An Agentic Just-in-Time Adaptive Intervention System for Personalized Sleep Support: Proof-of-Concept Study with N of 1 Data

Sleep monitoring using wearable data has shown promise for personal health, yet large language model (LLM)-based summarization and question answering remain insufficient for personalized sleep guidance. Training specialized models, however, often requires costly expert annotation. Moreover, privacy and accessibility concerns motivate lightweight, local deployment for end users. We present a two-stage framework to address these challenges. Specifically, in Stage1, a multi-agent LLM pipeline reasons structured sleep guidance from unannotated wearable records, enabling scalable dataset construction. Stage2 distills guidance reasoning trajectories into small language models (SLMs) through supervised fine-tuning and integrates a training-free Best-of-$N$ selection strategy to enhance inference. Experimental results demonstrate our method outperforms commercial general and medical LLMs and open-source models. Human evaluation further supports the quality of the generated guidance and the feasibility of personalized sleep guidance with SLMs.

Affective computing has advanced wearable state inference, but on-device reasoning about whether, when, and how to intervene remains challenging. We present Affective Agent, a three-layer reference architecture for personalized intervention reasoning under uncertainty on wearable-class hardware. It combines a compact sub-billion-parameter language model with physiological evidence, context, and user history to decide whether, when, and how to intervene, without cloud dependency or per-user retraining. The architecture is organized into three interacting layers (perception, personalization, and reasoning), adapting to individual users through host-managed structured memory evolution rather than per-user weight updates. We instantiate Affective Agent in indoor environmental quality control and evaluate it on held-out, simulator-generated longitudinal scenarios spanning physiological variation, context, signal quality, and intervention history. Results show that memory-driven personalization and two-pass structured reasoning improve intervention decisions within this synthetic evaluation. By moving the decision layer on-device, this work demonstrates a path from wearable state inference toward closed-loop, personalized intervention on wearable-class hardware.

Sleep diaries are central to behavioral sleep medicine and cognitive behavioral therapy for insomnia, yet daily completion is difficult to sustain, and static forms often provide limited context for interpreting night-to-night sleep variation. We designed an LLM-powered conversational voice diary that delivers clinically grounded morning and evening sleep diary questions through proactive smart-speaker prompts, structured conversational intake, and adaptive follow-up dialogue. We evaluated the system in a four-week between-subjects field study with 30 university students, comparing it with a text-based mobile diary using matched diary items, reporting windows, and reminder intervals. Compared with the text-based diary, the conversational voice diary showed higher adherence and elicited more detailed contextual self-report about routines, stressors, environmental conditions, and other sleep-related factors. Participants also described the voice diary as easier to integrate into daily routines, despite longer perceived completion time. However, voice-based conversational intake produced lower completeness for some structured diary fields, revealing a trade-off between expressive richness and structured precision. These findings show both the promise and the challenge of using LLM-powered conversational voice assistants for longitudinal health self-report.