A Transdiagnostic Self-management Web-Based App for Sleep Disturbance in Adolescents and Young Adults: Feasibility and Acceptability Study

Abstract

Background Sleep disturbance and its daytime sequelae, which comprise complex, transdiagnostic sleep problems, are pervasive problems in adolescents and young adults (AYAs) and are associated with negative outcomes. Effective interventions must be both evidence based and individually tailored. Some AYAs prefer self-management and digital approaches. Leveraging these preferences is helpful, given the dearth of AYA treatment providers trained in behavioral sleep medicine. We involved AYAs in the co-design of a behavioral, self-management, transdiagnostic sleep app called DOZE (Delivering Online Zzz’s with Empirical Support). Objective This study tests the feasibility and acceptability of DOZE in a community AYA sample aged 15-24 years. The secondary objective is to evaluate sleep and related outcomes in this nonclinical sample. Methods Participants used DOZE for 4 weeks (2 periods of 2 weeks). They completed sleep diaries, received feedback on their sleep, set goals in identified target areas, and accessed tips to help them achieve their goals. Measures of acceptability and credibility were completed at baseline and end point. Google Analytics was used to understand the patterns of app use to assess feasibility. Participants completed questionnaires assessing fatigue, sleepiness, chronotype, depression, anxiety, and quality of life at baseline and end point. Results In total, 83 participants created a DOZE account, and 51 completed the study. During the study, 2659 app sessions took place with an average duration of 3:02 minutes. AYAs tracked most days in period 1 (mean 10.52, SD 4.87) and period 2 (mean 9.81, SD 6.65), with a modal time of 9 AM (within 2 hours of waking). DOZE was appraised as highly acceptable (mode≥4) on the items “easy to use,” “easy to understand,” “time commitment,” and “overall satisfaction” and was rated as credible (mode≥4) at baseline and end point across all items (logic, confident it would work, confident recommending it to a friend, willingness to undergo, and perceived success in treating others). The most common goals set were decreasing schedule variability (34/83, 41% of participants), naps (17/83, 20%), and morning lingering in bed (16/83, 19%). AYAs accessed tips on difficulty winding down (24/83, 29% of participants), being a night owl (17/83, 20%), difficulty getting up (13/83, 16%), and fatigue (13/83, 16%). There were significant improvements in morning lingering in bed (P=.03); total wake time (P=.02); sleep efficiency (P=.002); total sleep time (P=.03); and self-reported insomnia severity (P=.001), anxiety (P=.002), depression (P=.004), and energy (P=.01). Conclusions Our results support the feasibility, acceptability, credibility, and preliminary efficacy of DOZE. AYAs are able to set and achieve goals based on tailored feedback on their sleep habits, which is consistent with research suggesting that AYAs prefer autonomy in their health care choices and produce good results when given tools that support their autonomy. Trial Registration ClinicalTrials.gov NCT03960294; https://clinicaltrials.gov/ct2/show/NCT03960294

Sleep Health Assessment and Treatment in Children and Adolescents with Chronic Pain: State of the Art and Future Directions

“…There is robust evidence indicating that self-guided web-based CBT-I produces similar effect sizes for improving insomnia symptoms in adults compared to face-to-face CBT-I [ 68 ], although similar data in youth are lacking. Recently, Carmona and colleagues [ 69 ] demonstrated feasibility and acceptability of a transdiagnostic web-based app for adolescents and young adults (AYAs), which provides self-guided training in sleep education, personalized feedback comparing the user’s sleep patterns to age-based norms, and tailored goal setting to improve sleep habits. We are not aware of any published randomized controlled trials testing technology delivered sleep health interventions for youth, although studies are currently underway (e.g., [ 70 ]).…”

Back to Basics: Lifestyle Interventions for Adolescent Depression

“…Table 1 provides examples of a paper sleep diary and several smartphone applications that can help teens track their sleep. Research shows that digital apps for managing sleep disturbances can yield significant reductions in depressive symptoms 71–73 …”

“…Research shows that digital apps for managing sleep disturbances can yield significant reductions in depressive symptoms. [71][72][73] Recent studies, such as Sleep and Education: Learning New Skills Early (SENSE) by Blake and colleagues, 75,76 have demonstrated the efficacy of interventions based on Dahl and Harvey's approach 69 in group formats (Table 2) and shown that that this protocol can be adapted into school, clinic, or community settings.…”

Additional Measurement Approaches for Sleep Disturbances. Comment on “A Transdiagnostic Self-management Web-Based App for Sleep Disturbance in Adolescents and Young Adults: Feasibility and Acceptability Study”

“…Carmona et al [ 1 ] analyzed the effect of DOZE (Delivering Online Zzz's with Empirical Support) on adolescents and young adults. However, this was done only via feedback from the participants.…”