Analysing and Fostering Better Sleep Hygiene Routines using a Smartphone Application

By Michael Ziörjen

The Problem

Several studies conducted in the USA, Western Europe (including Switzerland) and Japan estimate that one in three people suffer from poor sleep quality, short sleep duration and/or symptoms of insomnia. These results are concerning since poor sleep is linked to a variety of physiological and psychological health issues (e.g., weakening of immune system, negative effects on mood and cognitive performance).

The standard public health procedure for sleep related issues is to present the patient with a number of sleep hygiene recommendations. These recommendations include behaviours and environmental factors that should promote healthy sleep (e.g., disconnecting from devices 30 minutes before going to bed). As with all recommendations, merely being aware of them does usually not lead to behaviour change. We all know that we should probably exercise more, drink more water and spend a bit less time on social media. And yet we find ourselves falling back into old behaviours, sticking with our existing habits and routines.

Habits for the Rescue

Recent work in the domain of behavioural psychology focuses on habits and their potential for achieving behaviour change. This growing interest in the scientific literature is accompanied by bestselling books in the self-help literature on the topic (e.g., James Clear’s Atomic Habits). This thesis aimed to explore how habit formation techniques identified in the existing literature can be used to help establish better sleep hygiene habits. More precisely, it examined how habit-stacking (i.e., combining an existing habit with a new behaviour), implementation intention rehearsal (i.e., rehearsing the sentence “After / Before [existing habit], I will: [new habit]) and habit-tracking (i.e., tracking and reflecting about the progress with the new behaviour) can be combined and incorporated into a smartphone app.

Existing sleep hygiene apps provide visualisations, interactive videos and sometimes even guided meditation routines, but do not help the user to actually change existing habits or to incorporate the sleep hygiene recommendations as new habits. In some ways, installing these apps is equivalent to buying a gym membership without building an actual workout routine.

What if there was an an App for that?

The obvious thought that every informatics student has, when presented with a problem in society is: “What if there was an app for that?” — Consequently, this thesis aimed to investigate how a smartphone app could be designed to support habit-stacking and implementation intention rehearsal and how it impacts users’ sleep hygiene routines. The fully functional iOS app called “Habstack” developed during this thesis incorporates the three habit formation techniques mentioned above and combines them with a sleep diary to capture sleep related metrics. Users could enter existing habits and combine them with a sleep hygiene recommendation (e.g., drinking a glass of water before going to bed) to form habit-stacks. The app would then send daily reminders for the users to rehearse the implementation intention (”Before I go to bed I will drink a glass of water.”).

The app was evaluated during a two week user study with 14 participants, followed by a final interview to gain insights into users’ experience. The findings collected during the interviews were augmented with an analysis of the quantitative usage data collected by the app.

The Results

Overall, the app was successful in creating and raising awareness about users existing sleep hygiene routines and the habit formation techniques presented in the app were perceived as helpful. Users also reported that the app helped them to reflect more about their existing sleep hygiene behaviour.

What I’m realising just now is, that I am sometimes not aware of what I am doing [referring to existing habits]. These are such simple things but they are so unobtrusive in my daily life and take up so little time that they didn’t even occur to me. – P12

Throughout the study, the participants performed the new behaviour 50% of the time which indicates that the app led to short-term behaviour change. Finally, the empirical findings from the interviews provided novel insights into how the habit-formation techniques were used in combination with the app. Based on these insights and a discussion of the existing literature, design recommendations for future work could be derived.

Outlook

While these results seem promising, this work was limited due to the small sample size and the short duration of the study. Furthermore, the work only focused on the addition of new behaviour whereas sleep hygiene also involves avoiding “bad habits”. Nevertheless, this work provides preliminary evidence that it is feasible to support habit-formation techniques using a smartphone app in the domain of sleep hygiene. Since existing solutions do not yet focus on supporting behaviour change, incorporating habit-formation techniques could thus have a great impact on their effectiveness. While this work focused on sleep hygiene recommendations, the underlying approach could be transferred to other domains (e.g., morning routines or work-place routines) and the presented design and implementation of the app could be used as a foundation for more long-term research both in the domain of habit-formation and sleep hygiene.

        Student: Michael Ziörjen
        Date: Jul 2022 – Jan 2023
        Masters Thesis