The Design, Implementation and Evaluation of a Mobile App to Treat Insomnia

Abstract

The aim of this thesis was to design, implement and evaluate a new mobile behavioural sleep therapy application for insomnia (SleepFix®). The rationale behind this research is the high prevalence rates of insomnia and a lack of trained clinicians to provide face-to-face psychological therapy. The first study used a mixed-methods approach to understand the user needs and preferences of individuals with insomnia. Several design requirements were considered important for engagement by end-users, such as the inclusion of sleep tracking, alarms and personalised features. The next study was a systematic review critically assessing evidence for the design, implementation and evaluation of mobile apps for insomnia. Only 15 papers describing a total of 8 apps were identified. The majority of these papers described the design and implementation. There were very few papers evaluating efficacy with only one adequately powered randomised controlled trial (RCT), stressing the need for further evidence-based apps. To assess the implementation outcomes of SleepFix, a pilot feasibility study was conducted showing the app was highly engaging, acceptable and potentially efficacious. Statistically significant and clinically meaningful improvements were reported in insomnia severity. The final study aimed to assess the adjunctive use of a wearable device synchronised with SleepFix enhanced outcomes. This was the first RCT to assess the effect of an integrated wearable with a mobile app for insomnia. One-hundred and twenty-eight individuals with insomnia symptoms were randomised to SleepFix with a wearable device (Fitbit; n=62) or SleepFix alone (n=66). Although there was no significant impact of wearable usage on insomnia, wearable device users reported improved sleep outcomes and greater engagement with the app. Together, these studies provide a comprehensive evaluation of a mobile app for insomnia and provides evidence for its feasibility and effectiveness.