Poor sleep health affects a significant portion of the American population, with prevalent sleep-related issues impacting overall quality of life.1 A tiered approach to sleep health services is necessary, ranging from intensive interventions for severe cases to more widely accessible options for milder problems. Sleep coaching programs have emerged as a potential solution for addressing minor sleep concerns, offering education, support, and motivation to promote beneficial sleep habits.
While clinical interventions like cognitive behavioral therapy for insomnia (CBT-I) are well-established for severe sleep problems,2 less-intensive interventions for subclinical issues are still limited. Sleep coaching interventions aim to bridge this gap by providing support for improving sleep behaviors. Some recent pilot studies have demonstrated the efficacy of sleep coaching in enhancing sleep health for various populations, including shift workers, military personnel, and adolescents with chronic illnesses.
Sleep Reset App
A recent study published in the journal Frontiers in Sleep 3 evaluated the impact of a 12-week app-based sleep coaching program called “Sleep Reset” in a real-world setting. The program combines personalized coaching, education, and tracking components to promote healthier sleep habits. A total of 564 participants who completed the program were included in the study. Participants were initially screened for medical and psychological conditions that might contraindicate participation. Those individuals who likely needed more intensive care were referred to clinical resources.
The Sleep Reset program spans 12 weeks and includes three main aspects: tracking and assessment, education on sleep and circadian habits, and interactive coaching with a live coach. The coaches communicate with participants through the app, offering personalized recommendations and feedback. The curriculum covers a range of sleep-related topics, from sleep compression to managing stress and anxiety.
| Week | Topic Areas |
| 1 | Initial assessment, personalized sleep evaluation, introduction to the program, introduction to key techniques and concepts, setting an initial schedule |
| 2 | Begin stimulus control and some sleep compression, journaling, worry lists, and relaxation exercises |
| 3 | Daytime support activities, including managing bright light exposure, exercises, caffeine intake, napping, motivation, and self-talk |
| 4 | Addressing bedtime issues, snacking at night, environmental factors, sleep supplements, relaxation exercises |
| 5 | Bedroom-related factors, sleeping positions, mattresses, sleep technologies, reflection, and behavior change |
| 6 | Physical activity, nutrition, sleep as part of overall health, rest and recovery |
| 7 | Embracing setbacks, cultivating self-compassion, cognitive and emotion-focused techniques |
| 8 | Managing anxiety, reducing stress, dreaming, muscle relaxation and self-reflection |
| 9 | Reflection and maintenance of healthy habits, reinforcing stimulus control and schedules |
| 10 | Reflection and maintenance of healthy habits, reinforcing daytime and evening routines that support sleep health |
| 11 | Wapping up, relapse prevention, revisiting helpful behavioral exercises and ideas |
| 12 | Wrapping up, relapse prevention, revisiting helpful cognitive and emotional exercises and ideas |
The study’s primary goal was to assess whether participants completing the Sleep Reset program would show subjective improvements in sleep continuity (parameters like sleep latency, wake after sleep onset, number of awakenings, sleep efficiency), sleep duration, and use of sleep aids. It was hypothesized that participants would experience reduced sleep latency, wake after sleep onset, and awakenings, along with increased sleep duration and efficiency.
The results of the study demonstrated significant improvements in sleep parameters among participants who completed the program. Notably, there were reductions in sleep latency and wake after sleep onset, as well as improvements in sleep efficiency, number of awakenings, and total sleep time. Moreover, individuals with lower initial sleep efficiency and shorter sleep duration experienced more pronounced improvements. These findings suggest that the Sleep Reset program had a positive impact on sleep continuity and duration.
Among those who completed the program, sleep latency was reduced by 41%, wake time after sleep onset by 35%, and number of awakenings by 17%. They increased sleep efficiency by a relative 8% and sleep duration by about 45 minutes, or 11%.
| Week 1 | Week 12 | Paired t-test | ||||||||||||
| Mean | SD | Range | Mean | SD | Range | t | p | |||||||
| Sleep Latency (min) | 27.52 | 21.52 | 2-135 | 16.50 | 16.32 | 2-120 | -12.40 | <0.00001 | ||||||
| Wake After Sleep Onset (min) | 81.00 | 45.96 | 10-253 | 53.02 | 39.55 | 5-247 | -14.42 | <0.00001 | ||||||
| Sleep Efficiency (%) | 82.21% | 10.11% | 38%-98% | 88.79% | 8.40% | 36%-99% | 15.49 | <0.00001 | ||||||
| Number of Awakenings (#) | 2.38 | 0.83 | 1-5 | 1.97 | 0.78 | 1-5 | -9.61 | <0.00001 | ||||||
| Total Sleep Time (min) | 383.27 | 82.56 | 139-720 | 427.32 | 77.16 | 158-720 | 11.21 | <0.00001 | ||||||
Like any sleep intervention, those who stand the most to benefit are more likely to see greater improvements. Those who started with a lower sleep efficiency (<85%) were compared to those with a higher sleep efficiency at the outset. Those whose sleep efficiency started lower experienced greater improvements.
| Low Sleep Efficiency (N=292) | High Sleep Efficiency (N=272) | t-test | ||||
| Change | 95% CI | Change | 95% CI | t | p | |
| Sleep Latency (min) | -16.17 | (-18.94, -13.40) | -5.65 | (-7.58, -3.72) | 6.06 | <0.00001 |
| Wake After Sleep Onset (min) | -47.32 | (-52.94, -41.71) | -7.23 | (-11.04, -3.41) | 11.46 | <0.00001 |
| Sleep Efficiency (%) | 11.20% | (10.01%, 12.38%) | 1.63% | (0.78%, 2.48%) | -12.76 | <0.00001 |
| Number of Awakenings (#) | -0.48 | (-0.60, -0.36) | -0.34 | (-0.45. -0.22) | 1.62 | 0.106 |
| Total Sleep Time (min) | 65.32 | (53.69, 76.95) | 31.19 | (18.83, 45.54) | -3.96 | <0.00001 |
Additionally, those who started out sleeping less gained more sleep and improved their sleep to a greater degree than those already sleeping more hours.
| Short Sleep (N=221) | Longer Sleep (N=343) | t-test | ||||
| Change | 95% CI | Change | 95% CI | t | p | |
| Sleep Latency (min) | -12.8 | (-15.79, -9.81) | -10 | (-12.15, -7.84) | 1.53 | 0.126 |
| Wake After Sleep Onset (min) | -36.82 | (-43.48, -30.17) | -22.29 | (-26.79, -17.80) | 3.70 | 0.0002 |
| Sleep Efficiency (%) | 10.14% | (8.58%, 11.70%) | 4.29% | (3.44%. 5.15%) | -6.99 | <0.00001 |
| Number of Awakenings (#) | -0.49 | (-0.63, -0.35) | -0.36 | (-0.46, -0.25) | 1.58 | 0.115 |
| Total Sleep Time (min) | 85.10 | (40.30, 97.18) | 25.51 | (14.41, 36.60) | -6.95 | <0.00001 |
Taken together, on average, those who completed the Sleep Reset program saw notable, significant improvements in several dimensions of their sleep health. They were falling asleep faster, staying asleep longer, waking fewer times, and sleeping more hours. These effects were especially pronounced for those who started with worse sleep health since they had more room for improvement.
The study has some important limitations, including the absence of a control group and the focus on program completers, which might introduce biases. The reliance on self-reported sleep data through diaries could lack objectivity. Rigorous methodologies, such as control groups and intent-to-treat analyses, are needed to accurately assess the program’s effects.
This study highlights the potential of an app-based sleep coaching program, Sleep Reset, to improve sleep parameters and continuity for individuals without diagnosed sleep disorders. The multifaceted coaching, education, and tracking approach effectively promotes healthier sleep habits. However, further research involving control groups and broader samples is required to confirm the program’s efficacy. As sleep-related issues continue to affect public health, interventions like Sleep Reset offer promise for enhancing sleep health in various populations.
Dr. Michael Grandner is a licensed clinical psychologist, board-certified in behavioral sleep medicine, and the lead scientific advisor to Sleep Reset
This article originally appeared in SleepWorld Magazine Nov/Dec 2023.
References
- United States Center for Disease Control Sleep and Sleep Disorders https://www.cdc.gov/sleep/index.html
- Walker J, Muench A, Perlis ML, Vargas I. Cognitive Behavioral Therapy for Insomnia (CBT-I): A Primer. Klin Spec Psihol. 2022;11(2):123-137. doi:10.17759/cpse.2022110208
- Gorovoy SB, Campbell RL, Fox RS and Grandner MA (2023) App-supported sleep coaching: implications for sleep duration and sleep quality. Front. Sleep 2:1156844. doi: 10.3389/frsle.2023.1156844
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