Become your own sleepexpert: development and evaluation of a web application to support a pragmatic behavioral treatment program for insomnia in inpatient psychiatric care

Introduction: Mental disorders are among the leading causes for
reduced quality of life due to illness worldwide. The majority of
patients with mental disorders suffer from insomnia, associated
with adverse health outcomes. However, the first-line treatment,
cognitive behavioral therapy for insomnia (CBT-I), is often too complex
for patients with acute mental disorders and is not systematically
implemented in inpatient psychiatric care. Rather, insomnia
often remains untreated or treated with hypnotics, related to the
risk of adverse effects and dependency. Become your own SLEEPexpert
aims to empower patients with acute mental disorders to take
care of their own sleep health based on a pragmatic behavioral
treatment program.
Methods: SLEEPexpert was developed in collaboration with inpatients
and health care providers and centers on the sleep/circadian scienceand
evidence-based treatment components bedtime restriction and
circadian adaptation in three phases: therapist-guided treatment initiation,
self-management with nurse support, and self-management.
We further developed and tested the usability of a web application
based on questionnaires and systematic interviews with qualitativequantitative
text analyses in 15 inpatients across diagnostic entities
(8F, 4M, 26.7 ± 7.8) and 12 health care providers on psychiatric
wards.
Results: Evaluative pre-post assessments demonstrated feasibility of
the web application in an acute psychiatry setting in the hospital
(average System Usability Scale value 84.7, range 67.5; 97.5, indicative
of “ok” to “best imaginable”). Data show heightened interest from
patients and health care providers and a willingness to use a webbased
form of the SLEEPexpert program.
Conclusions: We present a novel sleep-centered intervention
(SLEEPexpert) that has the potential to be implemented and disseminated
in routine clinical care for patients with severe mental
disorders and comorbid insomnia. A current randomized controlled
trial aims to further test for efficacy. Given the substantive burden of insomnia and mental disorders, the proposed developments are expected to improve the care for patients with comorbid
insomnia.