Dr Ilaria Pina is a Research Associate for the WHOLE-SMI project at Newcastle University working in the area of health inequalities to improve holistic health in individuals living with severe mental illness. She has a great interest in the integration of physical and mental health, and how these are connected with sleep and movement. Ilaria was awarded a Circadian Mental Health Network ECR award to support her public engagement activities centred around how audio diaries could be used as a method for understanding different features of sleep. You can read all about her experience so far below.
Understanding sleep challenges and experiences in individuals living with mental ill-health often requires more than objective measures. While devices like actigraphy or polysomnography provide valuable data, we also need insights that come from understanding how people perceive and experience their own sleep. The use of audio diaries offers a way to capture this essential subjective information. This gives clinicians and researchers a richer understanding of the factors influencing sleep patterns and behaviours, along with a flexible and personalised approach for people living with mental ill-health.
Audio diaries can help clinicians explore critical questions: are patients sleeping better than they think? Is rumination affecting their rest and daily life? Are they open to reflecting on and adjusting behaviours that impact their sleep? Beyond assessment, audio diaries can serve as a tool, encouraging self-reflection and promoting engagement with therapeutic services.
I am deeply grateful to the Circadian Mental Health Network for providing me with this unique opportunity. With the funding received by the Circadian Mental Health Network, I have been able to run public involvement and engagement activities to further develop a list of recommendations on the potential use of audio diaries in clinical practice. So far, I had conversations with 6 staff members (occupational therapists, GPs, psychiatrists, and sleep specialists), who provided helpful inputs on audio diaries. I also had a chance to speak with members of the public with lived experience of mental ill-health, who are helping me to shape the list of recommendations to make sure they will be accessible and person-centred.
Why collect subjective data with audio diaries?
Experiences and personal reflections are critical for understanding sleep, particularly for individuals living with mental-ill health. These insights can reveal discrepancies between perceived and actual sleep quality, highlight triggers like rumination or stress, and uncover habits that might otherwise go unnoticed. Audio diaries make this process more accessible by removing the need for written journals or diaries, which some patients find daunting. Instead, they allow individuals to record their thoughts in real time, creating a space where they can speak openly and naturally. This not only could help clinicians gain a deeper understanding of their patients' sleep but also empowers individuals to reflect on their behaviours and emotions.
Initial recommendations for implementing audio diaries in clinical practice.
Provide the right tools: a simple, reliable digital voice recorder should be included in a “kit” with clear instructions. The recorder should enable easy, instant recording to ensure the process feels effortless for patients.
Create focused prompts: a set of daily prompts encourages patients to reflect on key aspects of their sleep and related behaviours (such as where they slept, their perception of the previous night’s sleep quality, activities such as screen use, smoking, caffeine intake, or exercise).
Address concerns and provide reassurance: patients may worry about giving “right” answers or feel unsure about how much to share. Reassure them that all their thoughts and reflections are valuable, and there is no judgment in their responses. Encourage them to record freely, even at night if they feel the need.
Structured timeframe: It’s recommended to collect recordings over two 7-day blocks, separated by at least two weeks. This allows for a break to reduce any potential burden and gives clinicians a chance to assess whether additional data collection is necessary.

Going forward
I am hoping to complete the recommendations and publish them at the beginning of the year, with the help and support of our staff and public contributors. Audio diaries may offer clinicians and patients a way to bridge the gap between perception and reality, uncovering patterns and opportunities for change.
Blog by Ilaria Pina
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