Feasibility of a Mobile App on Sleep

Participants' satisfaction will be measured by participant responses to the item, "On a scale of 1-5 (1=did not enjoy at all, 5=very much enjoyed), how would you rate your overall enjoyment with using Calm (i.e., likeable, pleasurable)?" on an investigator-developed survey. Participants rate their satisfaction on a five-point scale, ranging from 1 (did not enjoy at all) to 5 (very much enjoyed).

Participants' perceptions of appropriateness will be measured using six items on investigator-developed survey. Items inquire about participants' perceptions regarding the app's ease of use, aesthetics and graphics, and adequacy of the instruction (all rated on 1-5 scales, with higher ratings reflecting greater perceived appropriateness), and three items about the appropriateness of the duration of daily meditations, sleep meditations, and Sleep Stories (rated on a 1-4 scale, with higher ratings reflecting greater perceived appropriateness). Average scores will be reported for each item.

The amount of time that participants use the app will be recorded by Calm (internally) and shared with Arizona State University.

The frequency of using individual app components will be recorded by Calm (internally) and shared with Arizona State University.

The amount of time that participants use the app individual app components will be recorded by Calm (internally) and shared with Arizona State University.

Sleep duration will be calculated using participants' reports of the time they fell asleep at night, the time that they woke up in the morning, and the amount time spent awake after waking up during the night. These times are self-reported in a gold-standard daily sleep diary.

The amount of time required to fall asleep will be measured by participants' self-reports in their daily sleep diaries.

The frequency of mid-sleep awakenings will be measured by participants' self-reports in their daily sleep diaries.

The amount of time spent awake after mid-sleep awakenings will be measured by participants' self-reports in their daily sleep diaries.

Sleep quality will be measured by participants' responses to the question, "How would you rate the quality of your sleep? (1= very poor and 5= very good)," which is included in participants' daily sleep diaries.

The Pre-Sleep Arousal Scale is a 16-item self-report questionnaire that measures arousal before sleep. Items describe symptoms of cognitive and somatic arousal. Using a five-point scale (1, not at all; 2, slightly: 3, moderately; 4, a lot; 5, extremely), participants rate extent to which they generally experience each symptom as they attempt to fall asleep. The Pre-Sleep Arousal Scale is comprised of two eight-item subscales, which assess Cognitive Somatic arousal. Subscale scores are determined by summing ratings from the included items. Possible scores on each subscale range from 8 to 40, with higher scores indicating greater pre-sleep arousal.

The Fatigue Severity Scale is a nine-item self-report measure of fatigue and the extent to which fatigue interferes with daily living. Respondents rate the extent to which they agree with statements about their experience with fatigue during the past week. Items are scored on a seven-point scale ranging from 1 to 7 (1=strongly disagree, 7=strongly agree). Total scores range from 1 to 7, reflecting the mean rating of the items. Higher scores indicate greater fatigue.

The Epworth Sleepiness Scale is an eight-item measure of daytime sleepiness. Respondents use a four-point scale to rate the likeliness that they would doze off or fall asleep in eight situations involving activities with low levels of stimulation, relative immobility, and relaxation, based on their usual way of life in recent times. Item ratings range from 0 to 3 (0=would never doze, 3=high chance of dozing). Items are summed to calculate a total score, ranging from 0 to 24, with higher scores indicating greater sleepiness.

The Depression Anxiety Stress Scale-21 Items is a set of three seven-item self-report scales measuring depression, anxiety, and stress/tension. Respondents use a four-point scale, ranging from 0 to 3, to rate the extent to which symptoms of depression, anxiety, and stress apply to their experiences during the past week (0=did not apply to me at all, 3=applied to me very much, or most of the time). For each scale, ratings for the relevant items are summed, and sums for each scale are multiplied by two to allow for comparison with scores from the original the 42-item version of the Depression Anxiety Stress Scale; thus total scores range from 0 to 42, with higher scores indicating greater depression, anxiety, and stress.

The Hospital Anxiety and Depression Scale is a 14-item questionnaire, comprised of two seven-item subscales measuring depression and anxiety. Respondents rate the frequency or severity of anxious and depressive symptoms on a four-point scale. Item ratings range from 0 to 3, with higher ratings reflecting more frequent or severe symptoms. Items from each subscale are summed to calculate total scores for depression and anxiety.

The Depression Anxiety Stress Scale-21 Items is a set of three seven-item self-report scales measuring depression, anxiety, and stress/tension. Respondents use a four-point scale, ranging from 0 to 3, to rate the extent to which symptoms of depression, anxiety, and stress apply to their experiences during the past week (0=did not apply to me at all, 3=applied to me very much, or most of the time). For each scale, ratings for the relevant items are summed, and sums for each scale are multiplied by two to allow for comparison with scores from the original the 42-item version of the Depression Anxiety Stress Scale; thus total scores range from 0 to 42, with higher scores indicating greater depression, anxiety, and stress.

The Hospital Anxiety and Depression Scale is a 14-item questionnaire, comprised of two seven-item subscales measuring depression and anxiety. Respondents rate the frequency or severity of anxious and depressive symptoms on a four-point scale. Item ratings range from 0 to 3, with higher ratings reflecting more frequent or severe symptoms. Items from each subscale are summed to calculate total scores for depression and anxiety.

The Depression Anxiety Stress Scale-21 Items is a set of three seven-item self-report scales measuring depression, anxiety, and stress/tension. Respondents use a four-point scale, ranging from 0 to 3, to rate the extent to which symptoms of depression, anxiety, and stress apply to their experiences during the past week (0=did not apply to me at all, 3=applied to me very much, or most of the time). For each scale, ratings for the relevant items are summed, and sums for each scale are multiplied by two to allow for comparison with scores from the original the 42-item version of the Depression Anxiety Stress Scale; thus total scores range from 0 to 42, with higher scores indicating greater depression, anxiety, and stress.