The Effects of a CBT-I Based App-Program on Sleep Quality, Insomnia Severity, Psychological Strain and Quality of Life: A Pilot Study

Abstract

Purpose: Given rising numbers in sleep disorders like insomnia and insufficient availability of treatment options, the need for well-validated digital interventions rises. This pilot study aims at assessing the feasibility of an app-program which combines sleep-training based on core elements of Cognitive Behavioural Therapy for Insomnia (CBT-I) with reliable sleep-monitoring based on heart rate variability via an ECG-sensor. Patients and Methods: About 48 participants (26 females) aged 30–73 (M = 50.33 ± 11.88) were included in the study. At the beginning of the baseline (T0), at start (T1) and end (T2) of the 6-week training phase as well as 4 weeks after the end of the program (T3; follow-up) several questionnaires assessing sleep quality, insomnia severity, general psychological symptom severity, depression, anxiety as well as quality of life were completed. Furthermore, ambulatory polysomnography (PSG) was conducted three times at T0, T1 and T2. General feasibility was assessed by conducting interviews. Results: Overall, the app-program as well as the study protocol was deemed as feasible according to the participants, besides some difficulties regarding app-instructions and certain technical issues, as well as some expected complaints about worse sleep quality during PSG-recordings. For statistical results, insomnia severity (p < 0.001, r = 0.67), sleep quality (p < 0.001, r = 0.56), general psychological symptom severity (p < 0.001, r = 0.68), depression (p = 0.002, r = 0.50) and anxiety (p < 0.001, r = 0.60) improved significantly during the training phase, while quality of life [physical (p = 0.014, r = 0.41) and psychological health (p = 0.049, r = 0.35)] improved significantly during the follow-up-period. PSG data revealed a significant decrease in Wake After Sleep Onset over the course of the study (p = 0.025, r = 0.36), yet no significant changes were found for other sleep parameters. Conclusion: The app-program was largely feasible and potentially effective in improving sleep and well-being. PSG-derived WASO changes highlight the value of objective sleep measures. Future studies should refine protocols and include control conditions for greater generalizability.