Abstract Introduction Mindfulness meditation (MM) apps have gained popularity as a tool for promoting sleep. However, little is known, about the use of MM apps specifically at bedtime, or the efficacy and mechanisms of such practice on insomnia symptom severity and pre-sleep arousal. Methods In Phase 1, we conducted a mixed-methods single-arm pilot study to explore the feasibility of 4 weeks of app-guided bedtime MM practice using in-lab polysomnography and at-home (heart rate monitor and actigraphy) assessments, and self-reported sleep assessments (questionnaires and sleep diaries) in 10 participants with insomnia disorder with sleep initiation difficulties. In Phase 2, we conducted focus groups (16 patients with chronic insomnia and 8 experienced instructors) to identify facilitators and barriers to app use, and explore suggestions for integration with the bedtime routine for informing intervention refinement for a future randomized controlled trial. Results Phase 1 completion rates were over 90% with 95% completion of in-lab studies, 100% completion of questionnaires, 91% adhered with the intervention. Self-reported measures suggested improvement in sleep quality (PSQI change of -3.7, 95% CI: -6.7, -0.7), insomnia severity (ISI change of -4.5, 95% CI: -7.7, -1.4), and pre-sleep arousal (PSAS change of -7.7, 95% CI: -13.1, -2.3). Qualitative data revealed benefits and skills imparted by mindfulness including: decreased catastrophizing; acceptance/non-reactivity; body awareness/relaxation; self-kindness; awareness of sleep hygiene/bedtime routine; earlier defusing of stress; increased focus and presence; and calm throughout the day. In phase 2, suggestions from experienced instructors included setting up appropriate expectations, instructions on novel content and repetitive practice, integrating sleep hygiene tips in bedtime app use and MM practice. Conclusion The study of bedtime app-guided MM for insomnia disorder with both in-lab and remote home sleep assessments is feasible and acceptable. In preparation for future efficacy or mechanistic studies, it is important to refine the MM app intervention and study protocol according to clinical sleep recommendations to minimize heterogeneity in implementing the practice, and to decrease risks of app use at night. Our findings provide valuable information to inform the design of clinical and mechanistic research examining app-guided MM to impact insomnia severity and pre-sleep arousal. Support (if any) Harvard Osher pilot grant, NCCIH K23AT012475.
Ma et al. (Fri,) studied this question.