Targeting Anxiety to Improve Sleep Disturbance: A Randomized Clinical Trial of App-Based Mindfulness Training.
Study Goal
The researchers aimed to determine if app-based mindfulness training (MT) could reduce worry and improve sleep in individuals with worry-related sleep disturbances, while examining underlying mechanisms.
Results Summary
App-based MT significantly reduced worry-related sleep disturbances (27% reduction) compared to treatment as usual (6% reduction), mediated by decreased worry and improved nonreactivity. No significant differences in total sleep time or efficiency were found, but benefits were maintained at 4 months.
Population
Individuals reporting worry interfering with sleep (n = 80, split into two groups).
Effective Dosage
Not specified
Duration
2 months (with follow-up at 4 months)
Interactions
None mentioned
| Intervention | Direction | Endpoint | Population | Dosage | Impact | Claim # |
|---|---|---|---|---|---|---|
app-based mindfulness training (MT) | decrease | worry-related sleep disturbances (WRSD) scores | individuals reporting worry interfering with sleep | 27% | decreased | #1 |
treatment as usual (TAU) | decrease | worry-related sleep disturbances (WRSD) scores | individuals reporting worry interfering with sleep | 6% | decreased | #2 |
app-based mindfulness training (MT) | decrease | WRSD reductions | individuals reporting worry interfering with sleep | - | mediated by decreased worry | #3 |
app-based mindfulness training (MT) | increase | WRSD reductions | individuals reporting worry interfering with sleep | - | mediated by improved nonreactivity | #4 |
app-based mindfulness training (MT) | decrease | worry-related sleep disturbances (WRSD) | TAU group after beginning app-based MT at 2 months | 29% | reported a significant reduction | #5 |
app-based mindfulness training (MT) | decrease | WRSD reductions | TAU + MT group at 4 months | - | maintained its gains | #6 |
app-based mindfulness training (MT) | no change | average estimated total sleep time | individuals reporting worry interfering with sleep | - | No significant between-group differences | #7 |
app-based mindfulness training (MT) | no change | sleep efficiency | individuals reporting worry interfering with sleep | - | No significant between-group differences | #8 |
mindfulness training (MT) | increase | emotional nonreactivity | individuals who report that worry interferes with their sleep | - | demonstrate a mechanistic link | #9 |
mindfulness training (MT) | decrease | worry | individuals who report that worry interferes with their sleep | - | demonstrate a mechanistic link | #10 |
mindfulness training (MT) | decrease | reported sleep disturbances | individuals who report that worry interferes with their sleep | - | demonstrate a mechanistic link | #11 |
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.