App-Supported Sleep Coaching: Implications for Sleep Duration and Sleep Quality.

OBJECTIVES: The present study evaluated whether completers of a 12-week app-based, personalized text supported sleep coaching program demonstrated improvements in sleep continuity, sleep duration, and reduced use of sleep aids. METHODS: Data were obtained from Sleep Reset, a 12-week consumer product that offers app-based sleep education and monitoring, along with personalized text-based sleep coaching provided by live coaches. 564 completers were included in the study. Pre-post changes for sleep latency (SL), wake after sleep onset (WASO), number of awakenings (NWAK), total sleep time (TST), sleep efficiency (SE%) and use of "sleep aids" were evaluated. To evaluate whether the program produced meaningful results, the proportion of participants who demonstrated reductions in SL, WASO, and NWAK, and increases in TST and SE% were examined. RESULTS: Mean SL was reduced by 11 minutes, mean WASO was reduced by 28 minutes, mean SE% increased by 6.6%, and mean TST increased by about 44 minutes. Of those who reported using "sleep aids" during Week 1, 41% no longer used them by week 12. Those with low SE% at baseline demonstrated greater improvements in SL (16.2 vs 5.7mins), WASO (47.3 vs 7.2mins), SE% (11.2% vs 1.6%), and TST (65.3 vs 31.2mins). Those with ≤6 hours of sleep at baseline demonstrated greater improvements in WASO (36.8 vs 22.3mins), SE% (10.1% vs 4.3%), and TST (85.1 vs 25.5mins). CONCLUSIONS: Participants that completed the app-based, personalized text supported coaching intervention reported subjective improvements in sleep duration and quality that suggest more beneficial effects particularly in those with lower sleep efficiency or sleep duration at baseline. An effective sleep coaching program that utilizes trained sleep coaches with access to board-certified providers, may provide a valuable resource for subclinical populations.

Bedtime procrastination mediates the relation between anxiety and sleep problems.

The prevalence of sleep problems is high in primary care patients and in anxious individuals. This study assessed whether total sleep time and bedtime procrastination mediated the association between anxiety and sleep problems. We predicted higher anxiety would be negatively associated with total sleep time and positively associated with bedtime procrastination and sleep problems, and these variables would statistically mediate the association between anxiety and sleep problems. Participants were 308 adult primary care patients, predominantly female (non-Hispanic White = 158, Latinx = 111, mean age = 33.30), who initiated behavioral health services at an integrated primary care clinic. Patients completed a questionnaire regarding psychological health and sleep behaviors. Using structural equation modeling, we found higher anxiety related to higher sleep problems, partially mediated by bedtime procrastination but not total sleep time. This study highlights related factors like anxiety and prebedtime behaviors that may be effective treatment targets for sleep challenges.

An experimental test of the effects of acute sleep deprivation on affect and avoidance.

BACKGROUND AND OBJECTIVES: Avoidance and sleep have been identified as mechanisms involved in the development and maintenance of many mental health disorders. However, there has been little research into the relation between sleep and avoidance. METHODS: To address this, a randomized controlled experiment using behavioral and self-report measures of affect and avoidance was conducted. Compared to a control group, we hypothesized that sleep-deprived individuals would demonstrate increased negative, and decreased positive, affectivity, more avoidance behavior toward a negatively valenced stimulus, as well as increased self-reported avoidance. Fifty-two healthy individuals ages 18-30 years old were randomly assigned to a full night of sleep deprivation or normal sleep. They completed a baseline and post-manipulation behavioral avoidance task (BAT) using a disgusting stimulus and self-reports of avoidance and state affect. RESULTS: Repeated measures ANOVAs demonstrated negative affectivity and self-reported avoidance increased, and positive affectivity decreased, from pre-to post-manipulation in the sleep loss condition as expected. However, there were no effects of sleep deprivation on avoidance behaviors. LIMITATIONS: This study emphasized internal validity over generalizability. Additionally, the at-home sleep deprivation limited researcher control over the overnight activities of participants. CONCLUSIONS: Results replicate prior work on the affective consequences of sleep deprivation and highlight a discrepancy between the effect of sleep deprivation on behavioral avoidance toward a specific stimulus compared to self-reported cognitive and social avoidance behaviors.

Greater adolescent tiredness is related to more emotional arousal during a hyperventilation task: An area under the curve approach.

INTRODUCTION: Approximately 36% of adolescents report sleep problems (Crowley et al., 2018). Understanding the relation between sleep and emotional experience is crucial in understanding the high incidence of mental health concerns during adolescence. The current study sought to expand understanding in the area by testing the hypothesis that baseline tiredness ratings would predict greater emotional arousal and negative valence across the course of emotional response elicited by a voluntary hyperventilation procedure. METHODS: A community sample of 110 youth (10-18 years; 47.8% girls) provided baseline tiredness ratings and ratings of emotional valence and arousal, 2 min before, immediately after, and 3 min after a hyperventilation task. The area under the curve (AUC) was calculated using the repeated measures of valence and arousal, and correlations between the response curves and baseline tiredness were examined. RESULTS AND CONCLUSIONS: Findings indicated baseline tiredness was positively associated with AUC arousal (r = 0.23), but not valence. This suggests daytime tiredness is associated with the degree of emotional arousal elicited by a psychobiological stressor. By extension, adolescents may experience more arousing emotional reactions when tired, and thus the common sleep deprivation observed during this developmental period may increase risk for mental health problems associated with elevated emotional reactivity.

Sleep in PTSD: Conceptual model and novel directions in brain-based research and interventions.

Peri-traumatic sleep disturbances are growingly recognized as biologically-relevant and modifiable predisposing, precipitating, and perpetuating factors in posttraumatic stress disorder (PTSD). The exponential growth of the literature on sleep in PTSD over the last two decades has stimulated a paradigm shift in the conceptualization of the relationship between sleep and PTSD. A conceptual framework that captures this paradigm shift is offered. New research on existing and promising sleep-focused treatments for augmenting PTSD treatment outcomes is then summarized. New findings on the neurobiological correlates and underpinnings of the relationship between sleep and PTSD are also discussed. Informed by these recent findings and foundational literature, opportunities for innovation in clinical and experimental research are proposed.