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

Jennifer Huberty; Megan E. Puzia; Linda Larkey; Ana-Maria Vranceanu; Michael R. Irwin

doi:10.1371/journal.pone.0257518

Peer Review History

Original SubmissionMarch 16, 2021
8 Jul 2021 Decision Letter - Sergio A. Useche, Editor PONE-D-21-08707 Can a meditation app help my sleep? A cross-sectional survey of Calm users. PLOS ONE Dear Dr. Puzia, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. First of all, apologies for the excessive time spent in the first round of reviews of your paper. It has been really difficult to allocate suitable reviewers for this submission, as the topic covered is very specific. With the aim of expediting the process, I am submitting the review report of the referee that already sent their comments and suggestions. Although there are some minor revisions to perform, two of the comments address critical issues of the paper. Therefore, please try to cover and respond to all them as good as possible. Please submit your revised manuscript by Aug 22 2021 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. Please include the following items when submitting your revised manuscript: A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'. A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'. An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'. If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter. If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: http://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols. We look forward to receiving your revised manuscript. Kind regards, Sergio A. Useche, Ph.D. Academic Editor PLOS ONE Journal Requirements: When submitting your revision, we need you to address these additional requirements. 1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf 2. Thank you for stating the following in the Competing Interests section: 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. Please confirm that this does not alter your adherence to all PLOS ONE policies on sharing data and materials, by including the following statement: "This does not alter our adherence to PLOS ONE policies on sharing data and materials.” (as detailed online in our guide for authors http://journals.plos.org/plosone/s/competing-interests). If there are restrictions on sharing of data and/or materials, please state these. Please note that we cannot proceed with consideration of your article until this information has been declared. Please include your updated Competing Interests statement in your cover letter; we will change the online submission form on your behalf. 3. We note that you have stated that you will provide repository information for your data at acceptance. Should your manuscript be accepted for publication, we will hold it until you provide the relevant accession numbers or DOIs necessary to access your data. If you wish to make changes to your Data Availability statement, please describe these changes in your cover letter and we will update your Data Availability statement to reflect the information you provide. 4. Please include your full ethics statement in the ‘Methods’ section of your manuscript file. In your statement, please include the full name of the IRB or ethics committee who approved or waived your study, as well as whether or not you obtained informed written or verbal consent. If consent was waived for your study, please include this information in your statement as well. [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Yes ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes ****** 3. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: Yes ****** 4. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes ****** 5. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: The authors report on a large cross-sectional survey (N = 9907) of Calm users, examining associations between app usage and improvements in different aspects of sleep quality. Sleep components of the app were associated with reductions in sleep disturbance, whereas general meditation was not. Greater app usage was associated with more improvement. Greater severity of sleep disturbance was associated with more benefit from using the app. Participants also reported improvements in mental health (anxiety, depression). I found this to be a comprehensive secondary analysis of an interesting dataset, and it should be quite informative to those in the fields of digital wellness and sleep. The paper was clearly written, and an enjoyable read. I have just a few questions and suggestions. 1) I’m a bit confused about the administration of the PSQI. Participants were eligible for the study if they completed at least one session of Calm in the last 90 days, but the PSQI assesses sleep disturbances over the previous month, which means that data may reflect sleep quality before, during, or after the period of app usage. If I’m correct about that, a more nuanced discussion of the moderating effects of sleep quality is warranted, since does not necessarily reflect that improvement is associated poorer sleep at baseline. 2) Why did the authors choose to analyze self-reported app usage instead of directly accessing usage logs? The recent Parry et al. (2021; Nature Human Behaviour) paper highlights that associations between self-reported and log-based measures may be low, and the paper might be enriched if the researchers studied objective data instead. 3) Lines 307-309: “To our knowledge, this is the first study to explore perceived improvements in sleep and mental health…”. I suggest removing this: the authors have published previous reports on Calm usage and there are reports that other apps (e.g. Headspace; Flett et al., 2020, Psychology and Health) have effects in reducing distress and other symptoms. 4) Related to point #2, were there any available data on the time-of-day that general meditations were used? If these were often used at night, that would lend support to the argument made in the paragraph starting line 349 (about general meditation increasing arousal and attention) ****** 6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review?** For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: No [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step. https://doi.org/10.1371/journal.pone.0257518.r001
Revision 1
16 Aug 2021 Author Response PONE-D-21-08707 Can a meditation app help my sleep? A cross-sectional survey of Calm users. Response to reviewers Dear Dr. Useche, Thank for you the opportunity to submit our revised manuscript to be considered for publication at PLOS ONE. We appreciate the time that you and the reviewer have dedicated to providing feedback on our submission. We have responded to reviewer comments below and revised the manuscript in line with their suggestions. Please see below for point-by-point responses (italicized). Reviewer comments The authors report on a large cross-sectional survey (N = 9907) of Calm users, examining associations between app usage and improvements in different aspects of sleep quality. Sleep components of the app were associated with reductions in sleep disturbance, whereas general meditation was not. Greater app usage was associated with more improvement. Greater severity of sleep disturbance was associated with more benefit from using the app. Participants also reported improvements in mental health (anxiety, depression). I found this to be a comprehensive secondary analysis of an interesting dataset, and it should be quite informative to those in the fields of digital wellness and sleep. The paper was clearly written, and an enjoyable read. I have just a few questions and suggestions. Thank you for taking the time to read and provide feedback on this paper. We appreciate your thoughtful comments and have addressed your remaining questions below. 1) I’m a bit confused about the administration of the PSQI. Participants were eligible for the study if they completed at least one session of Calm in the last 90 days, but the PSQI assesses sleep disturbances over the previous month, which means that data may reflect sleep quality before, during, or after the period of app usage. If I’m correct about that, a more nuanced discussion of the moderating effects of sleep quality is warranted, since does not necessarily reflect that improvement is associated poorer sleep at baseline. Thank you for bringing this up, and we agree that this is an important point. We have reviewed and revised the results and discussion section to limit suggestion that our findings provide direct support for any specific temporal relationships or imply prescription of meditation apps at specific points in the trajectories of sleep disturbance or sleep-disturbance treatment. We have also added a section to the limitations section to note this explicitly and cite the need for future longitudinal research in this area. 2) Why did the authors choose to analyze self-reported app usage instead of directly accessing usage logs? The recent Parry et al. (2021; Nature Human Behaviour) paper highlights that associations between self-reported and log-based measures may be low, and the paper might be enriched if the researchers studied objective data instead. We agree that the paper is limited by our use of self-reported retrospective data, and thank you for sending the citation. We've added a sentence to the limitations to note this and cited the paper that you mentioned. 3) Lines 307-309: “To our knowledge, this is the first study to explore perceived improvements in sleep and mental health…”. I suggest removing this: the authors have published previous reports on Calm usage and there are reports that other apps (e.g. Headspace; Flett et al., 2020, Psychology and Health) have effects in reducing distress and other symptoms. After reviewing/re-reviewing several of these papers, we agree and have removed this sentence from the paper. 4) Related to point #2, were there any available data on the time-of-day that general meditations were used? If these were often used at night, that would lend support to the argument made in the paragraph starting line 349 (about general meditation increasing arousal and attention) We have additional self-report data on the time of day that Calm was most frequently used for sleep, published in the original paper with these survey data; however, most participants endorsed multiple responses and we do not know specifically which components were used at particular times. We have referenced the original paper in the discussion as it relates to this point, and noted that future research would benefit from collecting this information. Attachments Attachment Submitted filename: Response to reviewers_7-14-21 MEP.docx https://doi.org/10.1371/journal.pone.0257518.r002
6 Sep 2021 Decision Letter - Sergio A. Useche, Editor Can a meditation app help my sleep? A cross-sectional survey of Calm users. PONE-D-21-08707R1 Dear Dr. Puzia, We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements. Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication. An invoice for payment will follow shortly after the formal acceptance. To ensure an efficient process, please log into Editorial Manager at http://www.editorialmanager.com/pone/, click the 'Update My Information' link at the top of the page, and double check that your user information is up-to-date. If you have any billing related questions, please contact our Author Billing department directly at authorbilling@plos.org. If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. Kind regards, Sergio A. Useche, Ph.D. Academic Editor PLOS ONE Additional Editor Comments (optional): Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation. Reviewer #1: All comments have been addressed ******** 2. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Yes ****** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes ****** 4. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: Yes ****** 5. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes ****** 6. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: Thanks you for your revision, which was responsive to my concerns. I look forward to seeing the paper in print. ****** 7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review?** For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: No https://doi.org/10.1371/journal.pone.0257518.r003
Formally Accepted
14 Oct 2021 Acceptance Letter - Sergio A. Useche, Editor PONE-D-21-08707R1 Can a meditation app help my sleep? A cross-sectional survey of Calm users. Dear Dr. Puzia: I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now with our production department. If your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information please contact onepress@plos.org. If we can help with anything else, please email us at plosone@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Dr. Sergio A. Useche Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0257518.r004

Open letter on the publication of peer review reports

PLOS recognizes the benefits of transparency in the peer review process. Therefore, we enable the publication of all of the content of peer review and author responses alongside final, published articles. Reviewers remain anonymous, unless they choose to reveal their names.

We encourage other journals to join us in this initiative. We hope that our action inspires the community, including researchers, research funders, and research institutions, to recognize the benefits of published peer review reports for all parts of the research system.

Learn more at ASAPbio .