Non-guided, mobile, CBT-I-based sleep intervention in War-torn Ukraine: A feasibility study

BACKGROUND: War conditions can severely impact sleep and mental health at the population level, especially in the conflicts of such tremendous scale as in Ukraine. The aim of this research was to study whether a mobile, unguided Cognitive Behavioral Therapy-based Intervention for sleep problems, Sleep2, is feasible, acceptable, and potentially able to reduce mental health/sleep problems symptoms.

METHODS: A single-arm, open-label, uncontrolled pre-post evaluation study was conducted with 487 registered participants: 283 started, 160 (56.55%) finished, out of which 95 completed without an ambulatory heart rate (HR) sensor and 65 with. Assessments were conducted through online questionnaires and objective measurements via HR sensors. Besides feasibility and acceptability, outcome measures included symptoms in several mental health domains alongside self-reported and objectively reported sleep parameter.

RESULTS: Engagement with the Sleep2 app was high, achieving an 80.72% compliance rate, alongside high levels of feasibility and acceptance. Participants reported significant pre-post reductions in the severity of symptoms, with sleep problems decreasing by 22.60% (Cohen's d = 0.53), insomnia by 35.08% (d = 0.69), fear of sleep by 32.43% (d = 0.25), anxiety by 27.72% (d = 0.48), depression by 28.67% (d = 0.52), PTSD by 32.41% (d = 0.51), somatic symptoms by 24.52% (d = 0.51), and perceived stress by 17.90% (d = 0.39). Objective sleep measurements showed a significant reduction in sleep onset latency only.

CONCLUSION: The 'Sleep2Ukraine' program demonstrated high feasibility and acceptance, with significant improvements in subjective sleep and mental health measures among participants. However, given the study's uncontrolled design and reliance on self-selected participants, these findings should be considered preliminary. Randomized controlled trials are needed to establish efficacy. Nonetheless, the results highlight the potential of culturally adapted, scalable, mobile-based CBT-I interventions to address sleep and mental health needs in war-affected populations.