A web-based photo-alteration intervention to promote sleep: randomized controlled trial

Isabel Perucho, Kamalakannan M. Vijayakumar, Sean Talamas, Michael Wei-Lang Chee, David I. Perrett, Jean Liu*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


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 amongst 70 habitual short sleepers (healthy adults who reported having <7 hours of sleep routinely). Upon study enrolment, 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 outcome variables, sleep duration was monitored objectively via actigraphy (at baseline, and at post-intervention weeks 1 and 4), and participants completed a measure of sleep hygiene (at baseline, and at post-intervention 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: (i) were able to identify what they looked like at baseline, and (ii) judged that they would look more attractive with a longer sleep duration (t(26) = 10.35, P < .001). In turn, this translated to changes in sleep hygiene: whereas participants in the appearance group showed improvements following the intervention (F(1,107.99) = 9.05, P = .003), those in the information group did not (F(1,84.7) = 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 standalone – could have an adjunctive role in sleep promotion.
Original languageEnglish
Article numbere12500
Number of pages11
Issue number9
Publication statusPublished - 26 Sept 2019


  • Sleep
  • Public health
  • Physical appearance
  • Outward appearance


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