Introduction Academic achievements and social life on campus represent the main focus for students, while sleep is neglected. The emergence of social media, gaming reduces sleep opportunity, quality and ability. Students are sleep challenged and prone to develop chronic sleep difficulties in later life. Cognitive behavioral interventions are recognized as effective for insomnia and circadian misalignment. We aimed at detecting sleep difficulties, related habits, and at testing the efficacy of a mobile app in improving sleep in students with insomnia symptoms. Methods Observational study of US students who approached wellness staff and were offered the Refresh by Sleeprate mobile app that provides a sleep assessment followed by weekly cycles of personalized digital cognitive and behavioral reframing. The app collects perceived, and optional objective sleep data acquired using wearable devices. 892 students aged 18-30 years registered an account between Jan 1 and Oct 30, 2019. The study reports engagement data and outcomes of the assessment and the digital intervention. Results 507 completed their assessment (6.2 avg nights). 69% presented insomnia symptoms with or without circadian misalignment, 8% circadian misalignment, 12% sleep deprivation, 11% poor sleep hygiene. 192 (55.3% of students with insomnia symptoms) completed at least one week of intervention (5.6 weekly avg nights, 28 avg total nights). Sleep Latency (SL) in minutes decreased from 28.8 (21.5) (Mean/SD) to 22.1 (19.3), p<0.001. When the initial mean SL was longer than 30 minutes, the improvement was larger, from 53.9 (20.8) to 32.7 (25.4) (p<0.001). Mean perceived Wake After Sleep Onset (WASO) longer than 30 minutes decreased from 46.3 (19.0) to 35.8 (21.4), p<0.05. Sleep Efficiency (SE) increased by 1.6% (p<0.002) for all, and by 7.1% (p<0.001) for SE<85%. Conclusion The mobile app used reveals sleep problems and is efficient in improving insomnia symptoms in those who remain engaged. 55% of those who started the program also completed it. Engagement remains the main barrier to sleep improvement at scale. Support N/A
Introduction The ongoing COVID-19 pandemic emerges as one of the most impressive and strenuous events of the century, with unthinkably huge global effects. We aimed at analyzing if and how does the pandemic affect sleep and related behaviors. Methods We reviewed 48,047 nights recorded in the US with the Sleeprate application by 3,381 users during a period of 2 years, December 2018-November 2020. Nightly data included perceived and measured sleep parameters. In addition, users reported their perceived daytime stress and sleepiness. We analyzed the monthly variability of the studied parameters and compared their values during the COVID-19 period of March-November 2020 (CP) with those in the previous corresponding period in 2019, the pre-COVID-19 period (PCP). Results Starting March 2020, wake-up time (WUT) was significantly delayed relative to PCP. WUT in April 2020 was the latest (8:06AM±2:12hours, mean±SD, p<.000), being an hour later than in April 2019. This delay started to diminish in June 2020, reaching 7:27AM±2:10 hours by November 2020, which was not significantly higher than during PCP. Bedtime (BT) exhibited similar behavior, yet it returned to PCP times faster. Delayed BT and WUT on weekends were observed during CP as well as PCP. No consistent differences in sleep duration or sleep efficiency were detected between CP and PCP. Subjective sleep satisfaction was higher in CP relative to PCP. However, daytime sleepiness and daytime stress were also higher during most of CP compared to PCP. Conclusion Our data, based on digital in-app sleep diaries coupled with perceived sleep parameters, demonstrate the pandemic’s effects on sleep behavior in the US. Users in this study adapted to the new circumstances with delayed sleep schedule, while not reducing the sleep opportunity. The higher sleep satisfaction may be connected to later sleep schedules, allowing a wake-up time that fits better human biological clocks. The reported increased stress and sleepiness further portray the uncertainty and turbulence characterizing the pandemic’s effects on populations life during the pandemic. As good sleep is linked with immune response efficacy, higher quality of life, and improved mood, the importance of sleep must not be overlooked, especially during the pandemic. Support (if any):
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