A Smartphone App for Adolescents With Sleep Disturbance: Development of the Sleep Ninja

Abstract

BackgroundSleep disturbances are common in young people and have consequences for academic, social, emotional, and behavioral development. The most effective treatment is cognitive behavioral therapy for insomnia (CBT-I), with evidence suggesting that it is efficacious even when delivered digitally.ObjectiveThere are no commercially available digitally delivered CBT-I programs for use by young people. The aim of this project was to develop a smartphone app that delivers CBT-I to young people to improve sleep.MethodsTo inform the development of the app, young people (N=21) aged between 12 and 16 years attended one of the 3 focus groups (each with 4-10 participants). These focus groups were conducted at different stages of the development process such that the process could be iterative. Participants were asked the reasons why they might use an app to help them sleep, the kinds of features or functions that they would like to see in such an app, and any concerns they may have in using the app. Data were analyzed using a thematic analysis approach. Of the issues discussed by the participants, the researchers selected themes associated with content, functionality, and accessibility and user experience to examine, as these were most informative for the app design process.ResultsIn terms of content, young people were interested in receiving information about recommended sleep guidelines and personalized information for their age group. They reported that keeping a sleep diary was acceptable, but they should be able to complete it flexibly, in their own time. They reported mixed views about the use of the phone’s accelerometer. Young people felt that the functionality of the app should include elements of game playing if they were to remain engaged with the app. Flexibility of use and personalized features were also desirable, and there were mixed views about the schedule of notifications and reminders. Participants reported that for the app to be accessible and usable, it should be from a trusted developer, have engaging aesthetics, have a layout that is easy to navigate, not rely on Internet coverage, and preferably be free. Participants felt that being able to conceal the purpose of the app from peers was an advantage and were willing to provide personal information to use the app if the purpose and use of that information was made clear. Overall, participants endorsed the use of the app for sleep problems among their age group and reported motivation to use it.ConclusionsThe Sleep Ninja is a fully-automated app that delivers CBT-I to young people, incorporating the features and information that young people reported they would expect from this app. A pilot study testing the feasibility, acceptability, and efficacy of the Sleep Ninja is now underway.

Relations of Bedtime Mobile Phone Use to Cognitive Functioning, Academic Performance, and Sleep Quality in Undergraduate Students

“…Studies examining the effectiveness of sleep applications for developing healthy sleeping habits have been documented [ 45 ]. For example, Sleep Ninja, a cognitive behavior therapy smartphone application, has been developed to help young people to improve sleep quality while setting limitations to mobile phone use during bedtime [ 11 ].…”

“…Bedtime mobile phone use is defined as constant use of the mobile phone while in bed, a few nights per week within the hour before sleep, and hesitancy to switch off the device at night [ 9 , 10 , 11 , 12 ]. In addition, bedtime mobile phone use can also be manifested through a frequency of calls and text messages made and/or received after lights out [ 13 ].…”

Pilot evaluation of the Sleep Ninja: a smartphone application for adolescent insomnia symptoms

“…The Sleep Ninja app was derived from CBT-I and developed by our team, as a fully automated smartphone app. A participatory design process was used whereby young people contributed to the content, functionality and accessibility/user experience of the app through a series of focus groups 39. The core strategies included in the app were: psychoeducation, stimulus control, sleep hygiene and sleep-focused cognitive therapy.…”

“…Prior to this study, a separate group of young people were consulted in a series of focus groups to inform the design, features and structure of the app (for more information please see39). As a feasibility and acceptability study, participants were asked to report on their experiences with respect to both the app and the study procedures, via questionnaires and an in-depth semistructured interview.…”

Evaluation of an Internet-Based Behavioral Intervention to Improve Psychosocial Health Outcomes in Children With Insomnia (Better Nights, Better Days): Protocol for a Randomized Controlled Trial

“…To our knowledge, there are no published reports evaluating internet-based interventions for insomnia in preschool- and school-aged children. A recent study described the development of a mobile phone app to deliver cognitive behavioral therapy for insomnia in adolescents [ 54 ]. There are 2 studies that have reported on an internet-delivered intervention for infants and toddlers [ 55 , 56 ], both of which found significant improvement in children’s sleep including decreased sleep onset latency, decreased frequency and duration of night awakening, and significant improvement in parental sleep and mood as well as increased parental confidence to manage children’s sleep.…”