College of Education, Psychology and Social Work, Flinders University, Adelaide, Australia.
NQ Insomnia Clinic, South Townsville, Queensland, Australia.
J Clin Sleep Med. 2022 Jun 1;18(6):1515-1522. doi: 10.5664/jcsm.9892.
Intensive sleep retraining (ISR) is a behavioral treatment that involves a patient falling asleep repeatedly over 1 treatment session (< 24 hours in duration) to treat sleep-onset insomnia. ISR relies on high homeostatic sleep and circadian rhythm drives to facilitate rapid sleep onsets overnight. The high cost and inaccessibility of laboratory-based ISR is a significant practical barrier to treatment uptake. Smartphone-delivered ISR offers a significantly more affordable, flexible, and efficient method to treat chronic insomnia. The present study is the first trial of ISR administered via smartphone in the home environment.
Smartphone-delivered ISR was investigated with 12 individuals with chronic insomnia (9 women, 3 men, aged 49.75 ± 7.71 years) using a single-group, repeated-measures, case-replication series design. Participants received a single overnight session of home-based ISR treatment administered by smartphone. Sleep onset trials started at 23:00 and concluded after 40 trials or at 11:00 the following morning, whichever occurred first. Sleep diary and psychological variables associated with insomnia were measured at pretreatment, post-treatment, and 4- and 7-week follow-up.
Significant improvements with moderate to strong effects ( = 0.59-1.94) were indicated for sleep-onset latency, sleep efficiency, insomnia symptom severity, sleep self-efficacy, anticipatory sleep anxiety, dysfunctional beliefs about sleep, and daytime fatigue and functioning compared to baseline. Therapeutic benefits were largely maintained at the 7-week follow up.
This pilot study suggests that ISR may be feasibly administered via smartphone in the home. With fewer trials and a shorter treatment session, smartphone-delivered ISR seemed to achieve similar outcomes to the earlier laboratory-based ISR procedure. Randomized controlled trials are warranted to investigate the efficacy of smartphone-administered ISR.
Mair A, Scott H, Lack L. Intensive sleep retraining treatment for insomnia administered by smartphone in the home: an uncontrolled pilot study. 2022;18(6):1515-1522.
密集睡眠再训练（ISR）是一种行为治疗方法，包括让患者在一次治疗疗程中（<24 小时）多次入睡，以治疗入睡性失眠。ISR 依赖于高稳态睡眠和昼夜节律驱动来促进夜间快速入睡。实验室基础的 ISR 成本高且难以获得，这是治疗接受的一个重大实际障碍。智能手机提供的 ISR 提供了一种更经济实惠、灵活和高效的治疗慢性失眠的方法。本研究是首例在家庭环境中通过智能手机进行 ISR 的试验。
通过智能手机对 12 名慢性失眠患者（9 名女性，3 名男性，年龄 49.75 ± 7.71 岁）进行了智能手机提供的 ISR 研究，采用单组、重复测量、病例复制系列设计。参与者接受了一次由智能手机提供的家庭基础 ISR 治疗的单次过夜疗程。睡眠起始试验于 23:00 开始，在 40 次试验后或次日上午 11:00 前结束，以先到者为准。在治疗前、治疗后以及 4 周和 7 周随访时，测量了与失眠相关的睡眠日记和心理变量。
与基线相比，睡眠潜伏期、睡眠效率、失眠症状严重程度、睡眠自我效能、预期性睡眠焦虑、睡眠功能障碍信念、白天疲劳和功能均有显著改善，且具有中等至强效应（=0.59-1.94）。治疗效益在 7 周随访时基本保持。
这项初步研究表明，ISR 可能可以通过智能手机在家中进行管理。智能手机提供的 ISR 由于试验次数较少且治疗疗程较短，似乎与早期基于实验室的 ISR 程序取得了类似的结果。需要进行随机对照试验来研究智能手机提供的 ISR 的疗效。
Mair A, Scott H, Lack L. 智能手机在家中进行的失眠密集睡眠再训练治疗：一项非对照性初步研究。睡眠医学杂志。2022;18(6):1515-1522.
