Testing a mindfulness meditation mobile app for the treatment of sleep-related symptoms in adults with sleep disturbance: A randomized controlled trial

The effects of a personalized sleep improvement app in subclinical poor sleepers: A randomized controlled trial

The aim of this study was to determine the effects of a personalized smartphone application on subjective sleep quality, wellbeing and stress in participants with subclinical sleep problems. Healthy participants with subclinical threshold sleep issues that did not meet diagnostic criteria for insomnia were randomly assigned to use the app or be on a waiting list for app usage (control group). Subjective data on sleep quality (sleep quality component of Sleep Questionnaire B [primary endpoint] and the Pittsburgh Sleep Quality Index), feeling refreshed after the sleep component of Sleep Questionnaire B, Short Form-12 physical and mental components, and stress (Perceived Stress Scale) were compared between the app and control groups at baseline and after 6 and 12 weeks. Depending on their usage, app users were defined as "frequent", "occasional" or "rare/never" users. Two-hundred and six and 205 app users and 286 and 285 control participants completed the 6- and 12-week assessments, respectively. Sleep Questionnaire B scores improved in frequent (effect size 0.595; F = 13.7) and occasional users (0.653; F = 9.4) after 6 weeks; effects persisted at 12 weeks, and were similar for the Pittsburgh Sleep Quality Index. Feeling refreshed after the sleep component of Sleep Questionnaire B improved over time in all groups, with no significant difference between app users and controls. There were no changes in Short Form-12 physical component, Short Form-12 mental component, and Perceived Stress Scale scores. A personalized app positively affected subjective sleep quality in a population of users with subclinical threshold sleep issues, and could serve as a low-burden digital intervention to potentially prevent the exacerbation of sleep pathologies.

Mindfulness Meditation for Sleep Disturbances Among Individuals with Cognitive Impairment: A Scoping Review

Background: This scoping review investigates the effectiveness of mindfulness meditation in alleviating sleep disturbances among individuals with mild cognitive impairment (MCI) and Alzheimer's disease (AD). With the rising prevalence of dementia and its profound impact on cognitive function and quality of life, this review aims to synthesize existing research and identify gaps in the literature. Methods: We systematically searched six electronic databases (CINAHL, Embase, Medline, PsycINFO, PubMed, and Scopus) from 2004 to 2024, yielding 462 potentially relevant articles. Screening was conducted using ASReview, an AI ranking tool, which facilitated the selection of studies. Ultimately, seven studies that met our stringent eligibility criteria were included in the review. We adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines for reporting. Results: Our findings indicate that mindfulness meditation significantly improves sleep quality, reduces insomnia severity, and enhances overall well-being in this at-risk population. Notably, interventions that combine structured, face-to-face sessions with at-home practice emerged as the most effective. Conclusions: Despite these positive outcomes, methodological limitations, including small sample sizes and reliance on self-reported measures, underscore the need for more rigorous long-term studies. This review highlights the potential of mindfulness meditation as a low-cost, scalable intervention to improve sleep and cognitive health in older adults, paving the way for future research and clinical applications.

Effectiveness of meditation for fatigue management: Insight from a comprehensive systematic review and meta-analysis

OBJECTIVE

This systematic review and meta-analysis revealed the effectiveness of meditation in addressing fatigue, given its widespread use as a remedy for sleep disturbances and fatigue.

METHOD

We analyzed 29 randomized controlled trials from MEDLINE and the Cochrane Library, spanning from December 31, 2022. We conducted two metaanalyses using mean difference (MD) with normalized data and standardized mean difference (SMD) with original data.

RESULTS

These trials included various populations, with baseline fatigue severity observed at 52.2 ± 16.0 points among 4104 participants. After an average meditation duration of 9.6 ± 4.7 weeks, fatigue scores decreased significantly by 6.4 points of MD [95% CI, 4.3-8.5] compared to controls. The most significant reduction occurred in the sub-healthy group (MD 8.2 [95% CI, 2.7 to 13.8]), followed by the general group (MD 6.9 [95% CI, 0.4 to 13.4]), and the disease group (MD 5.7 [95% CI, 3.4 to 8.0]). Notably, meditation-based anti-fatigue effects were particularly pronounced for mental fatigue (MD 10.0 [95% CI, 4.3 to 15.6]), especially with expert guidance and supplementary homework.

CONCLUSION

These findings align with meta-analysis results using standardized mean difference (SMD), providing evidence for meditation as an effective nonpharmacological intervention for fatigue management, while also informing effective meditation approaches.

REGISTRATION NUMBER

CRD42023395551 in PROSPERO.

The Potential for Digital Phenotyping in Understanding Mindfulness App Engagement Patterns: A Pilot Study

Background: Low app engagement is a central barrier to digital mental health efficacy. With mindfulness-based mental health apps growing in popularity, there is a need for new understanding of factors influencing engagement. This study utilized digital phenotyping to understand real-time patterns of engagement around app-based mindfulness. Different engagement metrics are presented that measure both the total number of app-based activities participants completed each week, as well as the proportion of days that participants engaged with the app each week. Method: Data were derived from two iterations of a four-week study exploring app engagement in college students (n = 169). This secondary analysis investigated the relationships between general and mindfulness-based app engagement with passive data metrics (sleep duration, home time, and screen duration) at a weekly level, as well as the relationship between demographics and engagement. Additional clinically focused analysis was performed on three case studies of participants with high mindfulness activity completion. Results: Demographic variables such as gender, race/ethnicity, and age lacked a significant association with mindfulness app-based engagement. Passive data variables such as sleep and screen duration were significant predictors for different metrics of general and mindfulness-based app engagement at a weekly level. There was a significant interaction effect for screen duration between the number of mindfulness activities completed and whether or not the participant received a mindfulness notification. K-means clusters analyses using passive data features to predict mindfulness activity completion had low performance. Conclusions: While there are no simple solutions to predicting engagement with mindfulness apps, utilizing digital phenotyping approaches at a population and personal level offers new potential. The signal from digital phenotyping warrants more investigation; even small increases in engagement with mindfulness apps may have a tremendous impact given their already high prevalence of engagement, availability, and potential to engage patients across demographics.

The effectiveness of smartphone app-based interventions for insomnia and sleep disturbances: A meta-analysis of randomized controlled trials

There is growing enthusiasm towards the role of smartphone app-based interventions in the management of insomnia and related sleep problems. A considerable number of apps designed to address insomnia have been developed in recent years, and randomized controlled trials (RCTs) have begun to explore their efficacy. We conducted a meta-analysis investigating the effectiveness of apps for insomnia and sleep disturbances. From 19 RCTs, we identified significant pooled effect sizes for the primary outcomes of self-reported insomnia (g = 0.60; 05 % CI = 0.44, 0.76; NNT = 4.8) and sleep disturbances (g = 0.70; 95 % CI = 0.58, 0.83; NNT = 4.1) in favour of apps over control conditions. These effects remained robust when restricting the analyses to trials that delivered a placebo control, received a lower risk of bias rating, and had a larger sample size. Significant pooled effects in favour of apps were also observed for secondary outcomes of night time awakenings (g = 0.56), total sleep time (g = 0.33), and sleep onset latency (g = 0.32), but non-significant effects emerged for daytime sleepiness, dysfunctional beliefs about sleep, sleep efficiency, sleep hygiene, and wake after sleep onset. The pooled dropout rate from app conditions was 13.1 % (95 % CI = 8.3, 20.0), which was significantly higher than control conditions (OR = 1.78, 95 % CI = 1.39, 2.28). Findings suggest that stand-alone app-based interventions can effectively address insomnia and sleep disturbances, and may play an important role in the management of these symptoms.

User Engagement With mHealth Interventions to Promote Treatment Adherence and Self-Management in People With Chronic Health Conditions: Systematic Review

BACKGROUND

There are numerous mobile health (mHealth) interventions for treatment adherence and self-management; yet, little is known about user engagement or interaction with these technologies.

OBJECTIVE

This systematic review aimed to answer the following questions: (1) How is user engagement defined and measured in studies of mHealth interventions to promote adherence to prescribed medical or health regimens or self-management among people living with a health condition? (2) To what degree are patients engaging with these mHealth interventions? (3) What is the association between user engagement with mHealth interventions and adherence or self-management outcomes? (4) How often is user engagement a research end point?

METHODS

Scientific database (Ovid MEDLINE, Embase, Web of Science, PsycINFO, and CINAHL) search results (2016-2021) were screened for inclusion and exclusion criteria. Data were extracted in a standardized electronic form. No risk-of-bias assessment was conducted because this review aimed to characterize user engagement measurement rather than certainty in primary study results. The results were synthesized descriptively and thematically.

RESULTS

A total of 292 studies were included for data extraction. The median number of participants per study was 77 (IQR 34-164). Most of the mHealth interventions were evaluated in nonrandomized studies (157/292, 53.8%), involved people with diabetes (51/292, 17.5%), targeted medication adherence (98/292, 33.6%), and comprised apps (220/292, 75.3%). The principal findings were as follows: (1) >60 unique terms were used to define user engagement; "use" (102/292, 34.9%) and "engagement" (94/292, 32.2%) were the most common; (2) a total of 11 distinct user engagement measurement approaches were identified; the use of objective user log-in data from an app or web portal (160/292, 54.8%) was the most common; (3) although engagement was inconsistently evaluated, most of the studies (99/195, 50.8%) reported >1 level of engagement due to the use of multiple measurement methods or analyses, decreased engagement across time (76/99, 77%), and results and conclusions suggesting that higher engagement was associated with positive adherence or self-management (60/103, 58.3%); and (4) user engagement was a research end point in only 19.2% (56/292) of the studies.

CONCLUSIONS

The results revealed major limitations in the literature reviewed, including significant variability in how user engagement is defined, a tendency to rely on user log-in data over other measurements, and critical gaps in how user engagement is evaluated (infrequently evaluated over time or in relation to adherence or self-management outcomes and rarely considered a research end point). Recommendations are outlined in response to our findings with the goal of improving research rigor in this area.

TRIAL REGISTRATION

PROSPERO International Prospective Register of Systematic Reviews CRD42022289693; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022289693.

A shot in the dark: the impact of online visibility on the search for an effective sleep app

STUDY OBJECTIVES

Dictated by consumer ratings and concealed algorithms, high levels of online visibility are granted to certain sleep apps on mainstream modes of app selection. Yet, it remains unclear to what extent these highly visible apps are evidence-based. The objectives of this review were to identify and describe the apps with the greatest online visibility when searching for a sleep app and to assess the claimed and actual research associated with them.

METHODS

A keyword search was conducted in Google Play and Google search. Titles of the most visible apps were retrieved. App descriptions were examined to identify research claims made about app effectiveness on sleep and other health-related outcomes. A follow-up search on PubMed and Google Scholar was conducted to verify claims.

RESULTS

The keyword search identified 53 highly visible apps. Examination of app store descriptions found that no reference to research was made for the majority of apps (n = 45, 84.9%). Published research studies were available for just 3 apps, with most studies evaluating app impact on non sleep-related outcomes. There was some evidence to attesting to the effectiveness of 2 apps in improving sleep.

CONCLUSIONS

This review demonstrates how, when carrying out a typical search for a sleep app, information about the evidence base for the majority of highly visible apps is not available. Results highlight the need for the improvement of mainstream modes of app selection in terms of better consumer-app specificity and increased transparency regarding the access to information about the evidence base for apps.

CITATION

Power N, Boivin DB, Perreault M. A shot in the dark: the impact of online visibility on the search for an effective sleep app. J Clin Sleep Med. 2024;20(8):1379-1386.

Efficacy of the Flo App in Improving Health Literacy, Menstrual and General Health, and Well-Being in Women: Pilot Randomized Controlled Trial

BACKGROUND

Reproductive health literacy and menstrual health awareness play a crucial role in ensuring the health and well-being of women and people who menstruate. Further, awareness of one's own menstrual cycle patterns and associated symptoms can help individuals identify and manage conditions of the menstrual cycle such as premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD). Digital health products, and specifically menstrual health apps, have the potential to effect positive change due to their scalability and ease of access.

OBJECTIVE

The primary aim of this study was to measure the efficacy of a menstrual and reproductive health app, Flo, in improving health literacy and health and well-being outcomes in menstruating individuals with and without PMS and PMDD. Further, we explored the possibility that the use of the Flo app could positively influence feelings around reproductive health management and communication about health, menstrual cycle stigma, unplanned pregnancies, quality of life, work productivity, absenteeism, and body image.

METHODS

We conducted 2 pilot, 3-month, unblinded, 2-armed, remote randomized controlled trials on the effects of using the Flo app in a sample of US-based (1) individuals who track their cycles (n=321) or (2) individuals who track their cycles and are affected by PMS or PMDD (n=117).

RESULTS

The findings revealed significant improvements at the end of the study period compared to baseline for our primary outcomes of health literacy (cycle tracking: D̄=1.11; t311=5.73, P<.001; PMS or PMDD: D̄=1.20; t115=3.76, P<.001) and menstrual health awareness (D̄=3.97; t311=7.71, P<.001), health and well-being (D̄=3.44; t311=5.94, P<.001), and PMS or PMDD symptoms burden (D̄=-7.08; t115=-5.44, P<.001). Improvements were also observed for our secondary outcomes of feelings of control and management over health (D̄=1.01; t311=5.08, P<.001), communication about health (D̄=0.93; t311=2.41, P=.002), menstrual cycle stigma (D̄=-0.61; t311=-2.73, P=.007), and fear of unplanned pregnancies (D̄=-0.22; t311=-2.11, P=.04) for those who track their cycles, as well as absenteeism from work and education due to PMS or PMDD (D̄=-1.67; t144=-2.49, P=.01).

CONCLUSIONS

These pilot randomized controlled trials demonstrate that the use of the Flo app improves menstrual health literacy and awareness, general health and well-being, and PMS or PMDD symptom burden. Considering the widespread use and affordability of the Flo app, these findings show promise for filling important gaps in current health care provisioning such as improving menstrual knowledge and health.

TRIAL REGISTRATION

OSF Registries osf.io/pcgw7; https://osf.io/pcgw7 ; OSF Registries osf.io/ry8vq; https://osf.io/ry8vq.

Rates of attrition and engagement in randomized controlled trials of mindfulness apps: Systematic review and meta-analysis

Randomized controlled trials (RCT) have established the efficacy of mindfulness apps for numerous mental health and behavioral outcomes. However, studies of this kind are characterized by significant problems with attrition and engagement, making it challenging to interpret these findings and realize the full potential of mindfulness app-based solutions. This systematic review and meta-analysis aimed to examine rates of attrition from, and engagement in, mindfulness apps in 70 RCTs located through four databases. The weighted meta-analytic attrition rate from 9258 participants allocated to a mindfulness app was 24.7%. This estimate was higher (38.7%) when restricting analyses to larger studies (n ≥ 100 per condition) and for specific target samples (e.g., general population of adults). Studies that offered participants monetary compensation and required in-person enrolment methods were associated with the lowest attrition rates. Attrition was higher in mindfulness app conditions relative to waitlists, but was not different to placebo or active apps. Although engagement data were inadequately reported, qualitative synthesis highlighted clear problems with sustained user engagement with mindfulness apps. Findings have implications for powering, designing and appraising research trials of mindfulness apps, as well as the development of potentially effective retention and engagement strategies worthy of evaluation in future work.

Hybrid Delivery of Mindfulness Meditation and Perceived Stress in Pediatric Resident Physicians: A Randomized Clinical Trial of In-Person and Digital Mindfulness Meditation

Physicians are experiencing epidemic levels of work-related stress and burnout. Determine efficacy of mindfulness meditation delivered as a hybrid (in-person and digital) format to reduce perceived stress in pediatric residents. Pediatric residents (n = 66) were block randomized to a hybrid Mindful Awareness Practices (MAPs) intervention, comprised of one in-person 60-min session and 6-week access to a digitally delivered MAPs curriculum (n = 27) or wait-list control (n = 39). Perceived Stress Scale (PSS) was administered at baseline and post-intervention as the primary outcome measure. A priori secondary outcomes were measured using the Abbreviated Maslach Burnout Inventory-9, Beck Depression Inventory, Beck Anxiety Inventory, UCLA Loneliness Scale, and Pittsburgh Sleep Quality Index. After the first session, 58% participated at least one digital session (M = 2.0; SD = 1.3). MAPs participants showed significant decrease in PSS compared to controls, with between-group mean difference of 2.20 (95% CI 0.47-3.93) at post-intervention (effect size 0.91; 0.19-1.62). No secondary outcome group differences were detected. Exposure to a hybrid mindfulness intervention was associated with improvement in perceived stress among pediatric residents.Trial Registration: NCT03613441.

Combining Behavioral Economics-Based Incentives With the Anchoring Strategy: Protocol for a Randomized Controlled Trial

BACKGROUND

Chronic (ie, long-term) elevated stress is associated with a number of mental and physical health conditions. Mindfulness meditation mobile apps are a promising tool for stress self-management that can overcome several barriers associated with in-person interventions; however, to date, poor app-based intervention adherence has limited the efficacy of these mobile health tools. Anchoring, or pairing, a new behavior with an existing routine has been shown to effectively establish habits that are maintained over time, but this strategy typically only works for those with high initial motivation and has yet to be tested for maintaining meditation with a mobile app.

OBJECTIVE

This study will test novel combinations of behavioral economics-based incentives with the anchoring strategy for establishing and maintaining adherence to an effective dose of meditation with a mobile app.

METHODS

This 16-week study will use a 5-arm, parallel, partially blinded (participants only), randomized controlled design. We will implement a fractional factorial study design that varies the use of self-monitoring messages and financial incentives to support participants' use of their personalized anchoring strategy for maintaining adherence to a ≥10 minute-per-day meditation prescription during an 8-week intervention period, followed by an 8-week postintervention observation period. Specifically, we will vary the use of self-monitoring messages of either the target behavior (ie, meditation tracking) or the outcome associated with the target behavior (ie, mood symptom tracking). We will also vary the use of financial incentives conditional on either meditation at any time of day or meditation performed at approximately the same time of day as participants' personalized anchors.

RESULTS

Continuous meditation app use data will be used to measure weekly meditation adherence over the 16-week study period as a binary variable equal to 1 if participants complete ≥10 minutes of meditation for ≥4 days per week and 0 otherwise. We will measure weekly anchoring plan adherence as a binary variable equal to 1 if participants complete ≥10 minutes of meditation within +1 or -1 hour of the timing of their chosen anchor on ≥4 days per week and 0 otherwise. In addition to these primary measures of meditation and anchoring plan adherence, we will also assess the secondary measures of stress, anxiety, posttraumatic stress disorder, sleep disturbance, and meditation app habit strength at baseline, week 8, and week 16.

CONCLUSIONS

This study will fill an important gap in the mobile health literature by testing novel intervention approaches for establishing and maintaining adherence to app-based mindfulness meditation. If successful, this study will identify an accessible and scalable stress self-management intervention that can help combat stress in the United States.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05217602; https://clinicaltrials.gov/ct2/show/NCT05217602.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/39930.

Feasibility, appropriateness, and acceptability of a mobile mindfulness meditation intervention to improve sleep quality among a racially/ethnically diverse population

OBJECTIVES

To evaluate the acceptability, appropriateness, and feasibility of using a mindfulness meditation mobile application to improve sleep quality among a diverse group of adults.

METHODS

This explanatory qualitative study used online focus group discussions (N = 4 groups with 17 individuals) to collect information about user experiences with a mindfulness meditation mobile application (Headspace) among participants enrolled in the MINDS study. A rapid analyses approach was used to descriptively compare motivators of app use, barriers and facilitators to app use, and perceived tailoring needs across participants.

RESULTS

Participants on average were 30 years old, 88% female, and identified as Black/African American (52.9%), White (29.4%), Asian (11.8%), and Hispanic (17.6%). All participants felt the app was acceptable and appreciated the ability to personalize their app experience. Individuals with ≥50% intervention adherence (daily use for 30 days) reported being motivated to use the app because it helped them to fall asleep faster, while the remainder of participants used the app to relax throughout the day and faced external barriers to app use (eg, lack of time) and difficulty with app navigation. Only those participants who used the app exclusively in the evenings reported falling asleep faster and staying asleep. Suggestions for tailoring the app differed by race and age. Only Black/African American participants preferred using an instructor based on their race and gender.

CONCLUSION

Using a mobile meditation app to enhance sleep quality is acceptable and feasible, but additional tailoring for Black/African American individuals may improve uptake in this population.

Mindfulness as an Adjunct or Alternative to CBT-I

Mindfulness-based interventions (MBIs) are programs that teach mindfulness concepts through guided meditation and self-regulation practices. MBIs have been found to improve sleep and reduce cognitive arousal, which are central to the development and perpetuation of insomnia. In this article, we review theoretic frameworks and clinical trial effectiveness data supporting MBIs for insomnia. Based on this review, we provide suggestions for using MBIs as an adjunct or alternative treatment option to CBT-I with regard to how, when, and for whom. We conclude with an agenda for future directions that can clarify the use of mindfulness as a treatment option for insomnia.

Effects of mindfulness meditation and Acceptance and commitment therapy in patients with obstructive sleep apnea with residual excessive sleepiness: A randomized controlled pilot study

OBJECTIVE

Assessing the effects of Mindfulness-Based Stress Reduction (MBSR) on symptoms of OSA, especially on the primary outcome, excessive daytime sleepiness (EDS).

METHODS

Parallel randomized controlled trial. 16 OSA patients with residual EDS (rEDS) were randomized and assigned to either a standardized 8-week MBSR program or a time-matched program on Acceptance and Commitment Therapy (ACT). Both programs were conducted online. Participants answered questionnaires online at baseline (pre), post-intervention (post), three months after the intervention (follow-up) and were blinded to whether their group was the treatment or active control group but not to group allocation (partial blinding). Three participants dropped out early. Most analyses are based on the remaining 13 patients.

RESULTS

There was a significant difference between the MBSR (n = 7) and ACT group (n = 6) in changes of EDS between pre and post (Cohen's d = 1.24, CI [0.01, 2.42]) and a significant reduction of EDS for patients in the ACT group at post (Cohen's d = 1.18 and [0.08, 2.22]). This EDS reduction averaging 2.17 points on the Epworth Sleepiness Scale reached the prespecified bar for clinical significance of two points on that scale. Insomnia symptoms, a secondary outcome, reduced significantly following ACT (Cohen's d = 1.43 [0.23, 2.58]). In MBSR, both participants and the MBSR-trainer judged movement-based exercises to be most efficacious.

CONCLUSION

ACT shows potential as adjunctive therapy for OSA with rEDS, although further studies are needed. It seems promising to develop therapeutic approaches for OSA with rEDS using ACT, especially if they are tailored to the needs specific to this patient group.

TRIAL REGISTRATION

https://www.drks.de; Identifier: DRKS00026812.

Effects of a Social Media-Based Mind-Body Intervention Embedded With Acupressure and Mindfulness for Stress Reduction Among Family Caregivers of Frail Older Adults: Pilot Randomized Controlled Trial

BACKGROUND

Family caregivers of frail older adults experience high levels of stress. Mind-body interventions (MBIs) focused on caregiver stress are often limited in teaching approaches, difficult to practice, and costly. A social media-based MBI embedded with mindfulness meditation (MM) and self-administered acupressure (SA) may be effective for family caregivers, offer greater usability, and lead to greater adherence.

OBJECTIVE

The aim of this study was to test the feasibility and preliminary effects of a social media-based MBI embedded with MM and SA on family caregivers of frail older adults and to investigate the preliminary effects of the intervention using a pilot randomized controlled trial.

METHODS

A 2-arm randomized controlled trial design was adopted. Family caregivers of frail older adults (n=64) were randomized into either the intervention group (n=32), receiving 8 weeks of social media-based MM and SA, or the control group (n=32), receiving brief education on caregiving for people with frailty. The primary outcome (caregiver stress) and secondary outcomes (caregiver burden, sleep quality, and mindfulness awareness and attention) were measured using a web-based survey at baseline (T0), immediately after the intervention (T1), and at the 3-month follow-up (T2).

RESULTS

The feasibility of the intervention was established with a high attendance rate (87.5%), high usability score (79), and low attrition rate (1.6%). The generalized estimating equation results showed that participants in the intervention group at T1 and T2 experienced a significant improvement in stress reduction (P=.02 and P=.04, respectively), sleep quality (P=.004 and P=.01, respectively), and mindful awareness and attention (P=.006 and P=.02, respectively) compared with the control group. There were no substantial improvements in caregiver burden at T1 and T2 (P=.59 and P=.47, respectively). A focus group session conducted after the intervention had 5 themes: impact on the family caregivers, difficulty in practicing the intervention, the strength of the program, the limitations of the program, and perception of the intervention.

CONCLUSIONS

The findings support the feasibility and preliminary effects of social media-based MBI embedded with acupressure and MM on reducing stress among family caregivers of frail older people and enhancing sleep quality and mindfulness levels. A future study with a larger and more diverse sample is proposed to evaluate the longer-term effects and generalizability of the intervention.

TRIAL REGISTRATION

Chinese Clinical Trial Registry ChiCTR2100049507; http://www.chictr.org.cn/showproj.aspx?proj=128031.

Mindful mindfulness reporting: Media portrayals of scientific evidence for meditation mobile apps

Promoting mental health is a major global challenge. As mindfulness meditation apps can help maintain and restore good mental health, it is important to understand how their efficacy and safety are portrayed in the media. This study systematically evaluates whether evidence from academic research is used to communicate the health effects of two popular mindfulness apps, Calm and Smiling Mind. A scoping review mapped research findings from 16 relevant articles, and a media analysis examined the types of evidence used in news reporting. Analysing 105 news articles revealed that 98% did not use evidence from academic research on app-based meditation to support health claims. Only 28.5% of articles included advice from a health expert, and 9.5% mentioned potential risks and alternative treatments. Stronger evidence-based reporting on the health effects of mindfulness apps is needed to enable people to make more informed decisions for their health and wellbeing.

Adherence to CPAP Treatment: Can Mindfulness Play a Role?

Obstructive sleep apnea (OSA) is considered a chronic disease that requires long-term multidisciplinary management for effective treatment. Continuous Positive Airway Pressure (CPAP) is still considered the gold standard of therapy. However, CPAP effectiveness is limited due to poor patients' adherence, as almost 50% of patients discontinue treatment after a year. Several interventions have been used in order to increase CPAP adherence. Mindfulness-based therapies have been applied in other sleep disorders such as insomnia but little evidence exists for their application on OSA patients. This review aims to focus on the current data on whether mindfulness interventions may be used in order to increase CPAP adherence and improve the sleep quality of OSA patients. Even though controlled trials of mindfulness and CPAP compliance remain to be performed, this review supports the hypothesis that mindfulness may be used as an adjunct method in order to increase CPAP adherence in OSA patients.

Sleepiness Moderates the Associations between Personality and Financial Risk Tolerance and Spending Habits among College Students

OBJECTIVES

Personality and sleep characteristics are related to financial attitudes and behaviors. However, to our knowledge no study has examined how personality and sleep may be conjointly associated with these financial outcomes. The present study examined sleepiness as a moderator of the associations between college students' personality traits and financial risk tolerance and spending habits.

METHODS

Undergraduates (N = 177, 77% women, 78% White) self-reported their personality traits and sleepiness using well-established questionnaires. Financial attitudes and behaviors were assessed via students' self-reported responses to a set of scenarios assessing risk tolerance as well as their spending habits over the prior two weeks.

RESULTS

Multiple regression analyses were run. Across five significant two-way interactions, high levels of sleepiness exacerbated risk for greater financial risk tolerance and higher spending among those characterized by high open-mindedness and low neuroticism, whereas low sleepiness increased protection for lower risk tolerance and less spending among those high in agreeableness and conscientiousness.

CONCLUSIONS

Sleepiness may act as both a vulnerability and protective factor in relations between personality and financial attitudes and behaviors. Improvements in sleepiness, which is modifiable via intervention, may have significant implications for individuals' financial well-being.

Testing the Pragmatic Effectiveness of a Consumer-Based Mindfulness Mobile App in the Workplace: Randomized Controlled Trial

BACKGROUND

Mental health and sleep problems are prevalent in the workforce, corresponding to costly impairment in productivity and increased health care use. Digital mindfulness interventions are efficacious in improving sleep and mental health in the workplace; however, evidence supporting their pragmatic utility, potential for improving productivity, and ability to reduce employer costs is limited.

OBJECTIVE

This pragmatic, cluster randomized controlled trial aimed to evaluate the experimental effects of implementing a commercially available mindfulness app-Calm-in employees of a large, multisite employer in the United States. Outcomes included mental health (depression, anxiety, and stress), sleep (insomnia and daytime sleepiness), resilience, productivity impairment (absenteeism, presenteeism, overall work impairment, and non-work activity impairment), and health care use (medical visit frequency).

METHODS

Employees were randomized at the work site to receive either the Calm app intervention or waitlist control. Participants in the Calm intervention group were instructed to use the Calm app for 10 minutes per day for 8 weeks; individuals with elevated baseline insomnia symptoms could opt-in to 6 weeks of sleep coaching. All outcomes were assessed every 2 weeks, with the exception of medical visits (weeks 4 and 8 only). Effects of the Calm intervention on outcomes were evaluated via mixed effects modeling, controlling for relevant baseline characteristics, with fixed effects of the intervention on outcomes assessed at weeks 2, 4, 6, and 8. Models were analyzed via complete-case and intent-to-treat analyses.

RESULTS

A total of 1029 employees enrolled (n=585 in the Calm intervention group, including 101 who opted-in to sleep coaching, and n=444 in waitlist control). Of them, 192 (n=88 for the Calm intervention group and n=104 for waitlist) completed all 5 assessments. In the complete-case analysis at week 8, employees at sites randomized to the Calm intervention group experienced significant improvements in depression (P=.02), anxiety (P=.01), stress (P<.001), insomnia (P<.001), sleepiness (P<.001), resilience (P=.02), presenteeism (P=.01), overall work impairment (P=.004), and nonwork impairment (P<.001), and reduced medical care visit frequency (P<.001) and productivity impairment costs (P=.01), relative to the waitlist control. In the intent-to-treat analysis at week 8, significant benefits of the intervention were observed for depression (P=.046), anxiety (P=.01), insomnia (P<.001), sleepiness (P<.001), nonwork impairment (P=.04), and medical visit frequency (P<.001).

CONCLUSIONS

The results suggest that the Calm app is an effective workplace intervention for improving mental health, sleep, resilience, and productivity and for reducing medical visits and costs owing to work impairment. Future studies should identify optimal implementation strategies that maximize employee uptake and large-scale implementation success across diverse, geographically dispersed employers.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05120310; https://clinicaltrials.gov/ct2/show/NCT05120310.

The Indirect Effects of a Mindfulness Mobile App on Productivity Through Changes in Sleep Among Retail Employees: Secondary Analysis

Background

Chronic sleep disturbance is prevalent among United States employees and associated with costly productivity impairment. Mindfulness interventions improve sleep (ie, insomnia and daytime sleepiness) and productivity outcomes, and mobile apps provide scalable means of intervention delivery. However, few studies have examined the effects of mindfulness mobile apps on employees, and no research to date has tested the role of sleep improvement as a potential mechanism of action for productivity outcomes.

Objective

This study examined the effects of Calm, a consumer-based mindfulness app, and sleep coaching, on productivity impairment among retail employees through the indirect effects of changes in insomnia and daytime sleepiness.

Methods

This study was a secondary analysis of data from a randomized controlled trial (N=1029) comparing the use of Calm (n=585, 56.9%) to a waitlist control (n=444, 43.2%) for 8 weeks among employees of a large retail employer in the United States. A subset of individuals with elevated insomnia symptoms also had access to brief sleep coaching with Calm (n=101, 9.8%). Insomnia symptom severity, daytime sleepiness, and productivity impairment (ie, absenteeism, presenteeism, overall productivity impairment, and non–work activity impairment) were assessed at baseline and weeks 2, 4, 6, and 8. Indirect effects were evaluated with latent growth curve modeling to test whether the Calm intervention (Calm group vs waitlist control) was effective in reducing work productivity impairment through changes in sleep disturbance.

Results

No significant main effects of Calm intervention on productivity impairment were detected for any outcome at α level of .05, with the exception of non–work activity impairment models, in which Calm intervention reduced non–work activity impairment over time (P=.01 and P=.02 for insomnia and sleepiness models, respectively). Significant indirect effects of insomnia were detected for presenteeism (P=.002), overall work productivity (P=.01), and non–work activity impairment (P=.002); Calm intervention produced significantly greater reductions in insomnia symptoms (relative to waitlist control), and decreases in insomnia were associated with decreases in work productivity impairment. There was no significant indirect effect of change in insomnia on changes in absenteeism (P=.20). Furthermore, we detected no significant indirect effects of daytime sleepiness on productivity impairment.

Conclusions

We found that Calm (plus sleep coaching for a small subset of individuals) had beneficial effects on employee sleep, and these benefits on sleep were related to indirect effects on productivity impairment (ie, presenteeism, overall work productivity impairment, and non–work activity impairment). There were no overall main effects of Calm intervention on productivity impairment; however, insomnia appears to be a mechanism associated with benefits for employee productivity. This is one of the first studies to suggest that sleep benefits of a mindfulness mobile app may also indirectly relate to benefits for workplace productivity.

Trial Registration

ClinicalTrials.gov NCT05120310; https://clinicaltrials.gov/ct2/show/NCT05120310

Resting and Recharging: A Narrative Review of Strategies to Improve Sleep During Residency Training

BACKGROUND

Residency involves demanding training with long hours that may cause fatigue and sleep deprivation and adversely impact residents and patients under their care.

OBJECTIVE

To identify, using a narrative review, evidence-based interventions to reduce the physiologic effects of fatigue and sleep deprivation from overnight and night shift work.

METHODS

A PubMed literature search was conducted through August 30, 2021, using the terms "resident" and "sleep" in the title or abstract and further narrowed using a third search term. Observational studies, randomized controlled trials, systematic reviews, and meta-analyses of human subjects written and published in English were included. Studies that were not specific to residents or medical interns or did not investigate an intervention were excluded. Additional studies were identified by bibliography review. Due to the heterogeneity of study design and intervention, a narrative review approach was chosen with results categorized into non-pharmacological and pharmacological interventions.

RESULTS

Initially, 271 articles were identified, which were narrowed to 28 articles with the use of a third search term related to sleep. Bibliography review yielded 4 additional articles. Data on interventions are limited by the heterogeneity of medical specialty, sample size, length of follow-up, and reliance on self-report. Non-pharmacological interventions including strategic scheduling and sleep hygiene may improve sleep and well-being. The available evidence, including randomized controlled trials, to support pharmacological interventions is limited.

CONCLUSIONS

Non-pharmacological approaches to mitigating fatigue and sleep deprivation have varying effectiveness to improve sleep for residents; however, data for pharmacological interventions is limited.

"Hidden gains"? Measuring the impact of mindfulness-based interventions for people with mild traumatic brain injury: a scoping review

BACKGROUND

Mindfulness-based interventions can support recovery from mild traumatic brain injury (mTBI). Although measurement is a key determinant of outcomes, there is no comprehensive assessment of measurement approaches used to capture outcomes of these programs. Here, we review the domains targeted, measurement techniques used, and domains and techniques most affected by mindfulness-based interventions for mTBI.

METHODS

We conducted a scoping review. After screening and full-text review, we included 29 articles and extracted data related to measurement domains, techniques, and results.

RESULTS

We identified 8 outcome domains, each with multiple subdomains. The most common domains were cognitive symptoms and general health/quality of life. No quantitative studies directly assessed sleep, physical-function, or pain-catastrophizing. Self-report was the most common measurement technique, followed by performance-based methods. Coping, somatic symptoms, emotional symptoms, stress response, and domains of cognition (particularly attention) were the most frequently improved domains. Qualitative results described benefits across all domains and suggested novel areas of benefit. Biomarkers did not reflect significant change.

CONCLUSIONS

Mindfulness-based interventions for mTBI impact a range of clinical domains and are best captured with a combination of measurement approaches. Using qualitative methods and expanding the breadth of outcomes may help capture underexplored effects of mindfulness-based interventions for mTBI.

Exploring Whether Addictions Counselors Recommend That Their Patients Use Websites, Smartphone Apps, or Other Digital Health Tools to Help Them in Their Recovery: Web-Based Survey

Background

Hundreds of smartphone apps or websites claiming to help those with addictions are available, but few have been tested for efficacy in changing clinically relevant addictions outcomes. Although most of these products are designed for self-facilitation by users struggling with addictions, counselors and other addictions treatment providers will likely play a critical role in facilitating adoption by integrating their use into counseling or recommending them to their patients. Yet, few studies have explored the practices of addictions counselors in using or recommending addictions-focused digital health tools in their work.

Objective

The aim of this study was to understand whether addiction counselors are recommending that their patients use addictions-focused apps to help them in their recovery, and the factors that affect their desire to do so.

Methods

Licensed addiction counselors practicing in the United States (N=112) were recruited from professional and scientific organizations of alcohol or drug counselors to complete a web-based survey.

Results

In total, 74% (83/112) of counselors had recommended that their patients use a website or smartphone app to assist them in recovery, and those that had done so reported recommending an app with an average of 54% of their patients. The most commonly recommended app or website was SMARTRecovery.org (9%), I am Sober (8%), In the Rooms (7%), Insight Timer (4%), Calm (4%), Sober Tool (4%), Recovery Box (3%), and Sober Grid (3%). The most important reason that counselors recommended the websites or apps was that colleagues or patients told them they found it helpful (55%), followed by their workplaces recommending it (20%) and professional organizations recommending it (10%). Counselors’ intentions to recommend a hypothetical app were strongest for apps that had been tested in rigorous, scientific studies that showed they helped users stay sober or reduce their substance use; 94% (105/112) reported that they would “definitely” or “probably” use such an app.

Conclusions

Most addictions counselors surveyed are already recommending that their patients use apps or websites to help them in their recovery, despite the paucity of available products that have evidence supporting their efficacy for addictions outcomes. One way that product developers could increase adoption among addictions treatment providers is to make efficacy testing a priority and to disseminate results through professional organizations and clinics.

The importance of sleep for people with chronic pain: current insights and evidence

We are currently in the midst of a sleep crisis. Our current work and lifestyle environments are normalizing poor sleep with substantial negative impact on our health. Research on sleep has linked sleep deprivation to poorer mental health, obesity, cancer, diabetes, heart disease, and a myriad of other health conditions. Sleep deprivation is an even greater issues for people with musculoskeletal conditions and chronic pain. Between 67% and 88% of individuals with chronic pain experience sleep disruption and insomnia, and at least 50% of people with insomnia report chronic pain. The link between sleep and pain is well documented. Experimental, cohort, and longitudinal studies have all demonstrated that restricted sleep is linked to greater pain. Poor sleep therefore not only affects general health but has a direct impact on inflammation, pain response, and experience. Improving sleep in people living with musculoskeletal conditions and with chronic pain has the potential to deliver great benefit to many. This article describes the evidence base that can underpin such work, including research about the link between pain and sleep as well as theories and approaches to intervention that may help. © 2022 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.

Targeting Anxiety to Improve Sleep Disturbance: A Randomized Clinical Trial of App-Based Mindfulness Training

OBJECTIVE

Sleep disturbance is experienced by nearly 20% of Americans and is highly comorbid with anxiety. Sleep disturbances may predict the development of anxiety disorders. Mindfulness training (MT) has shown efficacy for anxiety yet remains limited by in-person-based delivery. Digitally delivered MT may target habitual worry processes, yet its effects on sleep have not been studied. This study tested if app-based MT for anxiety could reduce worry and improve sleep and examined the underlying mechanisms.

METHODS

Individuals reporting worry interfering with sleep were randomized to treatment as usual (TAU; n = 40) or TAU + app-based MT (n = 40). Treatment-related changes in worry-related sleep disturbances (WRSDs), worry, nonreactivity, and anxiety were evaluated via self-report questionnaires at 1 and 2 months after treatment initiation. Fitbit devices were used to record total sleep time and estimate sleep efficiency. At 2 months, TAU received access to app-based MT, and both groups were reassessed at 4 months.

RESULTS

In a modified intent-to-treat analysis, WRSD scores decreased by 27% in TAU + MT (n = 36) and 6% in TAU (n = 35) at 2 months (median [IQR] change = 11 [4.3] versus 15 [5.0], p = .001). These WRSD reductions were mediated by decreased worry, particularly improved nonreactivity (p values < .001). At 4 months, TAU reported a significant 29% reduction after beginning app-based MT at 2 months and TAU + MT maintained its gains. No significant between-group differences in average estimated total sleep time or sleep efficiency were found after 2 months of using the app.

CONCLUSIONS

Few mindfulness-related apps have been evaluated for clinical efficacy and/or mechanism. Results from this study demonstrate a mechanistic link between MT and increased emotional nonreactivity, decreased worry, and reduction in reported sleep disturbances, suggesting that app-based MT may be a viable option to help individuals who report that worry interferes with their sleep.Trial Registration: ClinicalTrials.gov identifier: NCT03684057.

A Mobile App for Stress Management in Middle-Aged Men and Women (Calm): Feasibility Randomized Controlled Trial

BACKGROUND

Middle-aged adults (40-65 years) report higher stress levels than most other age groups. There is a need to determine the feasibility of using a meditation app to reduce stress and improve stress-related outcomes in middle-aged adults with a focus on men, as previous meditation app-based studies have reported a low proportion of or even no male participants.

OBJECTIVE

This study aims to (1) determine the feasibility (ie, acceptability and demand with a focus on men) of a consumer-based meditation app (Calm), to reduce stress among middle-aged adults reporting elevated stress levels, and (2) explore the preliminary effects of Calm on perceived stress, psychological outcomes (anxiety, depressive symptoms, mindfulness, and general coping), health behaviors (physical activity and eating habits), and COVID-19 perceptions.

METHODS

This feasibility randomized controlled trial evaluated an app-based meditation intervention in middle-aged adults (N=83) with elevated stress levels (ie, Perceived Stress Scale score ≥15) and limited or no previous experience with meditation. Participants were randomized to the intervention group (Calm app) or a control (educational podcasts; POD) group. Participants completed self-report assessments at baseline and postintervention (week 4). Feasibility was measured as acceptability and demand using Bowen framework. Feasibility and COVID-19 perceptions data were examined using descriptive statistics, and preliminary effects were evaluated using repeated measures analysis of variance.

RESULTS

Participants were satisfied with Calm (27/28, 96%) and found it appropriate or useful (26/28, 93%). Most reported they would likely continue using the Calm app (18/28, 64%). More Calm users reported satisfaction, appropriateness or usefulness, and intent to continue app use than POD users. Calm users (n=33) completed a mean of 20 (SD 31.1) minutes of meditation on the days they meditated and 103 (SD 109.1) minutes of meditation per week. The average adherence rate to the prescribed meditation was 71% among Calm app users, compared to 62% among POD users. Recruitment rate of men was 35% (29/83). Of those randomized to Calm, 55% (15/29) were men, and retention among them was higher (14/15, 93%) than that among women (12/20, 60%). No significant within or between group differences were observed.

CONCLUSIONS

A 4-week, app-based mindfulness meditation intervention (Calm) may be feasible for middle-aged adults and a useful stress-management tool. Calm users expressed satisfaction with the app and felt it was appropriate and useful. Significant improvements in perceived stress and psychological outcomes or stress-related health behaviors were not observed. Even though men spent less time in meditation than women did and completed fewer weekly sessions, they were more likely to adhere to the prescription. Further research is needed for improving stress and stress-related outcomes among middle-aged adults with emphasis on the effects of mindfulness meditation apps for men.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04272138; https://clinicaltrials.gov/ct2/show/NCT04272138.

Insomnia as an Unmet Need in Chronic Hematologic Cancer Patients: A study design of a randomized controlled trial evaluating a consumer-based meditation app for treatment of sleep disturbance (Preprint)

Background

To address the need for long-term, accessible, nonpharmacologic interventions targeting sleep in patients with chronic hematological cancer, we propose the first randomized controlled trial to determine the effects of a consumer-based mobile meditation app, Calm, on sleep disturbance in this population.

Objective

This study aims to test the efficacy of daily meditation delivered via Calm compared with a health education podcast control group in improving the primary outcome of self-reported sleep disturbance, as well as secondary sleep outcomes, including sleep impairment and sleep efficiency; test the efficacy of daily meditation delivered via Calm compared with a health education podcast control group on inflammatory markers, fatigue, and emotional distress; and explore free-living use during a 12-week follow-up period and the sustained effects of Calm in patients with chronic hematological cancer.

Methods

In a double-blinded randomized controlled trial, we will recruit 276 patients with chronic hematological cancer to an 8-week app-based wellness intervention—the active, daily, app-based meditation intervention or the health education podcast app control group, followed by a 12-week follow-up period. Participants will be asked to use their assigned app for at least 10 minutes per day during the 8-week intervention period; complete web-based surveys assessing self-reported sleep disturbance, fatigue, and emotional distress at baseline, 8 weeks, and 20 weeks; complete sleep diaries and wear an actigraphy device during the 8-week intervention period and at 20 weeks; and complete blood draws to assess inflammatory markers (tumor necrosis factor-α, interleukin-6, interleukin-8, and C-reactive protein) at baseline, 8 weeks, and 20 weeks.

Results

This project was funded by the National Institutes of Health National Cancer Institute (R01CA262041). The projects began in April 2022, and study recruitment is scheduled to begin in October 2022, with a total project duration of 5 years. We anticipate that we will be able to achieve our enrollment goal of 276 patients with chronic hematological cancers within the allotted project time frame.

Conclusions

This research will contribute to broader public health efforts by providing researchers and clinicians with an evidence-based commercial product to improve sleep in the long term in an underserved and understudied cancer population with a high incidence of sleep disturbance.

Trial Registration

ClinicalTrials.gov NCT05294991; https://clinicaltrials.gov/ct2/show/NCT05294991

International Registered Report Identifier (IRRID)

PRR1-10.2196/39007

'Mindfulness Living with Insomnia': an mHealth intervention for individuals with insomnia in China: a study protocol of a randomised controlled trial

INTRODUCTION

Insomnia has a remarkably negative effect on the work, quality of life and psychosomatic health of individuals, and imposes a substantial economic burden on society. Mindfulness-based interventions (MBIs) have proven beneficial in the treatment of insomnia. However, the effect of mobile or online-based (mHealth) MBIs requires further verification. This study will evaluate the effectiveness of an mHealth MBI, 'Mindful Living with Insomnia' (MLWI), relative to that of mHealth cognitive behavioural therapy for insomnia (CBT-I).

METHODS AND ANALYSIS

The study is an mHealth, randomised controlled trial. Two hundred and fifty participants will be allocated randomly and equally to either the MLWI or CBT-I group. The intervention will involve 12 sessions over a 6-week course, with 2, 30 min sessions per week. The primary outcomes are sleep quality, severity of insomnia symptoms and sleep activity, according to the Pittsburgh Sleep Quality Index, Insomnia Severity Index and sleep tracker Mi Smart Band, respectively. The secondary outcomes are perceived stress, anxiety, depression and mindfulness. Outcomes will be evaluated at the baseline, end of the intervention period and at the 3-month follow-up. Data analyses will include covariance, regression analysis, χ², t-test and Pearson's correlations. Participants will be recruited from January to June 2022, or until the recruitment process is complete. The follow-up will be completed in December 2022. All trial results should be available by the end of December 2022.

ETHICS AND DISSEMINATION

Full approval for this study has been obtained from the Ethics Committee at The Third Xiangya Hospital, Central South University, Changsha, China (21010). Study results will be disseminated via social media and peer-reviewed publications.

TRIAL REGISTRATION NUMBER

NCT04806009.

Systematic Review for the Medical Applications of Meditation in Randomized Controlled Trials

Background: Meditation has been increasingly adapted for healthy populations and participants with diseases. Its beneficial effects are still challenging to determine due to the heterogeneity and methodological obstacles regarding medical applications. This study aimed to integrate the features of therapeutic meditation in randomized controlled trials (RCTs). Methods: We conducted a systematic review of RCTs with meditation for populations with diseases using the PubMed database through June 2021. We analyzed the characteristics of the diseases/disorders, participants, measurements, and their overall benefits. Results: Among a total of 4855 references, 104 RCTs were determined and mainly applied mindfulness-based (51 RCTs), yoga-based (32 RCTs), and transcendental meditation (14 RCTs) to 10,139 patient-participants. These RCTs were conducted for participants with a total of 45 kinds of disorders; the most frequent being cancer, followed by musculoskeletal and connective tissue diseases and affective mood disorder. Seven symptoms or signs were frequently assessed: depressive mood, feeling anxious, quality of life, stress, sleep, pain, and fatigue. The RCTs showed a higher ratio of positive outcomes for sleep (73.9%) and fatigue (68.4%). Conclusions: This systematic review produced the comprehensive features of RCTs for therapeutic meditation. These results will help physicians and researchers further study clinical adaptations in the future as reference data.

Pregnant women’s use of a consumer-based meditation mobile app: A descriptive study

Objective

The objectives of this study were to explore the satisfaction of pregnant or recently pregnant women with the existing Calm app content (i.e. non-pregnancy) and preferences and recommendations for the types of pregnancy-specific content that would be helpful to pregnant women.

Methods

This study was a national cross-sectional survey of subscribers to a meditation mobile app (i.e. Calm). Eligible participants were currently pregnant or recently pregnant (within the past 12 months) and used Calm during their pregnancy. Participants were asked about their Calm usage and perceived benefits of Calm during pregnancy, and interest in pregnancy-specific content. Descriptive statistics were used to characterize the sample.

Results

Participants (N  =  111) were on average 34 years old (SD  =  5.4) and half of the sample was currently pregnant (N  =  55). The most common reasons for using the Calm app during pregnancy was for sleep problems (29%; n  =  31) or anxiety (27%; n  =  29). Women reported Calm was most helpful for improving sleep (32%; n  =  32), anxiety (25%; n  =  25), and stress (21%; n  =  21). Nearly all women wanted pregnancy-specific meditation content within the app (98%; n  =  98) and expressed interest in topics including pregnancy-related anxiety (68%; n  =  67), postpartum (50%; n  =  49), pregnancy-related sleep problems (41%; n  =  40), and labor and delivery (38%; n  =  37).

Conclusion

Women who used the Calm app during pregnancy found it helpful for improving sleep, anxiety, and stress but desire pregnancy-specific content. Future meditation mobile app studies should utilize pregnancy-specific content and test the feasibility and efficacy of sleep and mental health in pregnant women.

The Intricate Web of Fatigue in Women

The modern woman has taken her rightful place in society as a worker, a caregiver, a mother, and a world citizen. However, along with the privileges of these roles comes the great cost of stress and resultant exhaustion and fatigue. Psychosocial, physical, cultural, and disease-related realms of stress act as strands of a web that serve to bind and hinder women with chronic stress. New areas of research, such as exercise intervention, improved social programs (e.g., childcare), and supplementation are constantly evaluated for effectiveness alongside traditional remedies such as exercise. This review will highlight some of the key issues regarding stress in women and explore reports of new treatment modalities in light of the specific requirements of the modern woman.

A mindfulness meditation mobile app improves depression and anxiety in adults with sleep disturbance: Analysis from a randomized controlled trial

OBJECTIVE

The objective of this study was to 1) determine the effects of a meditation app on depression and anxiety in adults with sleep disturbance, and 2) explore the potential mediating effects of fatigue, daytime sleepiness, and pre-sleep arousal on the relationship between use of the meditation app and changes in depression and anxiety.

METHODS

Participants were 239 adults with elevated insomnia symptoms (i.e., scores ≥ 10 on the Insomnia Severity Index) and limited or no previous experience with meditation. Depression, anxiety, fatigue, daytime sleepiness, and pre-sleep arousal were assessed at baseline, four weeks, and eight weeks. Repeated-measures ANCOVAs assessed intervention effects on depression and anxiety. Mediation models were estimated using the PROCESS macro.

RESULTS

Participants in the meditation group had more improvement in depression and anxiety symptoms during the intervention period than did those in the control group. Changes in somatic and cognitive pre-sleep arousal at mid-intervention fully mediated effects on depression and partially mediated effects on anxiety. There were no significant indirect effects of fatigue and daytime-sleepiness on changes in mental health.

CONCLUSIONS

A meditation app may improve depression and anxiety in adults with sleep disturbance, with effects being driven by improvements in pre-sleep arousal. Future studies should consider targeting pre-sleep arousal to improve mental health in this population.

On the usability of digital sleep interventions in sports

High sleep quality is highly related to better health and peak performance. Nowadays, multiple applications and platforms are available to track activity, to monitor heart rate, or to evaluate sleep quality. While activity tracking and heart rate monitoring are widely used, little is known about the potentials of digital tools to optimize sleep quality. Especially among athletes, who often suffer from reduced sleep quality because of full schedules and high competition performance pressure, interventions to maximize performance by optimizing recovery and sleep quality seem to be promising. In the present paper, we give an overview on existing research focusing on the potentials of digital interventions to enhance sleep quality among athletes. In particular, mindfulness-based digital interventions seem to be promising as they evidently foster high sleep quality and related health and performance patterns. Further, athletes can time- and cost-effectively integrate them into their daily routines. Future research is needed to empirically test the usability of digital features and suitable interventions to optimize sleep.