Zilu Liang
Edward Melcer
Nhung Huyen Hoang
Kingkarn Khotchasing1- 1Ubiquitous and Personal Computing Lab, Faculty of Engineering, Kyoto University of Advanced Science (KUAS), Kyoto, Japan
- 2Institute of Industrial Science (IIS), The University of Tokyo, Bunkyo, Tokyo, Japan
- 3School of Computer Science, Carleton University, Ottawa, ON, Canada
Sleep hygiene encompasses the habits, behaviors, and environmental adjustments conducive to achieving a restful sleep at night. Practices such as maintaining a consistent bedtime routine, avoiding sleep-disruptive substances such as alcohol and caffeine, and ensuring a dark and quiet bedroom are examples of good sleep hygiene. There is growing evidence that well-designed serious games can facilitate desired healthy behavioral changes, suggesting their potential for sleep hygiene intervention. This paper presents a narrative review of existing serious games and gamified systems designed for sleep hygiene intervention in daily life, providing an overview of the current landscape of Sleep Hygiene Games and Gamified Systems (SHG2S). We searched for peer-reviewed publications using four databases including Web of Science, PubMed, ACM Digital Library, and IEEE Xplore. The analysis focused on the targeted sleep hygiene, game design elements, and system evaluation and validation. We found that Accomplishment (e.g., rewards, level-up, leaderboard), Avoidance (e.g., punishment), and Social Relatedness (e.g., group quest, social prod, friending) were the most frequently employed game designs in SHG2S. Most SHG2S focused on addressing nighttime routine, while optimizing sleep environment has largely been underexplored. Existing SHG2S are also limited in addressing different cultural background and sleep patterns. Overall, empirical evidence is still limited regarding whether, why and how gamification leads to favorable effects on sleep hygiene over various temporal scales. Future work should focus on establishing a comprehensive and standardized evaluation framework to facilitate cross-study comparison and to collect evidence on the effectiveness of SHG2S.
1 Introduction
Adequate and high-quality sleep is vital for both mental and physical health (Reid et al., 2006; Clement-Carbonell et al., 2021; Ramar et al., 2021). However, sleep quality is heavily influenced by lifestyle choices and habits. Improving sleep, therefore, requires intentional behavior changes aimed at better sleep hygiene (Irish et al., 2015; Grandner, 2019; Liang et al., 2016; Liang, 2022). However, implementing and sustaining these changes over the long term can be challenging (Wilson et al., 2014; Rapp and Cena, 2014). To address this, innovative strategies such as gamification and serious games have emerged as powerful tools for promoting lasting behavior change (Connolly et al., 2012; Hamari et al., 2014; Boyle et al., 2016; Sardi et al., 2017; Chou, 2019).
Although seemingly similar, gamification and serious games differ in their approaches toward eliciting behavior change. Gamification integrates game features into non-game contexts (Deterding et al., 2011), aiming to enhance user experience or motivate behavior change (Seaborn and Fels, 2015; Alahäivälä and Oinas-Kukkonen, 2016; Chou, 2019). In health, gamification has been successfully applied to promote physical activity (Goh and Razikin, 2015; Johnson et al., 2016), encourage healthy eating (Lister et al., 2014), and support diabetes management (Theng et al., 2015; Priesterroth et al., 2019). Its low resource requirements make gamification ideal for mobile and wearable devices (Cechetti et al., 2017), allowing users to easily engage with mobile health interventions (Dennison et al., 2013; King et al., 2013).
On the other hand, serious games are specifically designed games with an additional “characterizing goal” beyond entertainment, such as education or health promotion (Dörner et al., 2016). They can lead to cognitive, behavioral, and motivational changes (Connolly et al., 2012; Boyle et al., 2016; Hamari and Keronen, 2017). In the context of health, serious games have been shown to increase engagement (Wattanasoontorn et al., 2013), drive motivation (Papastergiou, 2009), teach health knowledge (Primack et al., 2012; Lu and Kharrazi, 2018), improve adherence (Kato, 2010), elicit healthy behavior change (Haaranen et al., 2014; Smeddinck, 2016), and extend the reach of intervention programs to those who might not otherwise use them (Lenihan, 2012; Fleming et al., 2017).
Despite the success of gamification and serious games in promoting health behaviors, their application to sleep health is still in its early stages. Research emphasizes the importance of sleep hygiene for enhancing sleep health (Baranwal et al., 2023; Baron et al., 2021; Irish et al., 2015). Sleep hygiene comprises four key aspects (Irish et al., 2015; De Pasquale et al., 2024) establishing a consistent sleep-wake cycle (SH1), establishing a nighttime routine (SH2), optimizing the sleep environment (SH3), and cultivating healthy daily habits (SH4). This paper explores how games and gamification have been employed to address these aspects of sleep hygiene through research-grade Sleep Hygiene Games and Gamified Systems (SHG2S). We analyze SHG2S in terms of targeted sleep hygiene aspects, motivational design elements, and evaluation methods. Our findings offer an overview of the current state of SHG2S, discuss challenges, and highlight opportunities for future studies.
2 Materials and methods
This review aims to provide an overview of recent progress in sleep game research. We believe that such an overview is timely and can clarify current knowledge gaps and identify novel research opportunities at the intersection of sleep health and game research.
We followed a narrative review procedure (Sukhera, 2022) to identify published studies on SHG2S. Given the novelty of sleep game research, we restricted our search to studies between January 2018 to January 2025. We searched for four online databases (Web of Science, PubMed, ACM Digital Library and IEEE Xplore) using keywords: “Game or gamification or serious game or game-based,” “sleep or sleep hygiene.” We excluded terms such as “sensor or addition or videogame or excessive gaming or problematic gaming” to filter out studies on wireless sensor networks and the negative affects of entertainment video games on sleep. A total of 120 entries were retrieved. These were imported into Rayyan, a collaborative software for literature review. After removing three duplicates, three authors independently reviewed titles and abstracts based on inclusion criteria. Study had to (1) use gamification or serious games and (2) address sleep habits or behavior affecting sleep. We excluded studies on health conditions indirectly related to sleep (e.g., stress, anxiety) and apps that only monitor sleep data. Disagreements were resolved through discussion, leading to the inclusion of 5 publications at this stage. We also performed snowballing (Wohlin, 2014) by reviewing the reference lists of included papers and recent publications, which resulted in the inclusion of 4 more publications. In total, 9 publications presenting 13 SHG2S were imported into a spreadsheet for analysis. The analysis was guided by the Octalysis framework (Chou, 2019), a gamification design framework that lays out the eight core drives for human motivation.
3 Results
3.1 Targeted sleep hygiene
As shown in Table 1, 11 out of the 13 research-grade SHG2S were designed to address SH2, with four were exclusively designed for families with children (Shin et al., 2023; Pusateri et al., 2020, 2019; de Almondes and Leonardo, 2018). Six systems address SH1 and SH4, and only 2 focused on SH3. For example, Restful Journey includes educational content on maintaining bedroom temperature within an optimal range, while the Sleep Ninja app features an interactive “Bedroom Game” that prompts users to identify and click on items in a virtual bedroom that may disrupt sleep.
Table 1. Research-grade SHG2S included in the analysis.
3.2 Game design elements
Accomplishment is the most frequently employed motivational drive in SHG2S. Most systems incorporate extrinsic motivation, such as bonus cards and leaderboard in Perfect Bedroom (de Almondes and Leonardo, 2018), avatar level-ups in Sleep Ninja (Werner-Seidler et al., 2023), and smart lights as progress bars in Lights Out (Pusateri et al., 2019). Wander (Cai et al., 2021) rewards users with clearer morning images if they spend less time on their phones the night before. These game features motivate users by fostering a sense of growth and satisfaction.
The Avoidance dimension of the Octalysis framework serves as another extrinsic motivator, tapping into the fear of losing something or being punished. Sleepy Birds (Ilhan et al., 2022) employs complex punishment rules to discourage non-compliance with the planned sleep-wake schedule. For example, users lose one life for each 5 min of sleeping past the ideal wake-up time. The bird moves faster if users sleeps too early or too late, making it harder to control the bird's movement. Furthermore, users fall behind in competition by 25 meters for each 5 min of snoozing. Similarly, Perfect Bedroom (de Almondes and Leonardo, 2018) implements punishment through “pass the turn” cards that slow players' progress if they exhibit poor sleep hygiene. Notably, the Sleepy Birds study demonstrated that employing avoidance in the design of SHG2S led to better outcomes. Compared to a non-gamified version of the system, the game version motivated users to snooze less and wake up closer to the planned time to avoid losing lives in the game (Ilhan et al., 2022).
Social Relatedness is another key motivational drive used to boost users' intrinsic motivation. People often make sleep-related decisions within their social context, and prior studies have highlighted sleep games as a social practice (Pusateri et al., 2020). For example, Lights Out (Pusateri et al., 2019), Bedtime Pals (Shin et al., 2023), and Caring Heart (Shin et al., 2023) were designed for families with children, engaging both parents and children to work together to establish a pre-bed routine, thereby improving sleep for the entire family. Wander (Cai et al., 2021) allows users to share information with friends to collaboratively unravel the mystery of the Mist Forest. Office Shot (Pusateri et al., 2020) employs group quests to promote mindfulness of coffee consumption among office workers. Social features can be designed to encourage both competition and collaboration. For example, while Sleep Tamagochi allows users to play together with friends (Liang et al., 2024), Perfect Bedroom (de Almondes and Leonardo, 2018) enable users to battle with one another, motivating them to maintain good sleep hygiene to outperform their peers. Empirical evaluation show positive outcomes. The Office Shot became a talking point among coworkers to discuss sleep (Pusateri et al., 2020), while both Lights Out and Caring Heart led to positive behavior change in children before and during sleep (Pusateri et al., 2019; Shin et al., 2023).
In addition to social relatedness, humans also have an inherent need for Empowerment and Creativity. People enjoy games for the positive emotions and creativity they foster. Several SHG2S incorporate design elements surrounding Empowerment and Scarcity to create an engaging and playful experience. For instance, Restful Journey (Seaver et al., 2024) incentivizes players with earned coins to explore various islands and collecting jewels. Another way to engage players is by adding unpredictability to the game. Restful Journey (Seaver et al., 2024) introduces a random sleep goal for player to achieve. The Dream On aroma book (Pusateri et al., 2020) elegantly combines Empowerment and Unpredictability to enhance the playfulness of the game. Users are given tokens with different aroma scents to choose from, and their choices influence how the story progresses. In essence, players co-create a bedtime story with the system based on their lived experience of that moment.
3.3 Evaluation and validation
Evaluating SHG2S requires assessing their playability, usability, effectiveness in inducing behavior change, and their impact on sleep quality. Our analysis revealed that only about half of the games were empirically evaluated, typically over short periods of two weeks (Seaver et al., 2024; Ilhan et al., 2022; Pusateri et al., 2020; Shin et al., 2023). Sleep Ninja conducted the largest study, a randomized controlled trial (RCT) with 264 subjects, showing significant reduction in insomnia symptoms at 6 and 14 weeks with medium effect sizes (Werner-Seidler et al., 2023). The Sleepy Birds study (Ilhan et al., 2022), with a smaller sample (n = 26), used RCT design to compare the game version of the app with a non-game version. Results indicated that the game version helped users snooze less and adhere more closely to their sleep schedule, with a post-use questionnaire showing that 85% of participants found the app enjoyable. The Restful Journey app underwent a before-after comparison with 35 subjects with poor sleep, showing statistically significant improvement in sleep quality and anxiety levels over a 30-day field trial. The study found effect sizes ranging from small to large, although it lacked a control group (Seaver et al., 2024).
Dream On (Pusateri et al., 2020), Office Shot (Pusateri et al., 2020), Bedtime Pals (Shin et al., 2023), and Caring Heart (Shin et al., 2023) were evaluated through field trials with small cohorts (n = 2–7). Semi-structured interviews revealed positive impact on pre-sleep arousal and stimulated a sense of control in an unfamiliar sleep environment. Dream On participants reported that the sensory input helped reduce pre-sleep anxiety, while Office Shot participants showed improved awareness of sleep-related choices (Pusateri et al., 2020). Bedtime Pals and Caring Heart were positively received by children and parents, though they did not result in substantial sleep quality improvements for the parents (Shin et al., 2023).
4 Discussion
4.1 Principal findings
Among the motivational drives in SHG2S, Accomplishment (e.g., progress bars, level-ups, leaderboards) is the most commonly used. This aligns with prior research on gamified health systems (Chou, 2019; Stepanovic and Mettler, 2018). Other frequently used elements include Avoidance (e.g., punishment) and Social Relatedness (e.g., group quest, social prod, friending), followed by Ownership and Empowerment. In contrast, Epic Meaning & Calling is notably absent in all analyzed systems. This presents a promising design opportunity: future SHG2S, especially those aimed at families or couples, could integrate shared quests or missions that tap into users' sense of purpose, such as enhancing family wellbeing or nurturing a supportive relationship. Framing sleep health as a collaborative journey toward mutual goals may strengthen user motivation and promote sustained engagement.
While surface-level elements such as points and leaderboards can provide short-term motivation, their impact tends to diminish over time (Stepanovic and Mettler, 2018; Zuckerman and Gal-Oz, 2014), and excessive external rewards can undermine intrinsic motivation (Deci et al., 1999). Some SHG2S, such as Perfect Bedroom (de Almondes and Leonardo, 2018), Lights Out (Pusateri et al., 2019), Wander (Cai et al., 2021), combine Accomplishment and Social Relatedness to promote both extrinsic and intrinsic motivation. However, motivational drives like Empowerment, Social Influence, and Unpredictability/Curiosity are underutilized and could further enhance long-term engagement.
Our analysis also revealed that current SHG2S mainly target non-clinical populations in Western countries, focusing on sleep regularity (SH1) and nighttime routines (SH2). This excludes individuals with sleep disorders such as insomnia or sleep apnea. Furthermore, important aspects of sleep hygiene, such as optimizing the sleep environment (SH3) and promoting healthy daytime habits (SH4), are often neglected. A notable strength of existing SHG2S, however, is their occasional focus on children and families. These systems often feature tactile, multi-sensory games that can be played in various areas of the home, such as bedrooms or living rooms.
Sleep games as a research field is still in its infancy. Currently, empirical evidence is limited as to whether, why, and how gamification leads to favorable effects on sleep hygiene across different temporal scales. There could be two reasons for this gap. First, SHG2S are inherent complex, aiming not only to change user behaviors but also to improve the multifaceted phenomenon of sleep, which involves various interconnected factors (Baranwal et al., 2023; Jackson et al., 2020; Irish et al., 2015). For instance, interventions targeting sleep environment optimization (SH3) differ from those promoting healthy exercise and nutrition habits (SH4). The introduction of game elements further complicates evaluation, as it requires balancing behavior change with creating engaging and enjoyable user experience. Second, evaluating the effectiveness of SHG2S is challenging because the effects of sleep hygiene interventions take time to manifest in sleep quality (Baron et al., 2021). Many studies on SHG2S have been short-term (e.g., 2 weeks) (Pusateri et al., 2020; Shin et al., 2023), which may not be sufficient to observe significant improvement in sleep quality. As a result, much of the research to date has focused on usability and user satisfaction rather than measurable sleep improvements. Given the heterogeneity of game components, target users, and usage scenarios, direct comparison and synthesis across studies remain difficult.
4.2 Challenges and opportunities
To broaden the impact of SHG2S, future designs should address key gaps in the current systems. First, a more comprehensive use of diverse motivational drives in game design is essential. Elements like social support, feedback, and sharing can enhance user engagement, as demonstrated in other gamified health apps (Johnson et al., 2016). In addition, introducing variability and uncertainty in rewards has proven effective in boosting engagement in health apps (El-Hilly et al., 2016). Second, future SHG2S designs should target a broader demographic, including teenagers, college students, and senior citizens. It is also important to address common sleep disorders while incorporating under-explored aspects of sleep hygiene, such as optimizing the sleep environment (SH3) and promoting healthy daytime habits (SH4). Contextualizing sleep within the entire daily cycle may present new opportunities for SHG2S to influence daytime behaviors that, in turn, improve sleep quality (Liang et al., 2025). Finally, a robust and standardized evaluation framework is essential for advancing SHG2S research. This framework should encompass playability, usability, emotional impact, user attitudes, and efficacy in improving sleep quality. By integrating these elements, researchers will be better equipped to assess the true benefits of SHG2S in enhancing sleep hygiene and quality. Moreover, a holistic evaluation approach will enable more meaningful cross-study comparisons and strengthen the evidence for SHG2S effectiveness and drive progress in the field.
Author contributions
ZL: Conceptualization, Data curation, Formal analysis, Funding acquisition, Investigation, Methodology, Project administration, Resources, Software, Supervision, Validation, Visualization, Writing – original draft, Writing – review & editing. EM: Methodology, Supervision, Validation, Writing – original draft, Writing – review & editing. HH: Conceptualization, Data curation, Formal analysis, Investigation, Software, Writing – review & editing. KK: Data curation, Formal analysis, Investigation, Software, Writing – review & editing.
Funding
The author(s) declare that financial support was received for the research and/or publication of this article. This study was supported by JSPS KAKENHI Grant Number 21K17670 and KUAS Overseas Collaboration Grant.
Conflict of interest
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
Generative AI statement
The author(s) declare that no Gen AI was used in the creation of this manuscript.
Publisher's note
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References
Alahäivälä, T., and Oinas-Kukkonen, H. (2016). Understanding persuasion contexts in health gamification: a systematic analysis of gamified health behavior change support systems literature. Int. J. Med. Inform. 96, 62–70. doi: 10.1016/j.ijmedinf.2016.02.006
Baranwal, N., Yu, P. K., and Siegel, N. S. (2023). Sleep physiology, pathophysiology, and sleep hygiene. Prog. Cardiovasc. Dis. 77, 59–69. doi: 10.1016/j.pcad.2023.02.005
Baron, K. G., Duffecy, J., Reutrakul, S., Levenson, J. C., McFarland, M. M., Lee, S., et al. (2021). Behavioral interventions to extend sleep duration: a systematic review and meta-analysis. Sleep Med. Rev. 60:101532. doi: 10.1016/j.smrv.2021.101532
Boyle, E. A., Hainey, T., Connolly, T. M., Gray, G., Earp, J., Ott, M., et al. (2016). An update to the systematic literature review of empirical evidence of the impacts and outcomes of computer games and serious games. Comput. Educ. 94, 178–192. doi: 10.1016/j.compedu.2015.11.003
Cai, J., Chen, B., Wang, C., and Jia, J. (2021). “Wander: a breath-control audio game to support sound sleep,” in Extended Abstracts of the 2021 Annual Symposium on Computer-Human Interaction in Play, CHI PLAY '21 (New York, NY, USA: Association for Computing Machinery), 17–23. doi: 10.1145/3450337.3483461
Cechetti, N. P., Biduki, D., and De Marchi, A. C. B. (2017). “Gamification strategies for mobile device applications: a systematic review,” in 2017 12th Iberian Conference on Information Systems and Technologies (CISTI) (Lisbon: IEEE), 1–7. doi: 10.23919/CISTI.2017.7975943
Chou, Y.-K. (2019). Actionable Gamification: Beyond Points, Badges, and Leaderboards. Birmingham, AL: Packt Publishing Ltd.
Clement-Carbonell, V., Portilla-Tamarit, I., Rubio-Aparicio, M., and Madrid-Valero, J. J. (2021). Sleep quality, mental and physical health: a differential relationship. Int. J. Environ. Res. Public Health 18:460. doi: 10.3390/ijerph18020460
Connolly, T. M., Boyle, E. A., MacArthur, E., Hainey, T., and Boyle, J. M. (2012). A systematic literature review of empirical evidence on computer games and serious games. Comput. Educ. 59, 661–686. doi: 10.1016/j.compedu.2012.03.004
de Almondes, K. M., and Leonardo, M. E. M. (2018). Study protocol of sleep education tool for children: serious game perfect bedroom: learn to sleep well. Front. Psychol. 9, 1–13. doi: 10.3389/fpsyg.2018.01016
De Pasquale, C., El Kazzi, M., Sutherland, K., Shriane, A. E., Vincent, G. E., Cistulli, P. A., et al. (2024). Sleep hygiene - what do we mean? A bibliographic review. Sleep Med. Rev. 75:101930. doi: 10.1016/j.smrv.2024.101930
Deci, E. L., Koestner, R., and Ryan, R. M. (1999). A meta-analytic review of experiments examining the effects of extrinsic rewards on intrinsic motivation. Psychol. Bull. 125, 627–668. doi: 10.1037//0033-2909.125.6.627
Dennison, L., Morrison, L., Conway, G., and Yardley, L. (2013). Opportunities and challenges for smartphone applications in supporting health behavior change: qualitative study. J. Med. Internet Res. 15:e2583. doi: 10.2196/jmir.2583
Deterding, S., Dixon, D., Khaled, R., and Nacke, L. (2011). “From game design elements to gamefulness: Defining gamification,” in Proceedings of the 15th International Academic MindTrek Conference: Envisioning Future Media Environments, MindTrek '11 (New York, NY, USA: Association for Computing Machinery), 9–15. doi: 10.1145/2181037.2181040
Dörner, R., Göbel, S., Effelsberg, W., and Wiemeyer, J. (2016). Serious Games. Number 1. Springer: New York. doi: 10.1007/978-3-319-40612-1_1
El-Hilly, A. A., Iqbal, S. S., Ahmed, M., Sherwani, Y., Muntasir, M., Siddiqui, S., et al. (2016). Game on? smoking cessation through the gamification of mhealth: a longitudinal qualitative study. JMIR Serious Game 4, 1–13. doi: 10.2196/games.5678
Fleming, T. M., Bavin, L., Stasiak, K., Hermansson-Webb, E., Merry, S. N., Cheek, C., et al. (2017). Serious games and gamification for mental health: current status and promising directions. Front. Psychiatry 7:215. doi: 10.3389/fpsyt.2016.00215
Goh, D. H.-L., and Razikin, K. (2015). “Is gamification effective in motivating exercise?” in Human-Computer Interaction: Interaction Technologies: 17th International Conference, HCI International 2015, Los Angeles, CA, USA, August 2-7, 2015, Proceedings, Part II 17 (Springer: New York), 608–617. doi: 10.1007/978-3-319-20916-6_56
Grandner, M. A. (2019). “Social-ecological model of sleep health,” in Sleep and Health (Cambridge, CA: Elsevier), 45–53. doi: 10.1016/B978-0-12-815373-4.00005-8
Haaranen, A., Rissanen, T., Laatikainen, T., and Kauhanen, J. (2014). Digital and video games in health promotion: systematic review of games and health behavior. Finn. J. eHealth eWelf. 6, 153–163.
Hamari, J., and Keronen, L. (2017). Why do people play games? A meta-analysis. Int. J. Inf. Manag. 37, 125–141. doi: 10.1016/j.ijinfomgt.2017.01.006
Hamari, J., Koivisto, J., and Sarsa, H. (2014). “Does gamification work?-a literature review of empirical studies on gamification,” in 2014 47th Hawaii International Conference on System Sciences (Washington, DC: IEEE Computer Society), 3025–3034. doi: 10.1109/HICSS.2014.377
Ilhan, A. E., Sener, B., and Hacihabiboglu, H. (2022). Improving sleep-wake behaviors using mobile app gamification. Entertain. Comput. 40:100454. doi: 10.1016/j.entcom.2021.100454
Irish, L. A., Kline, C. E., Gunn, H. E., Buysse, D. J., and Hall, M. H. (2015). The role of sleep hygiene in promoting public health: a review of empirical evidence. Sleep Med. Rev. 22, 23–36. doi: 10.1016/j.smrv.2014.10.001
Jackson, C. L., Walker, J. R., Brown, M. K., Das, R., and Jones, N. L. (2020). A workshop report on the causes and consequences of sleep health disparities. Sleep 43:zsaa037. doi: 10.1093/sleep/zsaa037
Johnson, D., Deterding, S., Kuhn, K.-A., Staneva, A., Stoyanov, S., and Hides, L. (2016). Gamification for health and wellbeing: a systematic review of the literature. Internet Interv. 6, 89–106. doi: 10.1016/j.invent.2016.10.002
Kato, P. M. (2010). Video games in health care: closing the gap. Rev. Gen. Psychol. 14, 113–121. doi: 10.1037/a0019441
King, D., Greaves, F., Exeter, C., and Darzi, A. (2013). ‘Gamification': influencing health behaviours with games. J. R. Soc. Med. 106, 76–78. doi: 10.1177/0141076813480996
Lenihan, D. (2012). Health games: a key component for the evolution of wellness programs. Games Health J. 1, 233–235. doi: 10.1089/g4h.2012.0022
Liang, Z. (2022). Context-aware sleep health recommender systems (CASHRS): a narrative review. Electronics 11:3384. doi: 10.3390/electronics11203384
Liang, Z., Hwang, D., Chen, S., Hoang, N., Khotchasing, K., and Melcer, E. (2025). “User preferences for interaction timing in smartwatch sleep hygiene games,” in Proceedings of CHI Conference on Human Factors in Computing Systems, CHI '25 (New York, NY, USA: Association for Computing Machinery). doi: 10.1145/3706598.3713591
Liang, Z., Melcer, E., Khotchasing, K., Chen, S., Hwang, D., and Hoang, N. H. (2024). The role of relevance in shaping perceptions of sleep hygiene games among university students: mixed methods study. JMIR Serious Games 12:e64063. doi: 10.2196/64063
Liang, Z., Ploderer, B., Liu, W., Nagata, Y., Bailey, J., Kulik, L., et al. (2016). Sleepexplorer: a visualization tool to make sense of correlations between personal sleep data and contextual factors. Pers. Ubiquit. Comput. 20, 985–1000. doi: 10.1007/s00779-016-0960-6
Lister, C., West, J. H., Cannon, B., Sax, T., and Brodegard, D. (2014). Just a fad? gamification in health and fitness apps. JMIR Serious Games 2:e3413. doi: 10.2196/games.3413
Lu, A. S., and Kharrazi, H. (2018). A state-of-the-art systematic content analysis of games for health. Games Health J. 7, 1–15. doi: 10.1089/g4h.2017.0095
Papastergiou, M. (2009). Exploring the potential of computer and video games for health and physical education: a literature review. Comput. Educ. 53, 603–622. doi: 10.1016/j.compedu.2009.04.001
Priesterroth, L., Grammes, J., Holtz, K., Reinwarth, A., and Kubiak, T. (2019). Gamification and behavior change techniques in diabetes self-management apps. J. Diabetes Sci. Technol. 13, 954–958. doi: 10.1177/1932296818822998
Primack, B. A., Carroll, M. V., McNamara, M., Klem, M. L., King, B., Rich, M., et al. (2012). Role of video games in improving health-related outcomes: a systematic review. Am. J. Prev. Med. 42, 630–638. doi: 10.1016/j.amepre.2012.02.023
Pusateri, J., Leng, J., Timczyk, J., Chen, X., Wang, Q., Shah, K., et al. (2019). “Toward a design theory of sleepy games,” in Extended Abstracts of the Annual Symposium on Computer-Human Interaction in Play Companion Extended Abstracts, CHI PLAY '19 Extended Abstracts (New York, NY, USA: Association for Computing Machinery), 631–638. doi: 10.1145/3341215.3356268
Pusateri, J., Leng, J., Wang, Q., Chen, X., and Hammer, J. (2020). “Designing games for healthy sleep,” in Proceedings of the 2020 CHI Conference on Human Factors in Computing Systems, CHI '20 (New York, NY, USA: Association for Computing Machinery), 1–13. doi: 10.1145/3313831.3376413
Ramar, K., Malhotra, R. K., Carden, K. A., Martin, J. L., Abbasi-Feinberg, F., Aurora, R. N., et al. (2021). Sleep is essential to health: an American academy of sleep medicine position statement. J. Clin. Sleep Med. 17, 2115–2119. doi: 10.5664/jcsm.9476
Rapp, A., and Cena, F. (2014). “Self-monitoring and technology: challenges and open issues in personal informatics,” in Universal Access in Human-Computer Interaction. Design for All and Accessibility Practice: 8th International Conference, UAHCI 2014, Held as Part of HCI International 2014, Heraklion, Crete, Greece, June 22-27, 2014, Proceedings, Part IV 8 (Springer: New York), 613–622. doi: 10.1007/978-3-319-07509-9_58
Reid, K. J., Martinovich, Z., Finkel, S., Statsinger, J., Golden, R., Harter, K., et al. (2006). Sleep: a marker of physical and mental health in the elderly. Am. J. Geriatr. Psychiatry 14, 860–866. doi: 10.1097/01.JGP.0000206164.56404.ba
Sardi, L., Idri, A., and Fernández-Alemán, J. L. (2017). A systematic review of gamification in e-health. J. Biomed. Inform. 71, 31–48. doi: 10.1016/j.jbi.2017.05.011
Seaborn, K., and Fels, D. I. (2015). Gamification in theory and action: a survey. Int. J. Hum. Comput. Stud. 74, 14–31. doi: 10.1016/j.ijhcs.2014.09.006
Seaver, C., Bowers, C., Beidel, D., Holt, L., and Ramakrishnan, S. (2024). A game-based learning approach to sleep hygiene education: a pilot investigation. Front. Digit. Health 6:1334840. doi: 10.3389/fdgth.2024.1334840
Shin, J. Y., Li, T., Peng, W., and Lee, H. R. (2023). “Bedtime pals: a deployment study of sleep management technology for families with young children,” in Proceedings of the 2023 ACM Designing Interactive Systems Conference, DIS '23 (New York, NY, USA: Association for Computing Machinery), 1610–1629. doi: 10.1145/3563657.3596068
Smeddinck, J. D. (2016). “Games for health,” in Entertainment Computing and Serious Games: International GI-Dagstuhl Seminar 15283, Dagstuhl Castle, Germany, July 5–10, 2015, Revised Selected Papers (Springer: New York), 212–264.
Stepanovic, S., and Mettler, T. (2018). “Gamification applied for health promotion: does it really foster long-term engagement? A scoping review,” in Proceedings of the 26th European Conference on Information Systems (Atlanta, GA: Association for Information Systems), 1–16.
Sukhera, J. (2022). Narrative reviews: flexible, rigorous, and practical. J. Grad. Med. Educ. 14, 414–417. doi: 10.4300/JGME-D-22-00480.1
Theng, Y.-L., Lee, J. W., Patinadan, P. V., and Foo, S. S. (2015). The use of videogames, gamification, and virtual environments in the self-management of diabetes: a systematic review of evidence. Games Health J. 4, 352–361. doi: 10.1089/g4h.2014.0114
Wattanasoontorn, V., Boada, I., García, R., and Sbert, M. (2013). Serious games for health. Entertain. Comput. 4, 231–247. doi: 10.1016/j.entcom.2013.09.002
Werner-Seidler, A., Li, S. H., Spanos, S., Johnston, L., O'Dea, B., Torok, M., et al. (2023). The effects of a sleep-focused smartphone application on insomnia and depressive symptoms: a randomised controlled trial and mediation analysis. J. Child Psychol. Psychiatry 64, 1324–1335. doi: 10.1111/jcpp.13795
Wilson, K. E., Miller, A. L., Bonuck, K., Lumeng, J. C., and Chervin, R. D. (2014). Evaluation of a sleep education program for low-income preschool children and their families. Sleep 37, 1117–1125. doi: 10.5665/sleep.3774
Wohlin, C. (2014). “Guidelines for snowballing in systematic literature studies and a replication in software engineering,” in Proceedings of the 18th International Conference on Evaluation and Assessment in Software Engineering, EASE '14 (New York, NY, USA: Association for Computing Machinery), 1–10. doi: 10.1145/2601248.2601268
Keywords: sleep, serious games (SGs), sleep hygiene (SH), gamification (GAM), ubiquitous and mobile computing, mHealth (mobile Health), digital health
Citation: Liang Z, Melcer E, Hoang NH and Khotchasing K (2025) Sleep hygiene games and gamification: where are we and where are we heading? Front. Sleep 4:1607117. doi: 10.3389/frsle.2025.1607117
Received: 17 April 2025; Accepted: 14 July 2025;
Published: 30 July 2025.
Edited by:
Andrew W. McHill, Oregon Health and Science University, United StatesReviewed by:
Gawon Ju, Chungbuk National University, Republic of KoreaCopyright © 2025 Liang, Melcer, Hoang and Khotchasing. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Zilu Liang, bGlhbmcuemlsdUBrdWFzLmFjLmpw