An online behavioral self-help intervention rapidly improves acute insomnia severity and subjective mood during the coronavirus disease-2019 pandemic: a stratified randomized controlled trial.

STUDY OBJECTIVES: Stressful life events, such as the coronavirus disease-2019 (COVID-19) pandemic, can cause acute insomnia. Cognitive behavioral therapy for acute insomnia is effective but is both time and resource-intensive. This study investigated if an online behavioral self-help intervention, which has been successfully used alongside sleep restriction for acute insomnia, reduced insomnia severity and improved mood in acute insomnia. This study also assessed good sleepers to explore if a "sleep vaccination" approach was feasible. METHODS: In this online stratified randomized controlled trial, 344 participants (103 good sleepers and 241 participants with DSM-5 acute insomnia) were randomized to receive the intervention/no intervention (good sleepers) or intervention/intervention after 28 days (poor sleepers). Insomnia severity was assessed using the ISI (primary outcome), and anxiety and depression using the GAD-7/PHQ-9 (secondary outcomes) at baseline, 1 week, 1 month, and 3-month follow-up. RESULTS: In people with acute insomnia, relative to baseline, there were significant reductions in ISI (dz = 1.17), GAD-7 (dz = 0.70), and PHQ-9 (dz = 0.60) scores at 1-week follow-up. ISI, GAD-7, and PHQ-9 scores were significantly lower at all follow-up time points, relative to baseline. Subjective diary-derived sleep continuity was unaffected. No beneficial effects on sleep or mood were observed in good sleepers. CONCLUSIONS: An online behavioral self-help intervention rapidly reduces acute insomnia severity (within 1 week), and benefits mood in people with acute insomnia. These beneficial effects are maintained up to 3 months later. Although the use of the intervention is feasible in good sleepers, their subjective sleep was unaffected. CLINICAL TRIAL REGISTRATION: Testing an early online intervention for the treatment of disturbed sleep during the COVID-19 pandemic; prospectively registered at ISRCTN on 8 April 2020 (identifier: ISRCTN43900695).

Poor false sleep feedback does not affect pre-sleep cognitive arousal or subjective sleep continuity in healthy sleepers: a pilot study.

Modern wearable devices calculate a numerical metric of sleep quality (sleep feedback), which are intended to allow users to monitor and, potentially, improve their sleep. This feedback may have a negative impact on pre-sleep cognitive arousal, and subjective sleep, even in healthy sleepers, but it is not known if this is the case. This pilot study examined the impact of poor false sleep feedback, upon pre-sleep arousal and subjective sleep continuity in healthy sleepers. A total of 54 healthy sleepers (Mage = 30.19 years; SDage = 12.94 years) were randomly allocated to receive good, or poor, false sleep feedback, in the form of a numerical sleep score. Participants were informed that this feedback was a true reflection of their habitual sleep. Pre-sleep cognitive and somatic arousal was measured at baseline, immediately after the presentation of the feedback, and one week afterwards. Subjective sleep continuity was measured using sleep diaries for one week before, and after, the presentation of the feedback. There were no significant differences between good and poor feedback groups in terms of pre-sleep cognitive arousal, or subjective sleep continuity, before or after the presentation of the sleep feedback. The presentation of false sleep feedback, irrespective of direction (good vs. poor) does not negatively affect pre-sleep cognitive arousal or subjective sleep continuity in healthy sleepers. Whilst the one-off presentation of sleep feedback does not negatively affect subjective sleep, the impact of more frequent sleep feedback on sleep should be examined.