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      Can a meditation app help my sleep? A cross-sectional survey of Calm users

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          Abstract

          Use of mindfulness mobile apps has become popular, however, there is little information about subscribers’ perceptions of app content and its impact on sleep and mental health. The purpose of this study was to survey subscribers to Calm, a popular mindfulness meditation app, to explore perceived improvements in sleep and mental health, evaluate what components of the app were associated with improvements in sleep and mental health, and determine whether improvements differed based on sleep quality. Calm subscribers who had used a sleep-related component in the last 90 days completed a Web-based investigator-developed survey and the Pittsburgh Sleep Quality Index. The survey included questions about using Calm for sleep, sleep disturbances, mental health diagnoses (i.e., anxiety, depression, PTSD) and perceived impacts of the app. Participants reported on the extent to which they felt that using Calm had improved their sleep and mental health. Most participants reported sleep disturbance, and almost half reported a mental health diagnosis. The majority of participants reported that using Calm helped them fall asleep, stay asleep, and get restful sleep. All sleep components were associated with perceived improvements in sleep disturbance. Severity of sleep disturbance moderated relationships between using Calm components and reporting improved sleep. Among subscribers with mental health diagnoses, most reported that Calm helped improve symptoms. Perceived improvement in anxiety and depression was associated with using Calm’s meditation components but not Sleep Stories or music/soundscapes. Severity of sleep disturbance did not moderate relationships between using Calm components and reporting mental health improvements. Given the accessibility of app-based meditation, research is needed to evaluate the efficacy of meditation apps to improve sleep disturbance. While some sleep content may be helpful for sleep, more research is needed to test what specific content affects mental health.

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          Most cited references38

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          The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: guidelines for reporting observational studies.

          Much biomedical research is observational. The reporting of such research is often inadequate, which hampers the assessment of its strengths and weaknesses and of a study's generalisability. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Initiative developed recommendations on what should be included in an accurate and complete report of an observational study. We defined the scope of the recommendations to cover three main study designs: cohort, case-control, and cross-sectional studies. We convened a 2-day workshop in September 2004, with methodologists, researchers, and journal editors to draft a checklist of items. This list was subsequently revised during several meetings of the coordinating group and in e-mail discussions with the larger group of STROBE contributors, taking into account empirical evidence and methodological considerations. The workshop and the subsequent iterative process of consultation and revision resulted in a checklist of 22 items (the STROBE Statement) that relate to the title, abstract, introduction, methods, results, and discussion sections of articles. 18 items are common to all three study designs and four are specific for cohort, case-control, or cross-sectional studies. A detailed Explanation and Elaboration document is published separately and is freely available on the Web sites of PLoS Medicine, Annals of Internal Medicine, and Epidemiology. We hope that the STROBE Statement will contribute to improving the quality of reporting of observational studies.
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            The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research.

            Despite the prevalence of sleep complaints among psychiatric patients, few questionnaires have been specifically designed to measure sleep quality in clinical populations. The Pittsburgh Sleep Quality Index (PSQI) is a self-rated questionnaire which assesses sleep quality and disturbances over a 1-month time interval. Nineteen individual items generate seven "component" scores: subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, use of sleeping medication, and daytime dysfunction. The sum of scores for these seven components yields one global score. Clinical and clinimetric properties of the PSQI were assessed over an 18-month period with "good" sleepers (healthy subjects, n = 52) and "poor" sleepers (depressed patients, n = 54; sleep-disorder patients, n = 62). Acceptable measures of internal homogeneity, consistency (test-retest reliability), and validity were obtained. A global PSQI score greater than 5 yielded a diagnostic sensitivity of 89.6% and specificity of 86.5% (kappa = 0.75, p less than 0.001) in distinguishing good and poor sleepers. The clinimetric and clinical properties of the PSQI suggest its utility both in psychiatric clinical practice and research activities.
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              Why sleep is important for health: a psychoneuroimmunology perspective.

              Sleep has a critical role in promoting health. Research over the past decade has documented that sleep disturbance has a powerful influence on the risk of infectious disease, the occurrence and progression of several major medical illnesses including cardiovascular disease and cancer, and the incidence of depression. Increasingly, the field has focused on identifying the biological mechanisms underlying these effects. This review highlights the impact of sleep on adaptive and innate immunity, with consideration of the dynamics of sleep disturbance, sleep restriction, and insomnia on (a) antiviral immune responses with consequences for vaccine responses and infectious disease risk and (b) proinflammatory immune responses with implications for cardiovascular disease, cancer, and depression. This review also discusses the neuroendocrine and autonomic neural underpinnings linking sleep disturbance and immunity and the reciprocal links between sleep and inflammatory biology. Finally, interventions are discussed as effective strategies to improve sleep, and potential opportunities are identified to promote sleep health for therapeutic control of chronic infectious, inflammatory, and neuropsychiatric diseases.
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                Author and article information

                Contributors
                Role: ConceptualizationRole: InvestigationRole: MethodologyRole: SupervisionRole: Writing – original draftRole: Writing – review & editing
                Role: Data curationRole: Formal analysisRole: Project administrationRole: Writing – original draftRole: Writing – review & editing
                Role: ConceptualizationRole: MethodologyRole: Writing – review & editing
                Role: ConceptualizationRole: MethodologyRole: Writing – review & editing
                Role: ConceptualizationRole: MethodologyRole: Writing – review & editing
                Role: Editor
                Journal
                PLoS One
                PLoS One
                plos
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                22 October 2021
                2021
                : 16
                : 10
                : e0257518
                Affiliations
                [1 ] College of Health Solutions, Arizona State University, Phoenix, Arizona, United States of America
                [2 ] Behavioral Research and Analytics, LLC, Salt Lake City, Utah, United States of America
                [3 ] Edson College of Nursing and Health Innovation, Center for Health Promotion and Disease Prevention, Arizona State University, Phoenix, Arizona, United States of America
                [4 ] Department of Psychiatry, Integrated Brain Health Clinical and Research Program, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts, United States of America
                [5 ] Department of Psychiatry and Biobehavioral Sciences, Cousins Center for Psychoneuroimmunology, Mindful Awareness Research Center, Jane and Terry Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California, Los Angeles, California, United States of America
                Universitat de Valencia, SPAIN
                Author notes

                Competing Interests: JH is currently the Director of Science at Calm. JH has been conducting research with Calm as a partner almost 5 years before becoming the Director of Science and the Scientific Advisory Board. AMV, LL, and MI are members of Calm’s Scientific Advisory Board and are independent from Calm leadership. Their role is to ensure the quality of Calm’s science. There are no financial incentives from the growth of Calm to any author. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

                Author information
                https://orcid.org/0000-0002-5188-0445
                https://orcid.org/0000-0002-1502-8431
                Article
                PONE-D-21-08707
                10.1371/journal.pone.0257518
                8535359
                34679078
                fcdc7ebb-b036-4122-b1f6-09dd7094df74
                © 2021 Huberty et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 16 March 2021
                : 6 September 2021
                Page count
                Figures: 0, Tables: 11, Pages: 16
                Funding
                The author(s) received no specific funding for this work.
                Categories
                Research Article
                Custom metadata
                Data used in this study are available from the OSF repository at https://doi.org/10.17605/OSF.IO/Z5AJS (DOI: 10.17605/OSF.IO/Z5AJS).

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