Sleep science: Part three – CBT, digital interventions and our Unmind Sleep Tools study

In parts one and two we explained why it’s important to optimise sleep, and how to measure it. We described normal variations in sleep patterns, as well as common problems people have with sleep. And we set out some tips for improving your sleep. In this final part we’ll introduce the ideas behind CBT for sleep, talk about the different types of digital interventions (and what’s available on the Unmind platform), and introduce our recent efficacy study – where we evaluated the Unmind Sleep Tools. 

CBT for sleep

One of the most effective known treatments for sleep problems like insomnia is cognitive behavioural therapy (CBT). CBT helps identify thoughts and behaviours that keep us in a cycle of poor sleep, and focuses on strategies we can develop to change our thinking and behaviours to improve how we’re feeling. When applied to sleep, this can help boost the rest we're getting at night. 

The kinds of behaviours that might be relevant to poor sleep are things like habits, lifestyle factors, and things we do to try to control our sleep.

For example, when we’re experiencing trouble sleeping, we might take daytime naps or drink more coffee to try to stay awake, which makes it harder to fall asleep the following night. Or we might start trying even harder to fall asleep – but this in turn makes it harder to sleep because sleep is an automatic process. 

Our thinking may also be involved. As it can be frustrating and exhausting to experience poor sleep, we might spend lots of time worrying about our sleep and of the consequences of not getting enough sleep, or we might have such high expectations about how much sleep we should be getting that we feel stressed about sleeping.

These worries and thoughts can leave us feeling more anxious – and our bodies and minds more activated – making it harder to fall asleep.  

Both one-to-one and digital CBT interventions are effective for common sleep problems

Many people seek one-to-one CBT for common sleep issues, either in-person or by phone, which is often available through the NHS. There are also many digital CBT sleep interventions (known as I-CBT-i) available, like apps or on online platforms. Some apps are guided (in that they include some level of interaction with a therapist), while others are unguided. 

Research has found I-CBT-i is an effective treatment for insomnia. 

As waiting times for one-to-one therapy can be long, digital interventions are really valuable, because they’re more easily accessible and often lower in cost. Commercially available apps are also great, as you can choose to use them when sleep problems are relatively mild. This, in turn, may help prevent more severe problems developing. 

Understand and improve your sleep

The Unmind platform features four Series about sleep. These are short courses made up of three to eight sessions, each lasting about five to 10 minutes. These are:

• Sleep for shift work
• Maximising short sleep
• Optimising sleep
• Understanding sleep

I-CBT-i interventions and Unmind sleep Series are designed to be worked through, step-by-step, to help you understand your sleep. By doing this, you can learn strategies to use in day-to-day life, to help with sleep.

Another digital sleep intervention that's becoming increasingly popular is audio-based tools. These are designed to be used ad-hoc and in-the-moment – when you're trying to fall asleep, or to relax before going to bed. 

We have two libraries of audio-based tools for sleep (‘Sleep Tools’) on the Unmind platform: Sleep Tales and Nightwaves.

Sleep Tales are narrated stories with background music and sounds, like ‘Tropical relief’, ‘The artist’s studio’ and ‘Stargazing from a pier’. Nightwaves are ambient music and nature sounds, like ‘Forest ambience’, ‘Winter lake’ and ‘Relax by the campfire’. 

Evaluating Unmind's Sleep Tools 

While there’s plenty of evidence showing I-CBT-i is effective, there has been little high-quality research evaluating audio-based sleep tools.

Anecdotally, many people seem to like them or find them helpful, and Sleep Tools are also one of the most popular features on the Unmind platform. There are various possible reasons why they might improve sleep – like helping your body and mind relax, distracting your focus away from worries, or replacing unhelpful pre-bed routines. But there isn’t yet empirical evidence about the impact of audio-based sleep tools on sleep. 

At Unmind, carrying out rigorous research to evaluate our platform is a core pillar of our research mission. We want to ensure our platform is backed by high-quality scientific evidence. 

So we recently carried out a pilot randomised controlled trial (RCT), to look at how people use the Sleep Tools, and what impact they have on participants’ sleep and mental health. (We took a deeper dive into RCTs in parts one and two of our 'Research at Unmind' blog series – if you’d like to learn more).

If Sleep Tools are effective in improving sleep, then they could be a helpful option for people experiencing poor sleep, as well as being a potential aid for anyone else hoping to improve their sleep (which, as we’ve seen in part one, is important for looking after our physical and mental health). They’re also user-friendly, and can continue being used as and when they’re needed. 

Here’s what the study involved:

• 300 adults who were experiencing poor sleep volunteered to take part in the study. They hadn’t used Unmind before.
• Participants were randomly assigned to one of three groups. The first two groups were given access to either Sleep Tales or Nightwaves. For four weeks they were asked to choose a tool to listen to each night, and listen to it before going to bed, to help fall asleep, or to help get back to sleep during the night. The third group acted as a control (i.e. they were not given access to the tools during these four weeks).
• All participants answered standardised questionnaires about sleep disturbance, and mental health and wellbeing – before and after this four-week period. This included the Unmind Index, a unique 26-item measure of mental health and wellbeing developed at Unmind, which you can find on the Unmind platform or read more about in our 'Measurement matters' blog series.
• Next we gave the control group access to both Sleep Tales and Nightwaves, to use as little or as often as they liked, for four weeks, and then asked them to answer the same questionnaires again. That’s because we’re interested to see how people choose to use the tools when they’re not given specific instructions about when and how to use them. 

We also asked participants for open feedback – to help us understand more about people’s experiences of using the sleep tools – which will be useful for us as our app develops. We might look out for things like what kinds of stories or sounds people liked or disliked, feature suggestions, and how people preferred to use the tools. 

We’re also planning a larger-scale follow-up RCT to replicate these findings in a bigger group of participants.

Thanks for reading. Over this three-part series, we hope to have:

• Given you some insight into why we sleep, the science of sleep, and why optimising sleep is important.

• Helped you understand why and how sleep may be measured.

• Helped you appreciate the ways in which normal sleep patterns vary between people and throughout one’s life, as well as the most common sleep problems people experience.

• Given you some general tips to optimise sleep.

• Given you some insight into the different types of digital sleep interventions.

• Left you feeling excited about our sleep tools efficacy study.

Missed the rest of this blog series? Or so impressed you're busting to read it again? Don't fret: here's part one and two.

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