A Series of Remote Melatonin Supplement Interventions for Poor Sleep: Protocol for a Feasibility Pilot Study for a Series of Personalized (N-of-1) Trials (Preprint)

Abstract

BACKGROUND Poor sleep, defined as short-duration or poor-quality sleep, is a frequently reported condition with many deleterious effects including poorer cognitive functioning, increased accidents, and poorer health. Melatonin has been shown to be an efficacious treatment to manage symptoms of poor sleep. However, the treatment effects of melatonin on sleep can vary greatly between participants. Personalized, or N-of-1, trial designs represent a method for identifying the best treatment for individual participants. Though using N-of-1 trials of melatonin to treat poor sleep is possible, the feasibility, acceptability, and effectiveness of N-of-1 trials using melatonin is unknown. Using the National Institute of Health (NIH) Stage Model for Behavioral Intervention Development, a Stage IB (intervention refinement, modification, and adaptation and pilot testing) design appeared to be needed to address these feasibility questions. OBJECTIVE : The current trial series evaluates the feasibility, acceptability, and effectiveness of a series of personalized interventions for virtual delivery of 3 mg– and 0.5 mg–dose melatonin-versus-placebo supplements for self-reported poor sleep among 60 participants. The goal of this study is to provide valuable information about implementing virtual N-of-1 randomized controlled trials to improve poor sleep. METHODS Participants will complete a 2-week baseline followed by six 2-week alternating intervention periods of 3 mg melatonin, 0.5 mg melatonin, and placebo. Participants will be randomly assigned to 2 intervention orders. Feasibility and acceptability of the personalized trial approach will be determined with participants’ ratings of usability and satisfaction with the virtual, personalized intervention delivery system. Effectiveness of the intervention will be measured using participant self-reported sleep quality/duration and Fitbit tracker–measured sleep duration/efficiency. Additional measures will include ecological momentary assessment (EMA) measures of fatigue, stress, pain, mood, concentration, and confidence as well as measures of participant adherence to the intervention, use of the Fitbit tracker, and survey data collection. RESULTS As of the submission of this protocol, recruitment for this NIH Stage IB personalized trial series is approximately 78.3% complete (n = 47). We expect recruitment and data collection to be finalized by May of 2023. CONCLUSIONS Evaluating feasibility, acceptability, and effectiveness of a series of personalized interventions of melatonin will address the longer-term aim of this program of research—is integrating N-of-1 trials useful patient care? The personalized trial series results will be published in a peer-reviewed journal and will follow the CONSORT extension for N-of-1 trials (CENT 2015) reporting guidelines. This trial series was approved by the Northwell Health Institutional Review Board (IRB). CLINICALTRIAL ClinicalTrials.gov (number NCT05349188).