Non-guided, Mobile, CBT-I-based Sleep Training in War-torn Ukraine: A Feasibility Study

Objectives To study whether a mobile, unguided Cognitive Behavior Therapy-based Intervention for Sleep Disturbance, Sleep² is feasible, acceptable, and reduces mental health/sleep disturbance symptoms among the Ukrainian population during the ongoing war.

Methods A single-arm, open-label, uncontrolled pre-post evaluation study was conducted with 487 registered participants: 283 started, out of which 95 completed without an ambulatory heart rate (HR) sensor and 65 with. Assessments were conducted using online questionnaires and continuous objective measurements via HR sensors. Key outcome measures included sleep disturbance, insomnia, fear of sleep, anxiety, depression, PTSD, perceived stress, and somatic symptoms.

Results Engagement with the program was robust, achieving an 80.72% compliance rate, alongside high levels of feasibility and acceptance. Participants reported significant pre- post reductions in the severity of sleep disturbance (by 22.60%), insomnia (by 35.08%), fear of sleep (by 32.43%), anxiety (by 27.72%), depression (by 28.67%), PTSD (by 32.41%), somatic symptoms (by 24.52%), and perceived stress (by 17.90%), all with medium to high effect sizes. Objective sleep measurements showed a slight reduction in sleep onset latency.

Conclusion The ‘Sleep²Ukraine’ program demonstrated high feasibility and acceptance, with significant improvements in subjective sleep and mental health measures among participants. These findings demonstrate the potential of scalable mobile-based CBT-I interventions in war-torn regions with or without the instrument, based on the heart rate assessment.