Development and Evaluation of Nukkuaa4Ukraine: A CBT-based Online Sleep Treatment Program for Ukrainians

Introduction:
In the context of ongoing conflict in Ukraine, the mental health of the affected is a critical concern. The present study explores the effectiveness of the cognitive-behavioral therapy of insomnia (CBTi) delivered through the mobile application called “Nukkuaa” (developed in the Laboratory for Sleep and Consciousness Research at the University of Salzburg) for enhancement of the sleep quality in the war-torn region. We also assess its impact on some mental health symptoms (fear of sleep, anxiety, depression, PTSD, somatic symptoms) as it is known that sleep quality is directly linked to the state of mental health and well-being.
Method:
A total of 160 participants (76.9% female, mean age = 27.3) completed the intervention (~30-40 days) delivered through the translated and culturally-adapted mobile application “Nukkuaa” under the name “Nukkuaa4Ukraine”. We have conducted pre- and post-intervention assessments on the aforementioned psychological measures (using PSQI, ISI, FoSS, GAD-7, PHQ-9, PCL-5, SSS-8 correspondingly). Participants included a diverse cohort from various regions across Ukraine, with a significant portion experiencing or witnessing traumatic events due to the ongoing conflict.
Results:
The intervention resulted in statistically significant reductions in mean scores of sleep disturbances (from 8.93 to 6.90, p < .001) and insomnia (from 11.98 to 7.78, p < .001). In addition, we obtained significant reductions in fear of sleep (from 5.55 to 3.75, p = .002), anxiety (from 7.36 to 5.34, p < .001), depression (from 11.82 to 8.43, p < .001), PTSD (from 27.27 to 18.42, p < .001), and somatic symptoms (from 9.42 to 7.10, p < .001).
Conclusion:
The findings highlight the efficacy of CBTi e-intervention for improving sleep quality and reducing insomnia even in the war-torn region, despite the constantly present threat. In addition, it also improved mental health. Findings highlight the importance of sleep quality for maintenance of mental health, especially for people living in the war zone.