Objectives

The objective of the study is to find out the effects of internet addiction (IA) and smartphone addiction (SA) on psychological outcomes of dental students in an Indian institute.

Methods

In this cross-sectional study, 320 dental students were assessed for their internet and smartphone habits using the Young's IA test (YIAT) and the SA scale (SAS), respectively. Psychological outcomes were evaluated using the insomnia severity index, the Depression, Anxiety and Stress Scale, and the Rosenberg Self-Esteem Scale.

Results

The median YIAT score was 35 and interquartile range (IQR) of 24-49 with 23% subjects reporting potential IA. The median SAS score was 108 (IQR 91.25-128). Both IA and SA were significantly associated with participants' year of the study. Significant correlations were observed between IA and SA with psychological parameters.

Conclusions

The association of IA and SA with psychological parameters shows how these habits can affect the users' mental well-being. Public especially young adults should be made aware about potential harmful effects of the internet and smartphones.

Smartphone apps for insomnia: examining existing apps' usability and adherence to evidence-based principles for insomnia management

Insomnia affects up to 22% of the U.S. adult population. The use of mobile health applications (mHealth apps) has been posited as one way to increase access to evidence-based interventions for insomnia, such as cognitive behavioral therapy for insomnia (CBT-I). The purpose of the current study was to summarize the availability of mHealth apps that focus on providing users with the behavioral and/or cognitive skills to manage insomnia, assess their adherence to evidence-based principles, and examine their usability. The terms "insomnia," "insomnia treatment," and "sleep treatment" were used to search the Apple iTunes and Google Play stores in November 2016. Social network query within the authors' professional networks was also conducted. Apps that met inclusion criteria for the study were downloaded and reviewed by the research team for their general characteristics; inclusion of CBT-I skills, strategies, and principles; and aesthetics and usability. Of the 357 apps initially found, 12 met criteria for further review. Overall, the apps were moderately adherent to CBT-I principles, with a mean app score of 1.44 out of 3.00, and moderately usable, with a mean usability score of 3.54 out of 5.00. Few apps currently exist that utilize evidence-based principles to help users practice the behavioral and cognitive skills shown to manage insomnia. Thus, there are exciting opportunities for clinicians, researchers, and mHealth experts to develop effective apps that can help ease the public health burden of insomnia.