- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT05561829
Determination of Optimal Sleep Treatment Elements - MOST (DOSE)
Determination of Optimal Sleep Treatment Elements (The DOSE Project)
Study Overview
Status
Conditions
Detailed Description
The DOSE Project employs the Multiphase Optimization Strategy (MOST) to evaluate the relative efficacy of the individual cognitive behavioural therapy for insomnia (CBT-I) components. The present study represents the optimization phase of MOST, which aims to identify which combination of CBT-I components produces the best expected outcome, while taking constraints, such as economy, scalability, treatment complexity, and usability, into account.
The main objectives of the DOSE Project are
- To conduct MOST on a multi-component smartphone or web application targeting insomnia
- To identify the components and combination of components that demonstrate the best expected obtainable outcome
- To examine potential moderators of the effect of the individual treatment components on insomnia severity,
- To determine which application build (i.e., combination of components) is optimal to test in a subsequent RCT.
This study employs a fractional factorial experimental design conducted with individuals experiencing moderate-to-severe insomnia. With random allocation, participants will receive a version of the application in which one or more of the five core CBT-I components (i.e., sleep hygiene education, sleep restriction, stimulus control therapy, deactivation/relaxation training, cognitive therapy) are presented in various combinations. The intervention lasts 10 weeks, including an initial one-week assessment period.
Baseline group differences (concerning socio-demographic, disease-related, and psychosocial data) will be explored to test the success of the randomization. If differences are found, sensitivity analyses will be made to evaluate their possible influence on the results. Main effects will be analysed using Mixed Linear Models (MLMs) based on the intent-to-treat sample, comparing aggregated groups of N = 2 x 320 (e.g., plus/minus sleep restriction or plus/minus sleep hygiene etc.) on all outcome variables. MLMs account for the hierarchical, non-independent nature of the data (i.e., repeated measures nested within patients and treatment conditions), testing the time*group interaction effect, reflecting the effect of treatment. Moderation analyses will evaluate whether individual differences in various baseline variables (e.g., physical function, expectations, computer proficiency, chronotype, etc.) influence intervention effects.
Study Type
Enrollment (Actual)
Phase
- Not Applicable
Contacts and Locations
Study Contact
- Name: Sofie Møgelberg Knutzen, MSc
- Phone Number: +4524269277
- Email: sofie@psy.au.dk
Study Contact Backup
- Name: Ali Amidi, PhD, MSc
- Phone Number: +4587165305
- Email: ali@psy.au.dk
Study Locations
-
-
Midtjylland
-
Aarhus, Midtjylland, Denmark, 8000
- Aarhus University
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- Adults (≥18 years)
- Individuals who report moderate-to-severe insomnia symptoms (a score ≥10 on the Insomnia Severity Index, ISI)
- Individuals with access to a smartphone or computer with internet connection
- Individuals who report sufficient technological proficiency (e.g., ability to download apps)
Exclusion Criteria:
- Children (<18 years)
- Individuals who report mild or no clinically relevant insomnia symptoms (a score <10 on the ISI)
- Individuals who have a shift-work schedule or are on maternity/paternity leave, if this impacts their sleep quality or amount of sleep
- Individuals who are unable to read Danish
- Individuals who report severe physical or psychological comorbidity with known effects on sleep (e.g., psychosis, cardiovascular disease, cancer, COPD)
- Individuals who report other diagnosed sleep or circadian rhythm disorders (e.g., sleep apnea, narcolepsy)
- Individuals who have previously used the "Hvil®"-app
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Factorial Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Sleep Hygiene
Administration of sleep hygiene education (single intervention)
|
Automated digital administration of a sleep hygiene education module via mobile or web application, lasting approximately six weeks.
The aim is to identify and modify environmental and lifestyle factors that may interfere with sleep.
|
Experimental: Cognitive Therapy
Administration of cognitive therapy only (single intervention)
|
Automated digital administration of a cognitive therapy module via mobile or web application, lasting approximately six weeks.
The aim is to identify, challenge, and modify dysfunctional beliefs about sleep.
|
Experimental: Relaxation Training
Administration of relaxation training only (single intervention)
|
Automated digital administration of a relaxation training module via mobile or web application, lasting approximately six weeks.
The aim is to reduce somatic tension and limit intrusive thought processes that interfere with sleep.
|
Experimental: Relaxation Training, Cognitive Therapy, Sleep Hygiene
Administration of relaxation training, cognitive therapy, and sleep hygiene education (3 interventions)
|
Automated digital administration of a sleep hygiene education module via mobile or web application, lasting approximately six weeks.
The aim is to identify and modify environmental and lifestyle factors that may interfere with sleep.
Automated digital administration of a cognitive therapy module via mobile or web application, lasting approximately six weeks.
The aim is to identify, challenge, and modify dysfunctional beliefs about sleep.
Automated digital administration of a relaxation training module via mobile or web application, lasting approximately six weeks.
The aim is to reduce somatic tension and limit intrusive thought processes that interfere with sleep.
|
Experimental: Stimulus Control
Administration of stimulus control therapy only (single intervention)
|
Automated digital administration of a stimulus control therapy module via mobile or web application, lasting approximately six weeks.
The aim is to strengthen associations between sleep and the sleep environment and to eliminate conditioning of non-sleep behavior and the sleep environment.
|
Experimental: Stimulus Control, Cognitive Therapy, Sleep Hygiene
Administration of stimulus control therapy, cognitive therapy, and sleep hygiene education (3 interventions)
|
Automated digital administration of a sleep hygiene education module via mobile or web application, lasting approximately six weeks.
The aim is to identify and modify environmental and lifestyle factors that may interfere with sleep.
Automated digital administration of a cognitive therapy module via mobile or web application, lasting approximately six weeks.
The aim is to identify, challenge, and modify dysfunctional beliefs about sleep.
Automated digital administration of a stimulus control therapy module via mobile or web application, lasting approximately six weeks.
The aim is to strengthen associations between sleep and the sleep environment and to eliminate conditioning of non-sleep behavior and the sleep environment.
|
Experimental: Stimulus Control, Relaxation Training, Sleep Hygiene
Administration of stimulus control therapy, relaxation training, and sleep hygiene education (3 interventions)
|
Automated digital administration of a sleep hygiene education module via mobile or web application, lasting approximately six weeks.
The aim is to identify and modify environmental and lifestyle factors that may interfere with sleep.
Automated digital administration of a relaxation training module via mobile or web application, lasting approximately six weeks.
The aim is to reduce somatic tension and limit intrusive thought processes that interfere with sleep.
Automated digital administration of a stimulus control therapy module via mobile or web application, lasting approximately six weeks.
The aim is to strengthen associations between sleep and the sleep environment and to eliminate conditioning of non-sleep behavior and the sleep environment.
|
Experimental: Stimulus Control, Relaxation Training, Cognitive Therapy
Administration of stimulus control therapy, relaxation training, and cognitive therapy (3 interventions)
|
Automated digital administration of a cognitive therapy module via mobile or web application, lasting approximately six weeks.
The aim is to identify, challenge, and modify dysfunctional beliefs about sleep.
Automated digital administration of a relaxation training module via mobile or web application, lasting approximately six weeks.
The aim is to reduce somatic tension and limit intrusive thought processes that interfere with sleep.
Automated digital administration of a stimulus control therapy module via mobile or web application, lasting approximately six weeks.
The aim is to strengthen associations between sleep and the sleep environment and to eliminate conditioning of non-sleep behavior and the sleep environment.
|
Experimental: Sleep Optimization
Administration of sleep optimization only (single intervention)
|
Automated digital administration of a sleep optimization module via mobile or web application, lasting approximately six weeks.
Based on the participant's situation and needs, sleep restriction, sleep compression, or circadian-rhythm normalization is advised and conducted.
The aim is to optimise the participant's sleep efficiency.
|
Experimental: Sleep Optimization, Cognitive Therapy, Sleep Hygiene
Administration of sleep optimization, cognitive therapy, and sleep hygiene education (3 interventions)
|
Automated digital administration of a sleep hygiene education module via mobile or web application, lasting approximately six weeks.
The aim is to identify and modify environmental and lifestyle factors that may interfere with sleep.
Automated digital administration of a cognitive therapy module via mobile or web application, lasting approximately six weeks.
The aim is to identify, challenge, and modify dysfunctional beliefs about sleep.
Automated digital administration of a sleep optimization module via mobile or web application, lasting approximately six weeks.
Based on the participant's situation and needs, sleep restriction, sleep compression, or circadian-rhythm normalization is advised and conducted.
The aim is to optimise the participant's sleep efficiency.
|
Experimental: Sleep Optimization, Relaxation Training, Sleep Hygiene
Administration of sleep optimization, relaxation training, and sleep hygiene education (3 interventions)
|
Automated digital administration of a sleep hygiene education module via mobile or web application, lasting approximately six weeks.
The aim is to identify and modify environmental and lifestyle factors that may interfere with sleep.
Automated digital administration of a relaxation training module via mobile or web application, lasting approximately six weeks.
The aim is to reduce somatic tension and limit intrusive thought processes that interfere with sleep.
Automated digital administration of a sleep optimization module via mobile or web application, lasting approximately six weeks.
Based on the participant's situation and needs, sleep restriction, sleep compression, or circadian-rhythm normalization is advised and conducted.
The aim is to optimise the participant's sleep efficiency.
|
Experimental: Sleep Optimization, Relaxation Training, Cognitive Therapy
Administration of sleep optimization, relaxation training, and cognitive therapy (3 interventions)
|
Automated digital administration of a cognitive therapy module via mobile or web application, lasting approximately six weeks.
The aim is to identify, challenge, and modify dysfunctional beliefs about sleep.
Automated digital administration of a relaxation training module via mobile or web application, lasting approximately six weeks.
The aim is to reduce somatic tension and limit intrusive thought processes that interfere with sleep.
Automated digital administration of a sleep optimization module via mobile or web application, lasting approximately six weeks.
Based on the participant's situation and needs, sleep restriction, sleep compression, or circadian-rhythm normalization is advised and conducted.
The aim is to optimise the participant's sleep efficiency.
|
Experimental: Sleep Optimization, Stimulus Control, Sleep Hygiene
Administration of sleep optimization, stimulus control therapy, and sleep hygiene education (3 interventions)
|
Automated digital administration of a sleep hygiene education module via mobile or web application, lasting approximately six weeks.
The aim is to identify and modify environmental and lifestyle factors that may interfere with sleep.
Automated digital administration of a stimulus control therapy module via mobile or web application, lasting approximately six weeks.
The aim is to strengthen associations between sleep and the sleep environment and to eliminate conditioning of non-sleep behavior and the sleep environment.
Automated digital administration of a sleep optimization module via mobile or web application, lasting approximately six weeks.
Based on the participant's situation and needs, sleep restriction, sleep compression, or circadian-rhythm normalization is advised and conducted.
The aim is to optimise the participant's sleep efficiency.
|
Experimental: Sleep Optimization, Stimulus Control, Cognitive Therapy
Administration of sleep optimization, stimulus control therapy, and cognitive therapy (3 interventions)
|
Automated digital administration of a cognitive therapy module via mobile or web application, lasting approximately six weeks.
The aim is to identify, challenge, and modify dysfunctional beliefs about sleep.
Automated digital administration of a stimulus control therapy module via mobile or web application, lasting approximately six weeks.
The aim is to strengthen associations between sleep and the sleep environment and to eliminate conditioning of non-sleep behavior and the sleep environment.
Automated digital administration of a sleep optimization module via mobile or web application, lasting approximately six weeks.
Based on the participant's situation and needs, sleep restriction, sleep compression, or circadian-rhythm normalization is advised and conducted.
The aim is to optimise the participant's sleep efficiency.
|
Experimental: Sleep Optimization, Stimulus Control, Relaxation Training
Administration of sleep optimization, stimulus control therapy, and relaxation training (3 interventions)
|
Automated digital administration of a relaxation training module via mobile or web application, lasting approximately six weeks.
The aim is to reduce somatic tension and limit intrusive thought processes that interfere with sleep.
Automated digital administration of a stimulus control therapy module via mobile or web application, lasting approximately six weeks.
The aim is to strengthen associations between sleep and the sleep environment and to eliminate conditioning of non-sleep behavior and the sleep environment.
Automated digital administration of a sleep optimization module via mobile or web application, lasting approximately six weeks.
Based on the participant's situation and needs, sleep restriction, sleep compression, or circadian-rhythm normalization is advised and conducted.
The aim is to optimise the participant's sleep efficiency.
|
Experimental: Sleep Optimization, Stimulus Control, Relaxation Training, Cognitive Therapy, Sleep Hygiene
Administration of sleep optimization, stimulus control therapy, relaxation training, cognitive therapy, and sleep hygiene education (5 interventions)
|
Automated digital administration of a sleep hygiene education module via mobile or web application, lasting approximately six weeks.
The aim is to identify and modify environmental and lifestyle factors that may interfere with sleep.
Automated digital administration of a cognitive therapy module via mobile or web application, lasting approximately six weeks.
The aim is to identify, challenge, and modify dysfunctional beliefs about sleep.
Automated digital administration of a relaxation training module via mobile or web application, lasting approximately six weeks.
The aim is to reduce somatic tension and limit intrusive thought processes that interfere with sleep.
Automated digital administration of a stimulus control therapy module via mobile or web application, lasting approximately six weeks.
The aim is to strengthen associations between sleep and the sleep environment and to eliminate conditioning of non-sleep behavior and the sleep environment.
Automated digital administration of a sleep optimization module via mobile or web application, lasting approximately six weeks.
Based on the participant's situation and needs, sleep restriction, sleep compression, or circadian-rhythm normalization is advised and conducted.
The aim is to optimise the participant's sleep efficiency.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Insomnia severity post-intervention
Time Frame: 11 weeks after study entry (randomization)
|
Assessed with the Insomnia Severity Index (ISI), with scores ranging from 0 to 28, where higher scores indicate higher insomnia severity, and a score equal to or above 10 indicates clinical significance.
|
11 weeks after study entry (randomization)
|
Insomnia severity at 6 month follow-up
Time Frame: 6 months (180 days) after post-questionnaire, approximately 8,5 months after study entry (randomization).
|
Assessed with the Insomnia Severity Index (ISI), with scores ranging from 0 to 28, where higher scores indicate higher insomnia severity, and a score equal to or above 10 indicates clinical significance.
|
6 months (180 days) after post-questionnaire, approximately 8,5 months after study entry (randomization).
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Daytime fatigue post-intervention
Time Frame: 11 weeks after study entry (randomization)
|
Assessed with the Functional Assessment of Chronic Illness Therapy for Fatigue (FACIT-Fatigue), which covers physical fatigue, functional fatigue, and social consequences of fatigue.
|
11 weeks after study entry (randomization)
|
Cognitions about sleep post-intervention
Time Frame: 11 weeks after study entry (randomization)
|
Assessed with the Dysfunctional Beliefs and Attitudes about Sleep Scale (DBAS-16).
|
11 weeks after study entry (randomization)
|
Psychological distress post-intervention
Time Frame: 11 weeks after study entry (randomization)
|
Assessed with the Depression, Anxiety, and Stress Scales-21 (DASS-21), which evaluates the constructs depression, anxiety, and stress on sub-scales.
|
11 weeks after study entry (randomization)
|
Sleep diary outcomes post-intervention
Time Frame: 11 weeks after study entry (randomization)
|
Assessed with the Consensus Sleep Diary (CSD), which measures sleep- and waking time, sleep onset latency, wakefulness after initial sleep onset, early morning awakenings, and getting-up time, allowing for total sleep time, total time in bed, and sleep efficiency to be calculated.
|
11 weeks after study entry (randomization)
|
Sleep diary outcomes at 6-month follow-up
Time Frame: 6 months (180 days) after post-questionnaire, approximately 8,5 months after study entry (randomization).
|
Assessed with the Consensus Sleep Diary (CSD), which measures sleep- and waking time, sleep onset latency, wakefulness after initial sleep onset, early morning awakenings, and getting-up time, allowing for total sleep time, total time in bed, and sleep efficiency to be calculated.
|
6 months (180 days) after post-questionnaire, approximately 8,5 months after study entry (randomization).
|
Sleep quality post-intervention
Time Frame: 11 weeks after study entry (randomization)
|
Assessed with the Pittsburgh sleep quality index (PSQI), which measures clinically derived domains of sleep difficulties (i.e., subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, use of sleep medication, and daytime dysfunction).
|
11 weeks after study entry (randomization)
|
Sleep quality at 6-month follow-up
Time Frame: 6 months (180 days) after post-questionnaire, approximately 8,5 months after study entry (randomization).
|
Assessed with the Pittsburgh sleep quality index (PSQI), which measures clinically derived domains of sleep difficulties (i.e., subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, use of sleep medication, and daytime dysfunction).
|
6 months (180 days) after post-questionnaire, approximately 8,5 months after study entry (randomization).
|
Daytime fatigue at 6-month follow-up
Time Frame: 6 months (180 days) after post-questionnaire, approximately 8,5 months after study entry (randomization).
|
Assessed with the Functional Assessment of Chronic Illness Therapy for Fatigue (FACIT-Fatigue), which covers physical fatigue, functional fatigue, and social consequences of fatigue.
|
6 months (180 days) after post-questionnaire, approximately 8,5 months after study entry (randomization).
|
Cognitions about sleep at 6-month follow-up
Time Frame: 6 months (180 days) after post-questionnaire, approximately 8,5 months after study entry (randomization).
|
Assessed with the Dysfunctional Beliefs and Attitudes about Sleep Scale (DBAS-16).
|
6 months (180 days) after post-questionnaire, approximately 8,5 months after study entry (randomization).
|
Physical and mental functioning post-intervention
Time Frame: 11 weeks after study entry (randomization)
|
Assessed with the Short Form Health Survey (SF-12), which addresses different aspects of emotional states and daily activities.
The questionnaire allows for sub-scores for mental and physical health to be calculated based on population norms, with higher scores indicating better health.
|
11 weeks after study entry (randomization)
|
Physical and mental functioning at 6-month follow-up
Time Frame: 6 months (180 days) after post-questionnaire, approximately 8,5 months after study entry (randomization).
|
Assessed with the Short Form Health Survey (SF-12), which addresses different aspects of emotional states and daily activities.
The questionnaire allows for sub-scores for mental and physical health to be calculated based on population norms, with higher scores indicating better health.
|
6 months (180 days) after post-questionnaire, approximately 8,5 months after study entry (randomization).
|
Psychological distress at 6-month follow-up
Time Frame: 6 months (180 days) after post-questionnaire, approximately 8,5 months after study entry (randomization).
|
Assessed with the Depression, Anxiety, and Stress Scales-21 (DASS-21), which evaluates the constructs depression, anxiety, and stress on sub-scales.
|
6 months (180 days) after post-questionnaire, approximately 8,5 months after study entry (randomization).
|
Health-related well-being post-intervention
Time Frame: 11 weeks after study entry (randomization)
|
Assessed with the 5-item World Health Organisation's Well-Being Index (WHO-5).
|
11 weeks after study entry (randomization)
|
Health-related well-being at 6-month follow-up
Time Frame: 6 months (180 days) after post-questionnaire, approximately 8,5 months after study entry (randomization).
|
Assessed with the 5-item World Health Organisation's Well-Being Index (WHO-5).
|
6 months (180 days) after post-questionnaire, approximately 8,5 months after study entry (randomization).
|
Application usability
Time Frame: 11 weeks after study entry (randomization)
|
Assessed with the mHealth App Usability Questionnaire (MAUQ).
|
11 weeks after study entry (randomization)
|
Collaborators and Investigators
Sponsor
Investigators
- Principal Investigator: Robert Zachariae, DMSc, MSc, Aarhus University, Aarhus University Hospital
Publications and helpful links
General Publications
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- Ritterband LM, Thorndike FP, Ingersoll KS, Lord HR, Gonder-Frederick L, Frederick C, Quigg MS, Cohn WF, Morin CM. Effect of a Web-Based Cognitive Behavior Therapy for Insomnia Intervention With 1-Year Follow-up: A Randomized Clinical Trial. JAMA Psychiatry. 2017 Jan 1;74(1):68-75. doi: 10.1001/jamapsychiatry.2016.3249.
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- Zachariae R, Lyby MS, Ritterband LM, O'Toole MS. Efficacy of internet-delivered cognitive-behavioral therapy for insomnia - A systematic review and meta-analysis of randomized controlled trials. Sleep Med Rev. 2016 Dec;30:1-10. doi: 10.1016/j.smrv.2015.10.004. Epub 2015 Oct 24.
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- Virta JJ, Heikkila K, Perola M, Koskenvuo M, Raiha I, Rinne JO, Kaprio J. Midlife sleep characteristics associated with late life cognitive function. Sleep. 2013 Oct 1;36(10):1533-41, 1541A. doi: 10.5665/sleep.3052.
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Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Estimated)
Study Completion (Estimated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Estimated)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Other Study ID Numbers
- 2016-051-000001-2099-2
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
IPD Plan Description
All individual participant data collected during the study will be made available in an irreversibly anonymized form. However, only data of those participants can be shared who have explicitly given consent to this as part of their informed consent to study participation. This means that it may not be possible to share all data underlying a certain publication.
Data will be shared exclusively for research purposes.
IPD Sharing Time Frame
IPD Sharing Access Criteria
IPD Sharing Supporting Information Type
- STUDY_PROTOCOL
- SAP
- ICF
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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