Improving Sleep in BMT Survivors

Investigators will collect qualitative interview data from HCT survivors, caregivers, and clinicians to inform the development of a new mHealth intervention. Then, this new intervention will be developed by adapting existing interventions that were originally designed for other cancer and non‐cancer populations.A virtual reality relaxation component will also be developed as an adjunct to the mHealth stepped‐care intervention. Intervention participants will complete a baseline survey via the internet about their demographics, health, and well‐being. The baseline survey also includes questions about their sleep and will take approximately 1 hour to complete. Participants will then be provided brief behavioral therapy through the mHealth intervention. Participants would be monitored passively via actigraphy for the next 30 days. Those who continue demonstrating clinically significant sleep disturbance 30 days after starting the intervention would then receive a more intensive therapy with a trained therapist via videoconferencing. This videoconferencing therapy, adapted from cognitive behavioral therapy for insomnia, will also be a built‐in part of the mHealth intervention. Thus, the new mHealth intervention will be delivered via mobile device to enhance disseminability and improve access for survivors who typically live long distances from their HCT center. Then Sixty HCT survivors with clinically significant sleep disturbance will be recruited 90 days after HCT and be block‐randomized based on sex to receive usual care (n=20), the new mHealth stepped‐care intervention (n=20), or the new mHealth stepped‐care intervention +virtual relaxation component (n=20). Outcomes will be assessed before randomization as well as 30 and 60 days later. Participants will complete a validated self‐report measure of sleep disturbance, and for objective measurement of sleep participants will be asked to wear a Fitbit and allow Fitbit data to be uploaded to the intervention for customizing individuals' interventions. After the intervention, participants will be asked to complete a questionnaire to provide feedback on the intervention and participate in a post‐intervention interview with a member of the study team.