A Web-Based Photo-Alteration Intervention to Promote Sleep: Randomized Controlled Trial

Abstract

Background: Receiving insufficient sleep has wide-ranging consequences for health and well-being. Although educational programs have been developed to promote sleep, these have had limited success in extending sleep duration. To address this gap, we developed a Web-based program emphasizing how physical appearances change with varying amounts of sleep.

Objective: The aims of this study were to evaluate (1) whether participants can detect changes in appearances as a function of sleep and (2) whether this intervention can alter habitual sleep patterns.

Methods: We conducted a 5-week, parallel-group, randomized controlled trial among 70 habitual short sleepers (healthy adults who reported having <7 hours of sleep routinely). Upon study enrollment, participants were randomly assigned (1:1) to receive either standard information or an appearance-based intervention. Both groups received educational materials about sleep, but those in the appearance group also viewed a website containing digitally edited photographs that showed how they would look with varying amounts of sleep. As the outcome variables, sleep duration was monitored objectively via actigraphy (at baseline and at postintervention weeks 1 and 4), and participants completed a measure of sleep hygiene (at baseline and at postintervention weeks 2, 4, and 5). For each outcome, we ran intention-to-treat analyses using linear mixed-effects models.

Results: In total, 35 participants were assigned to each group. Validating the intervention, participants in the appearance group (1) were able to identify what they looked like at baseline and (2) judged that they would look more attractive with a longer sleep duration (t26=10.35, P<.001). In turn, this translated to changes in sleep hygiene. Whereas participants in the appearance group showed improvements following the intervention (F1,107.99=9.05, P=.003), those in the information group did not (F1,84.7=0.19, P=.66). Finally, there was no significant effect of group nor interaction of group and time on actigraphy-measured sleep duration (smallest P=.26).

Conclusions: Our findings suggest that an appearance-based intervention, while not sufficient as a stand-alone, could have an adjunctive role in sleep promotion.

Trial registration: ClinicalTrials.gov NCT02491138; https://ichgcp.net/clinical-trials-registry/NCT02491138.

Keywords: outward appearance; physical appearance; public health; sleep.

Conflict of interest statement

Conflicts of Interest: None declared.

©Isabel Perucho, Kamalakannan M Vijayakumar, Sean N Talamas, Michael Wei-Liang Chee, David I Perrett, Jean C J Liu. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 26.09.2019.

Figures

Schematic of study procedures. All participants received the intervention in week 1 and had their sleep patterns monitored through actigraphy in weeks 0 (baseline), 1, and 4. The sleep hygiene questionnaire was also administered in weeks 0 (baseline), 2, 4, and 5 (marked in the figure with an “x”).

In the appearance-based intervention, participants were shown what they would look like as a function of varying sleep duration. (A) Each participant’s face was digitally edited to show them their sleep restricted (left image) and well-rested selves (right image). (B) A continuum of 13 images was created and presented to participants through an online website.

Consolidated Standards of Reporting Trials flow diagram.

Participants viewed a continuum of 13 images transformed to show what they would look like with less or more sleep. When asked to identify their current selves, participants accurately identified an image close to the baseline (Image 6). They further judged that they would look more attractive following extended sleep. (Along the continuum, dots represent the mean images participants chose, and horizontal lines depict 95% CIs for the mean.).

Mean sleep hygiene scores for participants in the information and appearance groups, plotted as a function of time (baseline and postintervention weeks 2, 4, and 5). A higher score corresponds to poorer sleep hygiene, and vertical lines represent 1 standard error of the mean.

Mean sleep duration of participants in the information and appearance groups, plotted as a function of time (baseline and postintervention weeks 1 and 4). Vertical lines represent 1 standard error of the mean.