1
|
Abstract
OBJECTIVES This study aims to comprehensively review and update the literature concerning the correlates of sleep disturbance among caregivers of persons living with Alzheimer's disease and related dementias to identify gaps in the literature and antecedent targets for interventions. METHODS We searched PubMed, CINAHL, PsycINFO, and Embase using terms related to "sleep," "caregiver," and "dementia." RESULTS Thirty-six articles were included in this review. Based on the antecedents within the 3P model of insomnia, predisposing factors associated with caregiver sleep included caregiver demographics, and physiological factors like genotype and biomarkers. Precipitating factors related to caregiver sleep included caregiving status and responsibilities, and person living with dementia factors. CONCLUSIONS Sleep disturbance is a significant issue for caregivers of persons living with dementia. However, this review has identified multiple precipitating factors that are modifiable targets for interventions to improve or enhance caregiver sleep. CLINICAL IMPLICATIONS Numerous predisposing and precipitating factors contribute to caregivers of persons living with dementia being susceptible to sleep disturbance. Healthcare providers should ask patients about their caregiving status during annual visits. Healthcare providers should also evaluate caregivers' sleep patterns, and the predisposing and precipitating factors of sleep disturbance, with a focus on the modifiable factors, to enable timely intervention.
Collapse
Affiliation(s)
- Glenna S Brewster
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
| | - Dingyue Wang
- School of Nursing, Duke University, Durham, North Carolina, USA
| | | | - Fayron Epps
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
| | - Irene Yang
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
| |
Collapse
|
2
|
Hollenbeak CS, Jeon S, O’Connell M, Conley S, Yaggi H, Redeker NS. Costs and Resource Utilization of People with Stable Heart Failure and Insomnia: Evidence from a Randomized Trial of Cognitive Behavioral Therapy for Insomnia. Behav Sleep Med 2024; 22:263-274. [PMID: 37530117 PMCID: PMC10834836 DOI: 10.1080/15402002.2023.2241589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/03/2023]
Abstract
OBJECTIVES Nearly half of patients with chronic heart failure (HF) report insomnia symptoms. The purpose of this study was to examine the impact of CBT-I versus HF self-management on healthcare costs and resource utilization among patients with stable chronic HF who participated in a clinical trial of the effects of CBT-I compared to HF self-management education (attention control) over 1 year. METHODS We measured resource utilization as self-reported (medical record review) physician office visits, emergency department visits, and inpatient admissions at 3-month intervals for 1 year after enrollment. Costs were estimated by applying price weights to visits and adding self-reported out-of-pocket and indirect costs. Univariate comparisons were made of resource utilization and costs between CBT-I and the HF self-management group. A generalized linear model (GLM) was used to model costs, controlling for covariates. RESULTS The sample included 150 patients [79 CBT-I; 71 self-management (M age = 62 + 13 years)]. The CBT-I group had 4.2 inpatient hospitalizations vs 4.6 for the self-management group (p = .40). There were 13.1 outpatient visits, in the CBT-I compared with 15.4 outpatient visits (p-value range 0.39-0.81) for the self-management group. Total costs were not significantly different in univariate or ($7,813 CBT-I vs. $7,538 self-management), p = .96) or multivariable analyses. CONCLUSIONS Among patients with both HF and insomnia, CBT-I and HF self-management were associated with similar resource utilization and total costs. Additional research is needed to estimate the value of CBT-I relative to usual care and other treatments for insomnia in patients with HF.
Collapse
Affiliation(s)
- Christopher S. Hollenbeak
- Department of Health Policy and Administration, College of Health and Human Development, The Pennsylvania State University, University Park, PA
| | | | | | | | - Henry Yaggi
- Department of Internal Medicine, School of Medicine, Yale University, New Haven, CT
| | - Nancy S. Redeker
- School of Nursing, Yale University, West Haven, CT
- School of Nursing, University of Connecticut, Storrs, CT
| |
Collapse
|
3
|
O’Connell M, Feder SL, Nwanaji-Enwerem U, Redeker NS. Focus Group Study of Heart Failure Nurses' Perceptions of the Feasibility of Cognitive Behavioral Therapy for Insomnia. Nurs Res 2024; 73:109-117. [PMID: 37967228 PMCID: PMC10922255 DOI: 10.1097/nnr.0000000000000706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2023]
Abstract
BACKGROUND People with heart failure (HF) often report insomnia with daytime consequences, including fatigue and decreased functional performance. Cognitive behavioral therapy for insomnia is an efficacious treatment, but few have access because of a shortage of trained sleep specialists. Access may be improved by offering it where people with HF receive care. OBJECTIVES The purpose of this study was to explore the perceptions of nurses who specialize in HF regarding the value of cognitive behavioral therapy for insomnia to their patients, the feasibility of offering it in HF clinical settings, its delivery by nurses, and preferences for modes of delivery. METHODS We used a descriptive qualitative study design. We recruited focus group participants via e-mail to American Association of Heart Failure Nurses members and through requests for nurse collaborators to distribute within their networks. We conducted focus groups via Zoom. After describing cognitive behavioral therapy for insomnia and its efficacy for people with HF, we elicited perceptions about its value if provided in the HF outpatient clinical setting, facilitators and barriers to implementation, and other ways to increase access. We audio-recorded and transcribed the discussions. Two researchers coded the data and performed thematic analysis. RESULTS Four focus groups included 23 registered nurses and advanced practice nurses employed in outpatient HF clinics. We identified five themes: "Insomnia Overlooked," "Cognitive Behavioral Therapy for Insomnia Works," "Nurses' Role," "Barriers and Supports," and "Modes of Delivery." Nurses endorsed the importance of insomnia to people with HF and the value of providing cognitive behavioral therapy. They expressed interest in evaluating and addressing sleep, the need for increased resources to address it, and multiple modes of delivery. All nurses believed they had a role in promoting sleep health but differed in their views about providing cognitive behavioral therapy for insomnia. DISCUSSION Nurses specializing in HF support the implementation of cognitive behavioral therapy for insomnia. Implementation studies are needed to identify effective methods to increase access to this efficacious treatment in outpatient HF clinical settings, including support and training for nurses who are interested and able to deliver it.
Collapse
Affiliation(s)
- Meghan O’Connell
- University of Connecticut School of Nursing, 231 Glenbrook Rd. Storrs, CT 06269, USA
| | - Shelli L. Feder
- Yale School of Nursing, 400 West Campus Dr. Orange, CT 06477, USA
| | | | - Nancy S. Redeker
- University of Connecticut School of Nursing, 231 Glenbrook Rd. Storrs, CT 06269, USA
| |
Collapse
|
4
|
Schotland H, Wickwire E, Aaronson RM, Dawson SC, Khosla S, Lee-Iannotti JK, Leu RM, Lewin DS, McCrae CS, Neubauer D, Ong JC, Heffron TM, Whittington C, Martin JL. Increasing access to evidence-based insomnia care in the United States: findings from an American Academy of Sleep Medicine stakeholder summit. J Clin Sleep Med 2024; 20:455-459. [PMID: 37942936 PMCID: PMC11019205 DOI: 10.5664/jcsm.10922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 11/07/2023] [Indexed: 11/10/2023]
Abstract
Challenges exist in access to high-quality care for insomnia disorder. After the recent publication of a clinical practice guideline on behavioral and psychological treatments for insomnia in adults, the American Academy of Sleep Medicine (AASM) hosted a 1-day virtual Insomnia Summit in September 2022 to discuss improving care for patients with insomnia disorder. Fifty participants representing a variety of organizations (eg, medical, psychological, and nursing associations; patient advocacy groups; and federal institutions) participated in the event. Videos highlighting patient perspectives on insomnia and an overview of current insomnia disorder treatment guidelines were followed by thematic sessions, each with 3 to 4 brief, topical presentations by content experts. Breakout groups were used to brainstorm and prioritize issues in each thematic area. Top barriers to care for insomnia disorder include limited access, limited awareness of treatment options, low perceived value of insomnia treatment, and an insufficient number of trained clinicians. Top facilitators of high-quality care include education and awareness, novel care models to increase access, expanding the insomnia patient care workforce, incorporating research into practice, and increasing reimbursement for psychotherapies. Priorities for the future include increasing awareness among patients and providers, increasing the number of skilled behavioral sleep medicine providers, increasing advocacy efforts to address insurance issues (eg, billing, reimbursement, and performance measures), and working collaboratively with multidisciplinary organizations to achieve common goals. These priorities highlight that goals set to improve accessible, high-quality care for insomnia disorder will require sustained, coordinated efforts to increase awareness, improve reimbursement, and grow the necessary skilled health care workforce. CITATION Schotland H, Wickwire E, Aaronson RM, et al. Increasing access to evidence-based insomnia care in the United States: findings from an American Academy of Sleep Medicine stakeholder summit. J Clin Sleep Med. 2024;20(3):455-459.
Collapse
Affiliation(s)
| | - Emerson Wickwire
- Sleep Disorders Center, Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland
| | | | - Spencer C. Dawson
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, Indiana
| | - Seema Khosla
- North Dakota Center for Sleep, Fargo, North Dakota
| | - Joyce K. Lee-Iannotti
- Department of Internal Medicine, Department of Neurology, University of Arizona College of Medicine–Phoenix, Phoenix, Arizona
| | - Roberta M. Leu
- Division of Pulmonology and Sleep, Department of Pediatrics, Emory University, Atlanta, Georgia
- Children’s Healthcare of Atlanta, Atlanta, Georgia
| | | | - Christina S. McCrae
- Department of Psychiatry, University of Missouri-Columbia, Columbia, Missouri
| | - David Neubauer
- Sleep Disorders Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jason C. Ong
- Nox Health, Inc, Alpharetta, Georgia
- Center for Circadian and Sleep Medicine, Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | | | - Jennifer L. Martin
- VA Greater Los Angeles Healthcare System, Geriatric Research, Education and Clinical Center, Los Angeles, California
- David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, California
| |
Collapse
|
5
|
Gabbay FH, Wynn GH, Georg MW, Gildea SM, Kennedy CJ, King AJ, Sampson NA, Ursano RJ, Stein MB, Wagner JR, Kessler RC, Capaldi VF. Toward personalized care for insomnia in the US Army: a machine learning model to predict response to cognitive behavioral therapy for insomnia. J Clin Sleep Med 2024. [PMID: 38300822 DOI: 10.5664/jcsm.11026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
STUDY OBJECTIVES The standard of care for military personnel with insomnia is cognitive behavioral therapy for insomnia (CBT-I). However, only a minority seeking insomnia treatment receive CBT-I, and little reliable guidance exists to identify those most likely to respond. As a step toward personalized care, we present results of a machine learning (ML) model to predict CBT-I response. METHODS Administrative data were examined for n=1,449 nondeployed US Army soldiers treated for insomnia with CBT-I who had moderate-severe baseline Insomnia Severity Index (ISI) scores and completed one or more follow-up ISIs 6-12 weeks after baseline. An ensemble ML model was developed in a 70% training sample to predict clinically significant ISI improvement (reduction of at least two standard deviations on the baseline ISI distribution). Predictors included a wide range of military administrative and baseline clinical variables. Model accuracy was evaluated in the remaining 30% test sample. RESULTS 19.8% of patients had clinically significant ISI improvement. Model AU-ROC (SE) was 0.60 (0.03). The 20% of test sample patients with highest probabilities of improvement were twice as likely to have clinically significant improvement as the remaining 80% (36.5% versus 15.7%; χ21=9.2, p=.002). Nearly 85% of prediction accuracy was due to ten variables, the most important of which were baseline insomnia severity and baseline suicidal ideation. CONCLUSIONS Pending replication, the model could be used as part of a patient-centered decision-making process for insomnia treatment. Parallel models will be needed for alternative treatments before such a system is of optimal value.
Collapse
Affiliation(s)
- Frances H Gabbay
- Department of Psychiatry, Uniformed Services University, Bethesda, MD
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD
| | - Gary H Wynn
- Department of Psychiatry, Uniformed Services University, Bethesda, MD
| | - Matthew W Georg
- Department of Psychiatry, Uniformed Services University, Bethesda, MD
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD
| | - Sarah M Gildea
- Department of Health Care Policy, Harvard Medical School, Boston, MA
| | - Chris J Kennedy
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA
| | - Andrew J King
- Department of Health Care Policy, Harvard Medical School, Boston, MA
| | - Nancy A Sampson
- Department of Health Care Policy, Harvard Medical School, Boston, MA
| | - Robert J Ursano
- Department of Psychiatry, Uniformed Services University, Bethesda, MD
| | - Murray B Stein
- Department of Psychiatry, University of California San Diego, La Jolla, CA
- Psychiatric Service, VA San Diego Healthcare System, San Diego, CA
| | - James R Wagner
- Institute for Social Research, University of Michigan, Ann Arbor, MI
| | - Ronald C Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA
| | - Vincent F Capaldi
- Department of Psychiatry, Uniformed Services University, Bethesda, MD
| |
Collapse
|
6
|
Brewster GS, Higgins M, McPhillips MV, Bonds Johnson K, Epps F, Yeager KA, Bliwise DL, Hepburn K. The Effect of Tele-Savvy on Sleep Quality and Insomnia in Caregivers of Persons Living with Dementia. Clin Interv Aging 2023; 18:2117-2127. [PMID: 38111602 PMCID: PMC10726954 DOI: 10.2147/cia.s425741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 12/01/2023] [Indexed: 12/20/2023] Open
Abstract
Introduction Sleep disturbance is prevalent in caregivers of persons living with dementia (PLwD). Tele-Savvy, a 7-week virtual psychoeducational intervention, enhances caregivers' competence and self-care, and reduces depression. While not explicitly designed to do so, Tele-Savvy can potentially improve caregivers' disturbed sleep. The present study aimed to examine the longitudinal effects of Tele-Savvy on caregivers' sleep quality and insomnia. Methods This was a secondary data analysis of a 3-arm randomized control trial [Tele-Savvy (active treatment), Healthy Living (attention control), and usual care (waitlist control)]. Multilevel mixed modeling with intent-to-treat principles tested for group, time, and group-by-time effects. Effect sizes were estimated for all changes from baseline to the initial 6-month post-intervention point. Following completion of the 6-month post-randomization delay, we examined combined outcomes for Tele-Savvy. Results Participants (n=137; mean age 64.7 years) were predominantly female (68.6%) and White (68.6%). We found no initial group-by-time effects for the Pittsburgh Sleep Quality Index (PSQI) and the Insomnia Severity Index (ISI). For the combined Tele-Savvy group, there was a statistically significant improvement in ISI scores across time (p=0.050). The combined Tele-Savvy effect size for PSQI was d=0.126 and ISI was d=0.310. Discussion Tele-Savvy resulted in a significant long-term reduction in insomnia symptoms in this sample of caregivers of PLwD and demonstrated a positive trend for improvement in their sleep quality. Since sleep disturbance is so prevalent among caregivers of PLwD, the inclusion of sleep health education into psychoeducation caregiver interventions may yield even better outcomes for caregivers.
Collapse
Affiliation(s)
- Glenna S Brewster
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
| | - Melinda Higgins
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
| | | | | | - Fayron Epps
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
| | - Katherine A Yeager
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
| | - Donald L Bliwise
- Division of Sleep Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Kenneth Hepburn
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
| |
Collapse
|
7
|
Schuffelen J, Maurer LF, Lorenz N, Rötger A, Pietrowsky R, Gieselmann A. The clinical effects of digital cognitive behavioral therapy for insomnia in a heterogenous study sample: results from a randomized controlled trial. Sleep 2023; 46:zsad184. [PMID: 37428712 PMCID: PMC10636251 DOI: 10.1093/sleep/zsad184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 06/20/2023] [Indexed: 07/12/2023] Open
Abstract
STUDY OBJECTIVES Numerous studies worldwide have reported the beneficial effects of digital cognitive behavioral therapy for insomnia (dCBT-I). However, few focus on real-world study samples that reflect people in regular care. To test whether dCBT-I is suitable within German regular care, we designed a randomized controlled trial recruiting a heterogenous insomnia population. METHODS Participants aged ≥18 who met the criteria for insomnia disorder were randomized to 8-weeks dCBT-I + care-as-usual (CAU) or they were set on a waitlist + CAU. The intervention group was followed-up at 6- and 12-months. The primary outcome was self-reported insomnia severity, assessed with the Insomnia Severity Index (ISI) at 8-weeks post-randomization. A one-way ANCOVA with baseline score as a covariate was fitted to determine group differences. Secondary outcomes included measures of daytime functioning, quality of life, depression, anxiety, dreams, and nightmares. RESULTS Of the N = 238 participants (67.6% female), age range 19-81 years, n = 118 were randomized to dCBT-I and n = 120 to the control group. At posttreatment, the use of dCBT-I was associated with a large reduction in the ISI (Diffadj = -7.60) in comparison to WLC (d = -2.08). This clinical improvement was also reflected in responder and remission rates. Treatment effects were also observed for daytime functioning, quality of life, symptoms of depression and anxiety (ds = 0.26-1.02) and at long-term follow-up (intervention group only; ds = 0.18-1.65). No effects were found for dream and nightmare frequency. CONCLUSIONS This study showed that dCBT-I reduces insomnia symptoms and improves daytime functioning in a heterogenous insomnia population in Germany with sustained long-term treatment effects in the intervention group. Our results underscore the potential of digital health applications, their suitability within regular care, and their role in facilitating widespread implementation of CBT-I as a first-line treatment for insomnia.
Collapse
Affiliation(s)
- Jennifer Schuffelen
- Heinrich Heine University Düsseldorf, Institute of Experimental Psychology, Department of Clinical Psychology, GermanyGermany
| | | | - Noah Lorenz
- mementor DE GmbH, Department of Science, Germany
| | | | - Reinhard Pietrowsky
- Heinrich Heine University Düsseldorf, Institute of Experimental Psychology, Department of Clinical Psychology, GermanyGermany
| | - Annika Gieselmann
- Heinrich Heine University Düsseldorf, Institute of Experimental Psychology, Department of Clinical Psychology, GermanyGermany
| |
Collapse
|
8
|
Prguda E, Evans J, McLeay S, Romaniuk M, Phelps AJ, Lewis K, Brown K, Fisher G, Lowrie F, Saunders-Dow E, Dwyer M. Posttraumatic sleep disturbances in veterans: A pilot randomized controlled trial of cognitive behavioral therapy for insomnia and imagery rehearsal therapy. J Clin Psychol 2023; 79:2493-2514. [PMID: 37392411 DOI: 10.1002/jclp.23561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 05/29/2023] [Accepted: 06/07/2023] [Indexed: 07/03/2023]
Abstract
OBJECTIVES Posttraumatic stress disorder (PTSD) is associated with sleep disturbances including insomnia and nightmares. This study compared cognitive behavioral therapy for insomnia (CBT-I) with CBT-I combined with imagery rehearsal therapy (IRT) for nightmares to evaluate if the combined treatment led to greater reductions in trauma-related sleep disturbances in Australian veterans. METHODS Veterans with diagnosed PTSD, high insomnia symptom severity, and nightmares (N = 31) were randomized to eight group CBT-I sessions or eight group CBT-I + IRT sessions. Self-reported sleep, nightmare, and psychological measures (primary outcome: Pittsburgh Sleep Quality Index), and objective actigraphy data were collected; the effect of obstructive sleep apnea (OSA) risk on treatment outcomes was also examined. RESULTS No treatment condition effects were detected for the combined treatment compared to CBT-I alone, and no moderating effect of OSA risk was detected. On average, participants from both groups improved on various self-report measures over time (baseline to 3 months posttreatment). Despite the improvements, mean scores for sleep-specific measures remained indicative of poor sleep quality. There were also no significant differences between the groups on the actigraphy indices. CONCLUSIONS The findings indicate that there is potential to optimize both treatments for veterans with trauma-related sleep disturbances.
Collapse
Affiliation(s)
- Emina Prguda
- Gallipoli Medical Research Foundation, Brisbane, Queensland, Australia
- The University of Queensland, Brisbane, Queensland, Australia
| | - Justine Evans
- Gallipoli Medical Research Foundation, Brisbane, Queensland, Australia
| | - Sarah McLeay
- Gallipoli Medical Research Foundation, Brisbane, Queensland, Australia
| | - Madeline Romaniuk
- Gallipoli Medical Research Foundation, Brisbane, Queensland, Australia
- The University of Queensland, Brisbane, Queensland, Australia
| | - Andrea J Phelps
- Department of Psychiatry, Phoenix Australia-Centre for Posttraumatic Mental Health, University of Melbourne, Carlton, Victoria, Australia
| | - Kerri Lewis
- Gallipoli Medical Research Foundation, Brisbane, Queensland, Australia
| | - Kelly Brown
- Gallipoli Medical Research Foundation, Brisbane, Queensland, Australia
- The University of Queensland, Brisbane, Queensland, Australia
| | - Gina Fisher
- Gallipoli Medical Research Foundation, Brisbane, Queensland, Australia
- The University of Queensland, Brisbane, Queensland, Australia
| | - Fraser Lowrie
- Sleep Care, Greenslopes Private Hospital, Brisbane, Queensland, Australia
| | | | - Miriam Dwyer
- Gallipoli Medical Research Foundation, Brisbane, Queensland, Australia
- The University of Queensland, Brisbane, Queensland, Australia
| |
Collapse
|
9
|
Brewster GS, Pierpaoli Parker C, Epps F, Bonds Johnson K, Yeager KA. Sleep Profiles of Caregivers for Persons Living with Dementia: A Qualitative Study. West J Nurs Res 2023; 45:688-695. [PMID: 37161397 DOI: 10.1177/01939459231175242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Sleep disturbance is prevalent among caregivers of people living with dementia. However, gaps exist about caregivers' sleep patterns before and during their caregiving trajectory. This exploratory secondary analysis using a qualitative descriptive approach aimed to (1) identify and describe current caregivers' patterns of change in sleep before and during caregiving, and (2) understand caregivers' perceptions of their current sleep compared to their pre-caregiving sleep. We conducted semi-structured interviews with 19 caregivers taking part in a larger randomized controlled trial. Participants were female (n = 11), white (n = 13) and on average 63 years of age. Interview questions focused on caregivers' sleep patterns. The interviews were audio-recorded using a videoconferencing platform and ranged from 20 to 45 minutes. We conducted thematic analysis of the interview transcripts. Three distinct caregiver-sleep profiles emerged from the qualitative data: changed and dissatisfied, changed and satisfied, and unchanged and dissatisfied. Caregivers whose sleep was categorized as changed reported a difference when comparing their current sleep pattern to their pre-caregiving sleep pattern. This was usually a change from good to poor sleep. Caregivers whose sleep was unchanged had poor sleep pre-caregiving and continued to have poor sleep during caregiving. Caregivers also reported being satisfied or dissatisfied with their current sleep pattern, defined in terms of distress and impairment. These three subtypes highlight the heterogeneity of caregivers' sleep experiences and debut a useful clinical framework with which to identify, categorize, and target caregivers at risk for sleep disturbance, many who may be ready to engage in behaviors to improve their sleep. Knowing caregivers' sleep profiles will enable health care providers and researchers to determine caregivers' needs and readiness for interventions then work collaboratively with them to improve their sleep problems.
Collapse
Affiliation(s)
- Glenna S Brewster
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
| | - Christina Pierpaoli Parker
- Department of Psychiatry and Behavioral Neurobiology, Heersink School of Medicine, University of Alabama at Birmingham
| | - Fayron Epps
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
| | | | - Katherine A Yeager
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
| |
Collapse
|
10
|
Edinger JD, Wamboldt FS, Johnson RL, Simmons B, Tsai S, Morin CM, Holm KE. Adherence to behavioral recommendations of cognitive behavioral therapy for insomnia predicts medication use after a structured medication taper. J Clin Sleep Med 2023; 19:1495-1503. [PMID: 37086054 PMCID: PMC10394369 DOI: 10.5664/jcsm.10616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 03/31/2023] [Accepted: 03/31/2023] [Indexed: 04/23/2023]
Abstract
STUDY OBJECTIVES Cognitive behavioral therapy for insomnia (CBTI) has been paired with supervised medication tapering to help hypnotic-dependent individuals discontinue their hypnotics. This study examined the hypothesis that higher participant adherence to behavioral recommendations of CBTI will predict lower odds of using sleep medications 3 months after completion of a combined CBTI/sleep medication tapering protocol. METHODS Fifty-eight individuals who used sedative hypnotics completed four CBTI sessions followed by sleep medication tapering. Logistic regression was used to examine the association of stability of time in bed and stability of rise time (measured as the within-person standard deviation) at completion of CBTI with two outcomes at 3-month follow-up: use of sedative hypnotics and use of any medication/substance for sleep. RESULTS Participants with more stability in their rise time after CBTI than at baseline (ie, a decrease in their within-person standard deviation) had 69.5% lower odds of using sedative hypnotics at follow-up (odds ratio = 0.305, 95% confidence interval = 0.095-0.979, P = .046) than individuals who had no change or a decrease in the stability of their rise time. Results were similar for time in bed: participants with more stability in their time in bed after CBTI than at baseline had 83.2% lower odds of using sedative hypnotics (odds ratio = 0.168, 95% confidence interval = 0.049-0.580, P = .005). Increase in stability of rise time and stability of time in bed was also associated with reduced odds of using any medication/substance for sleep at follow-up. CONCLUSIONS Participants who implement behavioral recommendations of CBTI appear to have more success with discontinuing use of sleep medications. CLINICAL TRIAL REGISTRATION Registry: ClinicalTrials.gov; Name: The Role of Tapering Pace and Selected Traits on Hypnotic Discontinuation; URL: https://clinicaltrials.gov/ct2/show/NCT02831894; Identifier: NCT02831894. CITATION Edinger JD, Wamboldt FS, Johnson RL, et al. Adherence to behavioral recommendations of cognitive behavioral therapy for insomnia predicts medication use after a structured medication taper. J Clin Sleep Med. 2023;19(8):1495-1503.
Collapse
Affiliation(s)
- Jack D. Edinger
- National Jewish Health, Denver, Colorado
- Duke University Medical Center, Durham, North Carolina
| | | | | | | | | | | | - Kristen E. Holm
- National Jewish Health, Denver, Colorado
- Colorado School of Public Health, Denver, Colorado
| |
Collapse
|
11
|
Martin JL, DeViva J, McCarthy E, Gehrman P, Josephson K, Mitchell M, de Beer C, Runnals J. In-person and telehealth treatment of veterans with insomnia disorder using cognitive behavioral therapy for insomnia during the COVID-19 pandemic. J Clin Sleep Med 2023; 19:1211-1217. [PMID: 36859803 PMCID: PMC10315602 DOI: 10.5664/jcsm.10540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 02/22/2023] [Accepted: 02/23/2023] [Indexed: 03/03/2023]
Abstract
STUDY OBJECTIVES Cognitive behavioral therapy for insomnia (CBT-I) is the recommended first-line treatment for insomnia disorder. The goal of this study was to evaluate clinical benefits of CBT-I to veterans with insomnia disorder during the early months of the COVID-19 pandemic using an uncontrolled observational design. METHODS A cohort of 63 Veterans Affairs (VA) mental health providers delivered CBT-I to 180 veterans as part of an evidence-based psychotherapy training program and captured de-identified treatment outcome data through a data portal. The main patient outcomes were change in the Insomnia Severity Index (ISI) total score from the initial clinical assessment session to the last treatment session, response rate (% with ISI change > 7 from assessment to last session), and remission rate (% with ISI < 8 at the last session). We tested the noninferiority of telehealth only compared with at least 1 in-person session. RESULTS Fifty-six percent of veterans seen for an evaluation completed CBT-I treatment during the structured training program phase and completed an initial and final ISI. Among these veterans, ISI scores decreased by an average of 9.9 points from before to after treatment (P < .001), 66% experienced a clinically meaningful treatment response, and 43% experienced insomnia symptom remission. Benefits were similar whether the veteran received some in-person care or received CBT-I entirely via telehealth. CONCLUSIONS Findings suggest, regardless of treatment modality, CBT-I remained highly effective during the early months of the pandemic, which was a challenging time for both clinical providers and veterans in need of insomnia treatment. CITATION Martin JL, DeViva J, McCarthy E, et al. In-person and telehealth treatment of veterans with insomnia disorder using cognitive behavioral therapy for insomnia during the COVID-19 pandemic. J Clin Sleep Med. 2023;19(7):1211-1217.
Collapse
Affiliation(s)
- Jennifer L. Martin
- VA Greater Los Angeles Healthcare System, Geriatric Research, Education, and Clinical Center, Los Angeles, California
- David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Jason DeViva
- VA Connecticut Healthcare System, West Haven, Connecticut
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
| | - Elissa McCarthy
- Department of Veterans Affairs National Center for PTSD, White River Junction, Vermont
| | - Philip Gehrman
- Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania
- Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Karen Josephson
- VA Greater Los Angeles Healthcare System, Geriatric Research, Education, and Clinical Center, Los Angeles, California
| | - Michael Mitchell
- VA Greater Los Angeles Healthcare System, Geriatric Research, Education, and Clinical Center, Los Angeles, California
| | - Christopher de Beer
- Department of Veterans Affairs, Durham Healthcare System, Durham, North Carolina
| | - Jennifer Runnals
- Department of Veterans Affairs, Durham Healthcare System, Durham, North Carolina
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina
| |
Collapse
|
12
|
Zhang L, Jin Y, Zhang Q, Liu H, Chen C, Song L, Li X, Ma Z, Yang Q. Transcutaneous Vagus Nerve Stimulation for Insomnia in People Living in Places or Cities with High Altitudes: A Randomized Controlled Trial. Brain Sci 2023; 13:985. [PMID: 37508917 PMCID: PMC10377398 DOI: 10.3390/brainsci13070985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 06/19/2023] [Accepted: 06/20/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND The purpose of this study was to investigate the effectiveness and safety of transcutaneous vagus nerve stimulation (tVNS) to improve insomnia in the special environment of a plateau. METHODS This study was a single-center, single-blind, randomized controlled trial. A total of 100 patients with insomnia at high altitude were randomized into three groups receiving either transcutaneous vagus nerve stimulation intervention in the left ear tragus (treatment group), pseudo-stimulation intervention (sham group), or cognitive behavioral therapy for insomnia (CBTI group). The primary measure was the Pittsburgh Sleep Quality Index (PSQI) score. In addition, we assessed the patients' objective sleep status with polysomnography and evaluated changes in the Insomnia Severity Index Scale (ISI) and Generalized Anxiety Disorder-7 (GAD-7) scores. We used one-way ANOVA and repeated-measures ANOVA for analysis. RESULTS Patients' PSQI, ISI, and GAD-7 scale scores significantly decreased after 4 weeks of tVNS treatment and were greater than those of the control group. Polysomnographic data also demonstrated shortened sleep latency and longer deep sleep in the patients. CONCLUSION tVNS is effective in improving sleep quality and reducing anxiety levels in high-altitude insomnia patients but should be confirmed in future adequate and prolonged trials to guide clinical promotion.
Collapse
Affiliation(s)
- Liang Zhang
- Department of Military Medical Psychology, Air Force Military Medical University, Xi'an 710032, China
| | - Yinchuan Jin
- Department of Military Medical Psychology, Air Force Military Medical University, Xi'an 710032, China
| | - Qintao Zhang
- Department of Military Medical Psychology, Air Force Military Medical University, Xi'an 710032, China
| | - Hongyao Liu
- Department of Military Medical Psychology, Air Force Military Medical University, Xi'an 710032, China
| | - Chen Chen
- Department of Military Medical Psychology, Air Force Military Medical University, Xi'an 710032, China
| | - Lei Song
- Department of Military Medical Psychology, Air Force Military Medical University, Xi'an 710032, China
| | - Xiao Li
- Department of Military Medical Psychology, Air Force Military Medical University, Xi'an 710032, China
| | - Zhujing Ma
- Department of Military Medical Psychology, Air Force Military Medical University, Xi'an 710032, China
| | - Qun Yang
- Department of Military Medical Psychology, Air Force Military Medical University, Xi'an 710032, China
| |
Collapse
|
13
|
Edinger JD, Smith ED, Buysse DJ, Thase M, Krystal AD, Wiskniewski S, Manber R. Objective sleep duration and response to combined pharmacotherapy and cognitive behavioral insomnia therapy among patients with comorbid depression and insomnia: a report from the TRIAD study. J Clin Sleep Med 2023; 19:1111-1120. [PMID: 36798983 PMCID: PMC10235719 DOI: 10.5664/jcsm.10514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 02/12/2023] [Accepted: 02/14/2023] [Indexed: 02/18/2023]
Abstract
STUDY OBJECTIVES Several studies have shown that patients with short sleep duration show a poor response to cognitive behavioral therapy for insomnia (CBT-I), but such studies have not included patients with comorbid conditions. The current study was conducted to determine whether pretreatment sleep duration moderates the response of patients with major depression and insomnia disorders to a combined CBT-I and antidepressant medication treatment. METHODS This study comprised a secondary analysis of a larger randomized trial that tested combined CBT-I/antidepressant medication treatment of patients with major depression and insomnia. Participants (n = 99; 70 women; Mage = 47.712.4 years) completed pretreatment polysomnography and then were randomly assigned to a 12-week treatment with antidepressant medication combined with CBT-I or a sham therapy. Short and longer sleepers were defined using total sleep time cutoffs of < 5, < 6, and < 7 hours for short sleep. Insomnia and depression remission ascertained respectively from the Insomnia Severity Index and Hamilton Rating Scale for Depression were used to compare treatment responses of short and longer sleepers defined by the cutoffs mentioned. RESULTS Logistic regression analyses showed that statistically significant results were obtained only when the cutoff of < 5 hours of sleep was used to define "short sleep." Both the CBT-I recipients with < 5 hours of sleep (odds ratio = 0.053; 95% confidence interval = 0.006-0.499) and the sham-therapy group with ≥ 5 hours of sleep (odds ratio = 0.149; 95% confidence interval = 0.045-0.493) were significantly less likely to achieve insomnia remission than were CBT-I recipients with ≥ 5 hours of sleep. The shorter sleeping CBT-I group (odds ratio = 0.118; 95% confidence interval = 0.020-0.714) and longer sleeping sham-therapy group (odds ratio = 0.321; 95% confidence interval = 0.105-0.983) were also less likely to achieve insomnia and/or depression remission than was the longer sleeping CBT-I group with ≥ 5 hours of sleep. CONCLUSIONS Sleeping < 5 hours may dispose comorbid major depression/insomnia patients to a poor response to combined CBT-I/medication treatments for their insomnia and depression. Future studies to replicate these findings and explore mechanisms of treatment response seem warranted. CLINICAL TRIAL REGISTRATION Registry: ClinicalTrials.gov; Name: Treatment of Insomnia and Depression (TRIAD); URL: https://clinicaltrials.gov/ct2/show/results/NCT00767624; Identifier: NCT00767624. CITATION Edinger JD, Smith ED, Buysse DJ, et al. Objective sleep duration and response to combined pharmacotherapy and cognitive behavioral insomnia therapy among patients with comorbid depression and insomnia: a report from the TRIAD study. J Clin Sleep Med. 2023;19(6):1111-1120.
Collapse
Affiliation(s)
- Jack D. Edinger
- National Jewish Health, Denver, Colorado
- Duke University Medical Center, Durham, North Carolina
| | | | | | - Michael Thase
- University of Pennsylvania, Philadelphia, Pennsylvania
| | | | | | | |
Collapse
|
14
|
Redeker NS, Conley S, O’Connell M, Geer JH, Yaggi H, Jeon S. Sleep-related predictors of cognition among adults with chronic insomnia and heart failure enrolled in a randomized controlled trial of cognitive behavioral therapy for insomnia. J Clin Sleep Med 2023; 19:1073-1081. [PMID: 36740924 PMCID: PMC10235706 DOI: 10.5664/jcsm.10498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 01/26/2023] [Accepted: 01/26/2023] [Indexed: 02/07/2023]
Abstract
STUDY OBJECTIVES Cognitive impairment and insomnia are common in chronic heart failure (HF). We examined the effects of cognitive behavioral therapy for insomnia (CBT-I) and the extent to which demographic, clinical, symptom, and functional characteristics predicted cognition among people with chronic HF and insomnia who participated in a randomized controlled trial of CBT-I. METHODS Participants with HF were randomized to group-based CBT-I or an attention control (HF self-management education). Outcomes were measured over 1 year. We measured psychomotor vigilance and self-reported cognitive ability (PROMIS Cognitive Abilities Scale), clinical and demographic characteristics, history of sleep apnea, fatigue, pain, insomnia (Insomnia Severity Index), sleepiness (Epworth Sleepiness Scale), Six Minute Walk, EuroQoL Quality of Life, and wrist actigraphy (sleep characteristics and rest-activity rhythms). We used cosinor analysis to compute rest-activity rhythms and general linear models and general estimating equations to test the effects of predictors over 1 year. RESULTS The sample included 175 participants (mean age = 63 SD = 12.9 Years; 43% women). There was a statistically significant group-time effect on self-reported cognitive function and increases in the proportion of participants, with < 3 psychomotor vigilance lapses in the CBT-I group. Controlling for group-time effects and baseline cognition, decreased sleepiness, improved rest-activity rhythms, and 6-minute walk distance predicted a composite measure of cognition (psychomotor vigilance lapses and self-reported cognition). CONCLUSIONS CBT-I may improve cognition in adults with chronic HF. A future fully powered randomized controlled trial is needed to confirm the extent to which CBT-I improves multiple dimensions of cognition. CLINICAL TRIAL REGISTRATION Registry: ClinicalTrials.gov; Name: Cognitive Behavioral Therapy for Insomnia: A Self-Management Strategy for Chronic Illness in Heart Failure; URL: https://clinicaltrials.gov/ct2/show/NCT02660385; Identifier: NCT02660385. CITATION Redeker NS, Conley S, O'Connell M, Geer JH, Yaggi H, Jeon S. Sleep-related predictors of cognition among adults with chronic insomnia and heart failure enrolled in a randomized controlled trial of cognitive behavioral therapy for insomnia. J Clin Sleep Med. 2023;19(6):1073-1081.
Collapse
Affiliation(s)
- Nancy S. Redeker
- University of Connecticut Schools of Nursing and Medicine, Storrs Mansfield, Connecticut
| | | | - Meghan O’Connell
- University of Connecticut School of Nursing, Storrs Mansfield, Connecticut
| | | | - Henry Yaggi
- Yale School of Medicine, New Haven, Connecticut
| | | |
Collapse
|
15
|
Ryan AT, Brenner LA, Ulmer CS, Mackintosh MA, Greene CJ. The Use of Evaluation Panels During the Development of a Digital Intervention for Veterans Based on Cognitive Behavioral Therapy for Insomnia: Qualitative Evaluation Study. JMIR Form Res 2023; 7:e40104. [PMID: 36877553 PMCID: PMC10028512 DOI: 10.2196/40104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 12/20/2022] [Accepted: 01/04/2023] [Indexed: 03/07/2023] Open
Abstract
BACKGROUND Individuals enrolling in the Veterans Health Administration frequently report symptoms consistent with insomnia disorder. Cognitive behavioral therapy for insomnia (CBT-I) is a gold standard treatment for insomnia disorder. While the Veterans Health Administration has successfully implemented a large dissemination effort to train providers in CBT-I, the limited number of trained CBT-I providers continues to restrict the number of individuals who can receive CBT-I. Digital mental health intervention adaptations of CBT-I have been found to have similar efficacy as traditional CBT-I. To help address the unmet need for insomnia disorder treatment, the VA commissioned the creation of a freely available, internet-delivered digital mental health intervention adaptation of CBT-I known as Path to Better Sleep (PTBS). OBJECTIVE We aimed to describe the use of evaluation panels composed of veterans and spouses of veterans during the development of PTBS. Specifically, we report on the methods used to conduct the panels, the feedback they provided on elements of the course relevant to user engagement, and how their feedback influenced the design and content of PTBS. METHODS A communications firm was contracted to recruit 3 veteran (n=27) and 2 spouse of veteran (n=18) panels and convene them for three 1-hour meetings. Members of the VA team identified key questions for the panels, and the communications firm prepared facilitator guides to elicit feedback on these key questions. The guides provided a script for facilitators to follow while convening the panels. The panels were telephonically conducted, with visual content displayed via remote presentation software. The communications firm prepared reports summarizing the panelists' feedback during each panel meeting. The qualitative feedback described in these reports served as the raw material for this study. RESULTS The panel members provided markedly consistent feedback on several elements of PTBS, including recommendations to emphasize the efficacy of CBT-I techniques; clarify and simplify written content as much as possible; and ensure that content is consistent with the lived experiences of veterans. Their feedback was congruent with previous studies on the factors influencing user engagement with digital mental health interventions. Panelist feedback influenced multiple course design decisions, including reducing the effort required to use the course's sleep diary function, making written content more concise, and selecting veteran testimonial videos that emphasized the benefits of treating chronic insomnia symptoms. CONCLUSIONS The veteran and spouse evaluation panels provided useful feedback during the design of PTBS. This feedback was used to make concrete revisions and design decisions consistent with existing research on improving user engagement with digital mental health interventions. We believe that many of the key feedback messages provided by these evaluation panels could prove useful to other digital mental health intervention designers.
Collapse
Affiliation(s)
- Arthur Thomas Ryan
- Rocky Mountain Mental Illness Research, Education and Clinical Center for Suicide Prevention, Department of Veterans Affairs, Aurora, CO, United States
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Lisa Anne Brenner
- Rocky Mountain Mental Illness Research, Education and Clinical Center for Suicide Prevention, Department of Veterans Affairs, Aurora, CO, United States
- Departments of Physical Medicine and Rehabilitation, Psychiatry, and Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Christi S Ulmer
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, United States
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, United States
| | - Margaret-Anne Mackintosh
- National Center for Posttraumatic Stress Disorder Dissemination and Training Division, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, United States
| | - Carolyn J Greene
- University of Arkansas for Medical Sciences Translational Research Institute, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| |
Collapse
|
16
|
Korabelnikova EA, Akavov AN, Baranov ML. [Insomnia in neurological patients with disabilities]. Zh Nevrol Psikhiatr Im S S Korsakova 2023; 123:12-20. [PMID: 36843454 DOI: 10.17116/jnevro202312302112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
Abstract
Sleep is the most important factor reflecting the level of psychophysical well-being of a person and influencing him/her to the same extent. The greater susceptibility to sleep disturbances in patients with disabilities is associated with numerous factors. In the existing literature, there are few studies of insomnia in people with neurological disabilities. This article presents a current view on sleep disorders in disabled people and methods for their treatment.
Collapse
Affiliation(s)
- E A Korabelnikova
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - A N Akavov
- Dagestan State Medical University, Makhachkala, Russia
| | - M L Baranov
- Main Military Clinical Hospital of the National Guard Forces, Moscow, Russia
| |
Collapse
|
17
|
Sabot D, Baumann O. Neuroimaging Correlates of Cognitive Behavioral Therapy for Insomnia (CBT-I): A Systematic Literature Review. J Cogn Psychother 2023; 37:82-101. [PMID: 36787999 DOI: 10.1891/jcpsy-d-21-00006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Cognitive behavioral therapy for insomnia (CBT-I) is the gold-standard non-pharmacological treatment for insomnia, a complex disorder that comprises psychological, behavioral, and physiological components. This systematic literature review aimed to evaluate a growing body of exploratory studies that have examined CBT-I treatment effects using neuroimaging assessment. Nine studies met current review selection criteria, of which six studies compared insomnia groups with good sleepers, waitlist, and/or control groups. CBT-I administration varied in treatment length and duration across the studies, as did neuroimaging assessment, which included task-based and resting-state functional magnetic resonance imaging (fMRI), and structural magnetic resonance imaging (MRI). Functional connectivity abnormalities were observed in participants, including reduced engagement in task-related brain regions and apparent difficulties in regulating default mode brain areas that appeared to reverse following CBT-I treatment. Taken together, the neuroimaging results complement behavioral measures of treatment efficacy, indicating support for the effectiveness of CBT-I treatment in the recovery of brain function and structure.
Collapse
Affiliation(s)
- Debbie Sabot
- School of Psychology, Bond University, Robina QLD 4226 Australia
| | | |
Collapse
|
18
|
Forma F, Pratiwadi R, El-Moustaid F, Smith N, Thorndike F, Velez F. Network meta-analysis comparing the effectiveness of a prescription digital therapeutic for chronic insomnia to medications and face-to-face cognitive behavioral therapy in adults. Curr Med Res Opin 2022; 38:1727-1738. [PMID: 35938209 DOI: 10.1080/03007995.2022.2108616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE The purpose of this study was to compare the effectiveness of the only Food and Drug Administration-authorized prescription digital therapeutic (PDT) Somryst versus face-to-face cognitive behavioral therapy for insomnia (CBT-I), or FDA-approved prescription medications for insomnia. METHODS A systematic literature review was undertaken to identify relevant studies. A Bayesian network meta-analysis (NMA) was conducted to examine (1) mean change in insomnia severity index (ISI); (2) proportional change in ISI remitters; (3) mean change in wake after sleep onset (WASO); and (4) mean change in sleep onset latency (SOL). RESULTS Twenty studies provided data on the PDT, CBT-I, CBT-I in combination with self-help (SH), or two prescription medications (eszopiclone and zolpidem). The PDT was associated with significant mean change in ISI (-5.77, 95% Credible Interval [CrI] - 8.53, -3.07) and ISI remitters (OR 12.33; 95% CrI 2.28, 155.91) compared to placebo, and had the highest probability of being the most effective treatment overall for ISI mean change (56%), and ISI remitters (64%). All evaluated interventions significantly outperformed placebo for WASO but no significant differences were observed for SOL (five interventions). Sensitivity analyses excluding medications and meta-regression (assessing type, duration, delivery method for CBT-I) did not affect NMA results. CONCLUSIONS This network meta-analysis demonstrated that a PDT delivering CBT-I had the highest probability of being most effective compared to face-to-face CBT-I, prescription sleep medications, or placebo, as measured by reductions in mean ISI score from baseline and ISI-determined remittance.
Collapse
|
19
|
Forma F, Knight TG, Thorndike FP, Xiong X, Baik R, Velez FF, Maricich YA, Malone DC. Real-World Evaluation of Clinical Response and Long-Term Healthcare Resource Utilization Patterns Following Treatment with a Digital Therapeutic for Chronic Insomnia. Clinicoecon Outcomes Res 2022; 14:537-546. [PMID: 35983014 PMCID: PMC9379126 DOI: 10.2147/ceor.s368780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 07/01/2022] [Indexed: 11/23/2022] Open
Abstract
Background and Objectives This analysis evaluated insomnia severity and long-term impact on healthcare resource utilization (HCRU) and costs after treatment with Somryst® (previously called SHUTi), a digital therapeutic delivering cognitive behavioral therapy for insomnia (CBT-I). Methods Change from baseline in insomnia severity index (ISI) score was assessed using last observed ISI score. A pre/post analysis of claims data was conducted, comparing HCRU in patients with self-identified sleep problems who successfully initiated the therapeutic (index date) between June 1, 2016 and December 31, 2018. Results A total of 248 patients were analyzed (median age 56.5 years, 57.3% female, mean ISI score 19.13, 52.4% treated with sleep aid medications pre-index). After 9 weeks, mean ISI score declined by 37.2% from baseline (19.1 vs 12.0), 58.8% of patients achieved ISI responder status (ISI score improved by =>7; NNT: 1.7), and 26.6% of patients achieved insomnia remission (ISI score <8; NNT for remission: 3.8). After two-year follow-up, post-index events were reduced (compared to 2 years pre-index) for emergency department visits (-53%; IRR: 0.47; 95% CI 0.27, 0.82; P=0.008), hospiatizations (-21%; IRR: 0.79; 95% CI 0.46, 1.35; P=0.389) and hospital outpatient visits (-13%; IRR: 0.87; 95% CI 0.66, 1.14; P=0.315). Slightly increased rates were observed for ambulatory surgical center visits (2%; IRR: 1.02; 95% CI 0.73, 1.44; P=0.903) and office visits (2%; IRR: 1.02; 95% CI 0.92, 1.14; P=0.672). The number of patients treated with sleep aid medications dropped 18.5% (52.4% pre-index vs 42.7% post-index). Average number of prescriptions decreased from 3.98 pre-index to 3.73 post-index (P= 0.552). Total two-year cost reduction post-index vs pre-index was $510,678, or -$2059 per patient. Conclusion In a real-world cohort of patients with chronic insomnia, treatment with a digital therapeutic delivering CBT-I was associated with reductions in insomnia severity, emergency department visits, and net costs.
Collapse
Affiliation(s)
- Felicia Forma
- Pear Therapeutics, Inc., Medical Affairs Department, Boston, MA, USA
| | - Tyler G Knight
- Labcorp Drug Development, Market Access Consulting Department, Gaithersburg, MD, USA
| | | | - Xiaorui Xiong
- Pear Therapeutics, Inc., Medical Affairs Department, Boston, MA, USA
| | - Rebecca Baik
- Labcorp Drug Development, Market Access Consulting Department, Gaithersburg, MD, USA
| | - Fulton F Velez
- Pear Therapeutics, Inc., Medical Affairs Department, Boston, MA, USA
| | - Yuri A Maricich
- Pear Therapeutics, Inc., Medical Affairs Department, Boston, MA, USA
| | | |
Collapse
|
20
|
Chang YP, Pereira T, Salinas A, Or HY, Morales M, Le ML. Effects of an email delivered cognitive behavioral therapy for insomnia in college students. Perspect Psychiatr Care 2021; 57:1685-1692. [PMID: 33547638 DOI: 10.1111/ppc.12736] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 01/02/2021] [Accepted: 01/16/2021] [Indexed: 12/01/2022] Open
Abstract
PURPOSE This study aimed to examine the effect of an email delivered version of Cognitive Behavioral Therapy for Insomnia (CBT-I) in college students with insomnia. DESIGN AND METHODS The study used a two-group pre- and postdesign (N = 63). The intervention group received 6 weekly, email-delivered CBT-I sessions, and the comparison group received a link to a student wellness website for healthy sleep information. FINDINGS The intervention group demonstrated significant improvement in attitudes toward sleep, sleep quality, sleep hygiene, and daytime sleepiness from pretest to posttest. Furthermore, the intervention group showed more positive outcomes, compared to the comparison group at the posttest. PRACTICE IMPLICATIONS An email-delivered sleep intervention is a feasible and easy-to-use tool that nurses can utilize to promote sleep quality among college students.
Collapse
Affiliation(s)
- Yu-Ping Chang
- School of Nursing, The State University of New York, University at Buffalo, Buffalo, New York, USA
| | - Terrika Pereira
- School of Nursing, The State University of New York, University at Buffalo, Buffalo, New York, USA.,Buffalo General Medical Center, Buffalo, New York, USA
| | | | - Hiu Ying Or
- NYC Health+Hospitals/Harlem, New York, New York, USA
| | | | - My Lan Le
- Kenmore Mercy Hospital, Buffalo, New York, USA
| |
Collapse
|
21
|
Genovese TJ, Gehrman P, Yang M, Li Y, Garland SN, Orlow I, Mao JJ. Genetic Predictors of Response to Acupuncture or Cognitive Behavioral Therapy for Insomnia in Cancer Survivors: An Exploratory Analysis. J Pain Symptom Manage 2021; 62:e192-e199. [PMID: 33716034 PMCID: PMC9297333 DOI: 10.1016/j.jpainsymman.2021.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 02/24/2021] [Accepted: 03/04/2021] [Indexed: 11/30/2022]
Abstract
CONTEXT Insomnia is a common problem affecting cancer survivors. While effective nonpharmacological treatments are available, it is unknown whether individual genetic characteristics influence treatment response. OBJECTIVES We conducted an exploratory analysis of genetic associations with insomnia treatment response in a randomized trial of cognitive behavioral therapy for insomnia (CBT-I) vs. acupuncture in a heterogeneous group of cancer survivors. METHODS We successfully genotyped 136 participants for 11 genetic variants. Successful treatment response was defined as a reduction in Insomnia Severity Index score of at least eight points from baseline to week 8. We used Fisher exact tests to evaluate associations between genotype and treatment success for each treatment arm, for an alpha level of 0.05 with unadjusted and Holm-Bonferroni-adjusted P-values. RESULTS We found that more carriers of COMT rs4680-A alleles responded to acupuncture compared to the GG carriers (63.6% vs. 27.8%, P = 0.013). More carriers of the NFKB2 rs1056890 CC genotype also responded to acupuncture compared to TT or CT carriers (72.2% vs. 38.9%, P = 0.009). There were no significant differences found between any of the tested gene variants and CBT-I response. None of the results remained statistically significant after adjustment for multiple testing. CONCLUSION In cancer survivors, specific variants in the COMT and NFKB2 genes are potentially associated with response to acupuncture but not to CBT-I. Confirming these preliminary results will help inform precision insomnia management for cancer survivors.
Collapse
Affiliation(s)
- Timothy J Genovese
- Harvard T.H. Chan School of Public Health, Boston, MA, USA; The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Philip Gehrman
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
| | - MingXiao Yang
- Integrative Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Yuelin Li
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sheila N Garland
- Departments of Psychology and Oncology, Memorial University of Newfoundland, St. John's, Newfoundland, Canada
| | - Irene Orlow
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jun J Mao
- Integrative Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| |
Collapse
|
22
|
Bramoweth AD, Tighe CA, Berlin GS. Insomnia and Insomnia-Related Care in the Department of Veterans Affairs: An Electronic Health Record Analysis. Int J Environ Res Public Health 2021; 18:8573. [PMID: 34444321 PMCID: PMC8394102 DOI: 10.3390/ijerph18168573] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 08/10/2021] [Accepted: 08/11/2021] [Indexed: 11/18/2022]
Abstract
The objective was to examine insomnia and insomnia-related care within a regional network of Department of Veterans Affairs (VA) facilities since the VA roll-out of cognitive behavioral therapy for insomnia (CBT-I) in 2011. A retrospective analysis of VA electronic health records (EHR) data from 2011 to 2019 was conducted. The annual and overall prevalence of four insomnia indicators was measured: diagnoses, medications, consultations for assessment/treatment, and participation in CBT-I. Also examined were sociodemographic and clinical differences among veterans with and without an insomnia indicator, as well as differences among the four individual insomnia indicators. The sample included 439,887 veterans, with 17% identified by one of the four indicators; medications was most common (15%), followed by diagnoses (6%), consults (1.5%), and CBT-I (0.6%). Trends over time included increasing yearly rates for diagnoses, consults, and CBT-I, and decreasing rates for medications. Significant differences were identified between the sociodemographic and clinical variables across indicators. An evaluation of a large sample of veterans identified that prescription sleep medications remain the best way to identify veterans with insomnia. Furthermore, insomnia continues to be under-diagnosed, per VA EHR data, which may have implications for treatment consistent with clinical practice guidelines and may negatively impact veteran health.
Collapse
Affiliation(s)
- Adam D. Bramoweth
- VISN 4 Mental Illness Research, Education and Clinical Center, VA Pittsburgh Healthcare System, Research Office Building (151RU/MIRECC), University Drive, Pittsburgh, PA 15240, USA;
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Research Office Building (151C), University Drive, Pittsburgh, PA 15240, USA
| | - Caitlan A. Tighe
- VISN 4 Mental Illness Research, Education and Clinical Center, VA Pittsburgh Healthcare System, Research Office Building (151RU/MIRECC), University Drive, Pittsburgh, PA 15240, USA;
| | - Gregory S. Berlin
- VA Connecticut Healthcare System, 950 Campbell Avenue (116B), West Haven, CT 06516, USA;
- Department of Psychiatry, Yale University School of Medicine, 300 George Street, New Haven, CT 06511, USA
| |
Collapse
|
23
|
Climent-Sanz C, Valenzuela-Pascual F, Martínez-Navarro O, Blanco-Blanco J, Rubí-Carnacea F, García-Martínez E, Soler-González J, Barallat-Gimeno E, Gea-Sánchez M. Cognitive behavioral therapy for insomnia (CBT-i) in patients with fibromyalgia: a systematic review and meta-analysis. Disabil Rehabil 2021; 44:5770-5783. [PMID: 34297651 DOI: 10.1080/09638288.2021.1954706] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE We aimed to evaluate the effectiveness of CBT-i in patients with fibromyalgia in comparison with other non-pharmacological treatments. METHODS Randomized controlled trials assessing the effects of CBT-i in adults with fibromyalgia, published in English or Spanish, were eligible. Electronic searches were performed using PubMed, Scopus, The Cochrane Library, WebOfKnowledge and Psicodoc databases in March 2021. The main outcome measures were sleep efficiency and sleep quality. Secondary outcomes included pain, depression, and anxiety. RESULTS Of 226 studies reviewed, five were included in the meta-analysis. CBT-i compared with non-pharmacological treatments showed no significant improvements in sleep efficiency (p = 0.05; standardized mean difference (SMD) [95% CI] 0.31 [-0.00 to 0.61]). CBT-i showed significant improvements in sleep quality (p = 0.009; SMD [95% CI] - 0.53 [-0.93 to -0.13]), pain (p = 0.002; SMD [95% CI] - 0.41 [-0.67 to -0.16]), anxiety (p = 0.001; SMD [95% CI] - 0.46 [-0.74 to 0.18]) and depression (p = 0.02; SMD [95% CI] - 0.33 [-0.61 to -0.05]), compared to non-pharmacological treatments. Effect sizes ranged from small to moderate. CONCLUSIONS CBT-i was associated with a significant improvement in sleep quality, pain, anxiety, and depression, although these results are retrieved from very few studies with only very low to low quality evidence. Trial registration: The review protocol was registered with PROSPERO (Record ID = CRD42016030161).IMPLICATIONS FOR REHABILITATIONCBT-i has been proven to improve sleep quality, pain, anxiety and depression, although with small effect sizes.Implementing hybrid CBT for pain and sleep or combining CBT and mindfulness may improve symptoms in people diagnosed with FM.This meta-analysis results highlight the need to enhance sleep management skills among people suffering from this health condition.
Collapse
Affiliation(s)
- Carolina Climent-Sanz
- Department of Nursing and Physiotherapy, University of Lleida, Lleida, Spain.,Grup d'Estudis Societat, Salut, Educació i Cultura, University of Lleida, Lleida, Spain.,Grup de Recerca de Cures en Salut, IRBLleida (Lleida Institute for Biomedical Research Dr. Pifarré Foundation), Lleida, Spain
| | - Fran Valenzuela-Pascual
- Department of Nursing and Physiotherapy, University of Lleida, Lleida, Spain.,Grup d'Estudis Societat, Salut, Educació i Cultura, University of Lleida, Lleida, Spain.,Grup de Recerca de Cures en Salut, IRBLleida (Lleida Institute for Biomedical Research Dr. Pifarré Foundation), Lleida, Spain
| | | | - Joan Blanco-Blanco
- Department of Nursing and Physiotherapy, University of Lleida, Lleida, Spain.,Grup d'Estudis Societat, Salut, Educació i Cultura, University of Lleida, Lleida, Spain.,Grup de Recerca de Cures en Salut, IRBLleida (Lleida Institute for Biomedical Research Dr. Pifarré Foundation), Lleida, Spain
| | - Francesc Rubí-Carnacea
- Department of Nursing and Physiotherapy, University of Lleida, Lleida, Spain.,Grup d'Estudis Societat, Salut, Educació i Cultura, University of Lleida, Lleida, Spain.,Grup de Recerca de Cures en Salut, IRBLleida (Lleida Institute for Biomedical Research Dr. Pifarré Foundation), Lleida, Spain
| | - Ester García-Martínez
- Department of Nursing and Physiotherapy, University of Lleida, Lleida, Spain.,Grup de Recerca de Cures en Salut, IRBLleida (Lleida Institute for Biomedical Research Dr. Pifarré Foundation), Lleida, Spain
| | - Jorge Soler-González
- Grup d'Estudis Societat, Salut, Educació i Cultura, University of Lleida, Lleida, Spain.,Faculty of Medicine, University of Lleida, Lleida, Spain.,Catalan Health Institute, Lleida, Spain
| | - Eva Barallat-Gimeno
- Department of Nursing and Physiotherapy, University of Lleida, Lleida, Spain.,Grup d'Estudis Societat, Salut, Educació i Cultura, University of Lleida, Lleida, Spain.,Grup de Recerca de Cures en Salut, IRBLleida (Lleida Institute for Biomedical Research Dr. Pifarré Foundation), Lleida, Spain
| | - Montserrat Gea-Sánchez
- Department of Nursing and Physiotherapy, University of Lleida, Lleida, Spain.,Grup d'Estudis Societat, Salut, Educació i Cultura, University of Lleida, Lleida, Spain.,Grup de Recerca de Cures en Salut, IRBLleida (Lleida Institute for Biomedical Research Dr. Pifarré Foundation), Lleida, Spain
| |
Collapse
|
24
|
Thorndike FP, Berry RB, Gerwien R, Braun S, Maricich YA. Protocol for Digital Real-world Evidence trial for Adults with insomnia treated via Mobile (DREAM): an open-label trial of a prescription digital therapeutic for treating patients with chronic insomnia. J Comp Eff Res 2021; 10:569-581. [PMID: 33682430 DOI: 10.2217/cer-2021-0004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background: Cognitive behavioral therapy for insomnia (CBT-I) is underused in healthcare settings and is challenging for people with insomnia to access because of uneven geographical distribution of behavioral sleep medicine providers. Prescription digital therapeutics can overcome these barriers. This study evaluates the effectiveness of a specific digital CBT-I therapeutic. Materials & methods: Digital Real-world Evidence trial for Adults with insomnia treated via Mobile (DREAM) is a 9-week, open-label, decentralized clinical trial to collect real-world evidence for a digital therapeutic (Somryst™) delivering CBT-I to patients with chronic insomnia. The primary objective is to examine the effectiveness of Somryst to reduce self-reported insomnia symptoms and severity in a real-world population (n = 350). Conclusion: This pragmatic study seeks to assess the potential benefits of treating insomnia with an asynchronous, mobile, tailored prescription digital therapeutic. Clinical trial registration: NCT04325464 (ClinicalTrials.gov).
Collapse
Affiliation(s)
| | - Richard B Berry
- University of Florida Health Sleep Disorders Center, FL 32606, USA
| | | | | | | |
Collapse
|
25
|
Williams-Cooke C, LeSuer L, Drerup M, Siengsukon C. The Impact of Cognitive Behavioral Therapy for Insomnia on Sleep Log and Actigraphy Outcomes in People with Multiple Sclerosis: A Secondary Analysis. Nat Sci Sleep 2021; 13:1865-1874. [PMID: 34675730 PMCID: PMC8520446 DOI: 10.2147/nss.s324879] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 09/09/2021] [Indexed: 11/23/2022] Open
Abstract
PURPOSE While studies indicate cognitive behavioral therapy for insomnia (CBT-I) improves self-report sleep outcomes from questionnaires in people with multiple sclerosis (MS), it is unclear if CBT-I improves outcomes from a sleep log or sleep assessed objectively via actigraphy in people with MS. This study aimed to determine if CBT-I improves sleep log and actigraphy outcomes in individuals with MS. PATIENTS AND METHODS Twenty-five participants (Mage = 53.04, SD= 10.90) were included in this secondary analysis of data from a pilot randomized control study to assess the feasibility and treatment effect of CBT-I in individuals with MS. Participants were asked to maintain a sleep log and wear an actigraph for a week at baseline and post-intervention. Participants were randomized into one of three groups (CBT-I, active control, or one-time brief education control group). One-way ANOVAs were used to assess for group differences and within group change in sleep latency, sleep efficiency (SE), time in bed, total sleep time (TST), wake after sleep onset, variability of SE, and variability of TST. RESULTS CBT-I resulted in an increase in sleep efficiency (SE) and decrease in time in bed (TIB) and variability of SE from the sleep log. The CBT-I group also experienced a decrease in TIB and total sleep time (TST) from actigraphy. The active control group demonstrated an increase in variability of SE from actigraphy. CONCLUSION This study indicates that individuals with MS may experience an improvement in sleep log and actigraphy sleep outcomes following CBT-I, but findings need to be replicated in a larger prospective study. The decrease in TST from actigraphy mirrors results from prior studies.
Collapse
Affiliation(s)
- Cierra Williams-Cooke
- Department of Physical Therapy, Rehabilitation Science, and Athletic Training, University of Kansas Medical Center, Kansas City, KS, USA
| | - Leslie LeSuer
- Department of Physical Therapy, Rehabilitation Science, and Athletic Training, University of Kansas Medical Center, Kansas City, KS, USA
| | - Michelle Drerup
- Sleep Disorders Clinic, Cleveland Clinic, Cleveland, OH, USA
| | - Catherine Siengsukon
- Department of Physical Therapy, Rehabilitation Science, and Athletic Training, University of Kansas Medical Center, Kansas City, KS, USA
| |
Collapse
|
26
|
Abstract
Introduction: Prescription digital therapeutics (PDTs) represent a new class of software-based medical devices authorized by the Food and Drug Administration (FDA) to treat disease. Somryst™, the first PDT for treating chronic insomnia, delivers cognitive behavioral therapy for insomnia (CBT-I) via a mobile application. CBT-I is the guideline-recommended, first-line treatment for chronic insomnia, but availability of CBT-I therapists is limited. Somryst addresses this need by providing asynchronous access to CBT-I treatment. As a contactless therapeutic medium, Somryst is also an ideal option when face-to-face therapy is not available or recommended for safety reasons (e.g. because of possible exposure to the SARS-CoV-2 virus). Areas covered: This review summarizes the mechanisms of action and technical features of Somryst, and describes safety and effectiveness data from the randomized trials on which FDA clearance was based. Expert opinion: Somryst demonstrates robust clinical efficacy with a favorable benefit-to-risk profile for treating adults with chronic insomnia. FDA clearance was based on data from 2 clinical trials of the first-generation web-based CBT-I platform Sleep Healthy Using the Internet (SHUTi). Somryst, and PDTs in general, are promising devices to address the need for greater accessibility to effective therapies.
Collapse
Affiliation(s)
- Charles M Morin
- School of Psychology, Laval University , Quebec City, Canada
| |
Collapse
|
27
|
Ong JC, Crawford MR, Dawson SC, Fogg LF, Turner AD, Wyatt JK, Crisostomo MI, Chhangani BS, Kushida CA, Edinger JD, Abbott SM, Malkani RG, Attarian HP, Zee PC. A randomized controlled trial of CBT-I and PAP for obstructive sleep apnea and comorbid insomnia: main outcomes from the MATRICS study. Sleep 2020; 43:zsaa041. [PMID: 32170307 PMCID: PMC7487869 DOI: 10.1093/sleep/zsaa041] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 01/30/2020] [Indexed: 11/14/2022] Open
Abstract
STUDY OBJECTIVES To investigate treatment models using cognitive behavioral therapy for insomnia (CBT-I) and positive airway pressure (PAP) for people with obstructive sleep apnea (OSA) and comorbid insomnia. METHODS 121 adults with OSA and comorbid insomnia were randomized to receive CBT-I followed by PAP, CBT-I concurrent with PAP, or PAP only. PAP was delivered following standard clinical procedures for in-lab titration and home setup and CBT-I was delivered in four individual sessions. The primary outcome measure was PAP adherence across the first 90 days, with regular PAP use (≥4 h on ≥70% of nights during a 30-day period) serving as the clinical endpoint. The secondary outcome measures were the Pittsburgh Sleep Quality Index (PSQI) and Insomnia Severity Index (ISI) with good sleeper (PSQI <5), remission (ISI <8), and response (ISI reduction from baseline >7) serving as the clinical endpoints. RESULTS No significant differences were found between the concomitant treatment arms and PAP only on PAP adherence measures, including the percentage of participants who met the clinical endpoint. Compared to PAP alone, the concomitant treatment arms reported a significantly greater reduction from baseline on the ISI (p = .0009) and had a greater percentage of participants who were good sleepers (p = .044) and remitters (p = .008). No significant differences were found between the sequential and concurrent treatment models on any outcome measure. CONCLUSIONS The findings from this study indicate that combining CBT-I with PAP is superior to PAP alone on insomnia outcomes but does not significantly improve adherence to PAP.
Collapse
Affiliation(s)
- Jason C Ong
- Center for Circadian and Sleep Medicine, Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Megan R Crawford
- School of Psychological Sciences and Health, University of Strathclyde, Glasgow, UK
| | - Spencer C Dawson
- Center for Circadian and Sleep Medicine, Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Louis F Fogg
- College of Nursing, Rush University Medical Center, Chicago, IL
| | - Arlener D Turner
- Center for Sleep and Brain Health, Department of Psychiatry, New York University, New York, NY
| | - James K Wyatt
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL
| | | | | | - Clete A Kushida
- Division of Sleep Medicine, Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA
| | - Jack D Edinger
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, National Jewish Health, Denver, CO
| | - Sabra M Abbott
- Center for Circadian and Sleep Medicine, Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Roneil G Malkani
- Center for Circadian and Sleep Medicine, Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Hrayr P Attarian
- Center for Circadian and Sleep Medicine, Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Phyllis C Zee
- Center for Circadian and Sleep Medicine, Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| |
Collapse
|
28
|
Abstract
Purpose of Review To evaluate and summarize recent research articles pertaining to insomnia in older adults that can guide healthcare providers on factors to consider when assessing and managing insomnia. Recent Findings Up to 75% of older adults experience symptoms of insomnia. Insomnia is associated with socioeconomic status, racial and ethnic classification, family relationships, medical and mental health disorders, cognitive function, and dementia. Although one-fifth of older adults are still prescribed sleep medications, cognitive behavioral therapy for insomnia is the first line treatment for insomnia, resulting in short-term and long-term benefits. Summary To manage insomnia safely and effectively, healthcare providers need to consistently assess for insomnia during baseline and annual assessments, evaluate medical and social factors associated with insomnia, minimize the use of sleep medications, and provide referrals to and/or collaborate with providers who perform cognitive behavioral therapy for insomnia. Insomnia screening is important as it facilitates early intervention with behavioral management, reduces the potential for pharmacological management, which increases fall risk in older adults, and enables further assessment and early identification of outcomes such as cognitive impairment.
Collapse
|
29
|
Minakawa EN, Wada K, Nagai Y. Sleep Disturbance as a Potential Modifiable Risk Factor for Alzheimer's Disease. Int J Mol Sci 2019; 20:E803. [PMID: 30781802 DOI: 10.3390/ijms20040803] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Revised: 01/30/2019] [Accepted: 02/03/2019] [Indexed: 12/13/2022] Open
Abstract
Sleep disturbance is a common symptom in patients with various neurodegenerative diseases, including Alzheimer’s disease (AD), and it can manifest in the early stages of the disease. Impaired sleep in patients with AD has been attributed to AD pathology that affects brain regions regulating the sleep–wake or circadian rhythm. However, recent epidemiological and experimental studies have demonstrated an association between impaired sleep and an increased risk of AD. These studies have led to the idea of a bidirectional relationship between AD and impaired sleep; in addition to the conventional concept that impaired sleep is a consequence of AD pathology, various evidence strongly suggests that impaired sleep is a risk factor for the initiation and progression of AD. Despite this recent progress, much remains to be elucidated in order to establish the benefit of therapeutic interventions against impaired sleep to prevent or alleviate the disease course of AD. In this review, we provide an overview of previous studies that have linked AD and sleep. We then highlight the studies that have tested the causal relationship between impaired sleep and AD and will discuss the molecular and cellular mechanisms underlying this link. We also propose future works that will aid the development of a novel disease-modifying therapy and prevention of AD via targeting impaired sleep through non-pharmacological and pharmacological interventions.
Collapse
|
30
|
Fung CH, Martin JL, Alessi C, Dzierzewski JM, Cook IA, Moore A, Grinberg A, Zeidler M, Kierlin L. Hypnotic Discontinuation Using a Blinded (Masked) Tapering Approach: A Case Series. Front Psychiatry 2019; 10:717. [PMID: 31708806 PMCID: PMC6822133 DOI: 10.3389/fpsyt.2019.00717] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 09/09/2019] [Indexed: 12/04/2022] Open
Abstract
Chronic use of hypnotic medications such as benzodiazepines is associated with adverse consequences including increased risk of falls. Efforts to help patients discontinue these medications have had varying levels of success. We developed a blinded (masked) tapering protocol to help patients taper off hypnotics. In this blinded protocol, patients consented to a drug taper but agreed to forego knowledge about the specific tapering schedule or the actual dose each night until the end of the taper. Blinded tapering aims to reduce negative expectancies for withdrawal effects that may impair a patient's successful discontinuation of hypnotics. In preparation for a randomized trial, we tested the feasibility of adding a blinded tapering component to current best evidence practice [supervised hypnotic taper combined with cognitive behavioral therapy for insomnia (CBTI)] in 5 adult patients recruited from an outpatient mental health practice in Oregon. A compounding pharmacy prepared the blinded capsules for each patient. During the gradual blinded taper, each participant completed CBTI. Measures collected included feasibility/process (e.g., recruitment barriers), hypnotic use, the Dysfunctional Beliefs and Attitudes about Sleep Scale, Insomnia Severity Index, Epworth Sleepiness Scale, and Patient Health Questionnaire-9 (depressive symptoms). The intervention was feasible, and participants reported high satisfaction with the protocol and willingness to follow the same treatment again. All five participants successfully discontinued their hypnotic medication use post-treatment. Dysfunctional beliefs/attitudes about sleep and insomnia severity improved. Blinded tapering is a promising new method for improving hypnotic discontinuation among patients treated with a combination of hypnotic tapering plus CBTI.
Collapse
Affiliation(s)
- Constance H Fung
- Geriatric Research, Education and Clinical Center, VA Greater Los Angeles Healthcare System, North Hills, CA, United States.,Department of Medicine, David Geffen School of Medicine at the University of California, Los Angeles (UCLA), Los Angeles, CA, United States
| | - Jennifer L Martin
- Geriatric Research, Education and Clinical Center, VA Greater Los Angeles Healthcare System, North Hills, CA, United States.,Department of Medicine, David Geffen School of Medicine at the University of California, Los Angeles (UCLA), Los Angeles, CA, United States
| | - Cathy Alessi
- Geriatric Research, Education and Clinical Center, VA Greater Los Angeles Healthcare System, North Hills, CA, United States.,Department of Medicine, David Geffen School of Medicine at the University of California, Los Angeles (UCLA), Los Angeles, CA, United States
| | - Joseph M Dzierzewski
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, United States
| | - Ian A Cook
- Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles, CA, United States.,Los Angeles TMS Institute, Los Angeles, CA, United States
| | - Alison Moore
- Department of Medicine, University of California, San Diego School of Medicine, La Jolla, CA, United States
| | - Austin Grinberg
- Geriatric Research, Education and Clinical Center, VA Greater Los Angeles Healthcare System, North Hills, CA, United States.,Department of Medicine, David Geffen School of Medicine at the University of California, Los Angeles (UCLA), Los Angeles, CA, United States
| | - Michelle Zeidler
- Geriatric Research, Education and Clinical Center, VA Greater Los Angeles Healthcare System, North Hills, CA, United States.,Department of Medicine, David Geffen School of Medicine at the University of California, Los Angeles (UCLA), Los Angeles, CA, United States
| | - Lara Kierlin
- Northwest Sleep and Behavior, Lake Oswego, OR, United States
| |
Collapse
|
31
|
Pulantara IW, Parmanto B, Germain A. Clinical Feasibility of a Just-in-Time Adaptive Intervention App (iREST) as a Behavioral Sleep Treatment in a Military Population: Feasibility Comparative Effectiveness Study. J Med Internet Res 2018; 20:e10124. [PMID: 30530452 PMCID: PMC6303679 DOI: 10.2196/10124] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 08/22/2018] [Accepted: 09/10/2018] [Indexed: 01/23/2023] Open
Abstract
Background Although evidence-based cognitive behavioral sleep treatments have been shown to be safe and effective, these treatments have limited scalability. Mobile health tools can address this scalability challenge. iREST, or interactive Resilience Enhancing Sleep Tactics, is a mobile health platform designed to provide a just-in-time adaptive intervention (JITAI) in the assessment, monitoring, and delivery of evidence-based sleep recommendations in a scalable and personalized manner. The platform includes a mobile phone–based patient app linked to a clinician portal. Objective The first aim of the pilot study was to evaluate the effectiveness of JITAI using the iREST platform for delivering evidence-based sleep interventions in a sample of military service members and veterans. The second aim was to explore the potential effectiveness of this treatment delivery form relative to habitual in-person delivery. Methods In this pilot study, military service members and veterans between the ages of 18 and 60 years who reported clinically significant service-related sleep disturbances were enrolled as participants. Participants were asked to use iREST for a period of 4 to 6 weeks during which time they completed a daily sleep/wake diary. Through the clinician portal, trained clinicians offered recommendations consistent with evidence-based behavioral sleep treatments on weeks 2 through 4. To explore potential effectiveness, self-report measures were used, including the Insomnia Severity Index (ISI), the Pittsburgh Sleep Quality Index (PSQI), and the PSQI Addendum for Posttraumatic Stress Disorder. Results A total of 27 participants completed the posttreatment assessments. Between pre- and postintervention, clinically and statistically significant improvements in primary and secondary outcomes were detected (eg, a mean reduction on the ISI of 9.96, t26=9.99, P<.001). At posttreatment, 70% (19/27) of participants met the criteria for treatment response and 59% (16/27) achieved remission. Comparing these response and remission rates with previously published results for in-person trials showed no significant differences. Conclusion Participants who received evidence-based recommendations from their assigned clinicians through the iREST platform showed clinically significant improvements in insomnia severity, overall sleep quality, and disruptive nocturnal disturbances. These findings are promising, and a larger noninferiority clinical trial is warranted.
Collapse
Affiliation(s)
- I Wayan Pulantara
- Health and Rehabilitation Informatics Laboratory, Department of Health Information Management, University of Pittsburgh, Pittsburgh, PA, United States
| | - Bambang Parmanto
- Health and Rehabilitation Informatics Laboratory, Department of Health Information Management, University of Pittsburgh, Pittsburgh, PA, United States
| | - Anne Germain
- Sleep and Behavioral Neuroscience Center, Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, United States
| |
Collapse
|
32
|
Yeung T, Martin JL, Fung CH, Fiorentino L, Dzierzewski JM, Rodriguez Tapia JC, Song Y, Josephson K, Jouldjian S, Mitchell MN, Alessi C. Sleep Outcomes With Cognitive Behavioral Therapy for Insomnia Are Similar Between Older Adults With Low vs. High Self-Reported Physical Activity. Front Aging Neurosci 2018; 10:274. [PMID: 30271340 PMCID: PMC6146107 DOI: 10.3389/fnagi.2018.00274] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 08/27/2018] [Indexed: 11/13/2022] Open
Abstract
We examined whether baseline self-reported physical activity is associated with the efficacy of cognitive behavioral therapy for insomnia (CBT-I) in older veterans. Community-dwelling veterans aged 60 years and older with insomnia received CBT-I in a randomized controlled trial. Participants who received active treatment were divided into low and high physical activity based on self-report. Sleep outcomes were measured by sleep diary, questionnaire and wrist actigraphy; collected at baseline, post-treatment, 6-month and 12-month follow-up. Mixed-effects models compared differences between physical activity groups in change in sleep outcome from baseline to each follow-up, and equivalence tests examined if physical activity groups were clinically equal. There were no significant differences in sleep outcomes between physical activity groups. Equivalence tests suggested possible equality in physical activity groups for five of seven sleep outcomes. Efficacy of CBT-I in older veterans was not associated with self-reported physical activity at baseline. Older adults with insomnia who report low levels of physical activity can benefit from CBT-I.
Collapse
Affiliation(s)
- Timothy Yeung
- Washington & Jefferson College, Washington, PA, United States
| | - Jennifer L Martin
- Geriatric Research, Education and Clinical Center, VA Greater Los Angeles Healthcare System, North Hills, CA, United States.,Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Constance H Fung
- Geriatric Research, Education and Clinical Center, VA Greater Los Angeles Healthcare System, North Hills, CA, United States.,Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Lavinia Fiorentino
- Department of Psychiatry, University of California, San Diego, San Diego, CA, United States
| | - Joseph M Dzierzewski
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, United States
| | - Juan C Rodriguez Tapia
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States.,Department of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Yeonsu Song
- Geriatric Research, Education and Clinical Center, VA Greater Los Angeles Healthcare System, North Hills, CA, United States.,Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Karen Josephson
- Geriatric Research, Education and Clinical Center, VA Greater Los Angeles Healthcare System, North Hills, CA, United States
| | - Stella Jouldjian
- Geriatric Research, Education and Clinical Center, VA Greater Los Angeles Healthcare System, North Hills, CA, United States
| | - Michael N Mitchell
- Geriatric Research, Education and Clinical Center, VA Greater Los Angeles Healthcare System, North Hills, CA, United States
| | - Cathy Alessi
- Geriatric Research, Education and Clinical Center, VA Greater Los Angeles Healthcare System, North Hills, CA, United States.,Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| |
Collapse
|
33
|
Zhang Y, Su J, Wang J, Tang G, Hu W, Mao J, Ren W, Liu Y, Yu Z. Cognitive behavioral therapy for insomnia combined with eszopiclone for the treatment of sleep disorder patients transferred out of the intensive care unit: A single-centred retrospective observational study. Medicine (Baltimore) 2018; 97:e12383. [PMID: 30213004 PMCID: PMC6156064 DOI: 10.1097/md.0000000000012383] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Patients transferred out of the intensive care unit (ICU) are always impaired by sleep disorders. Cognitive behavioral therapy for insomnia (CBT-I) and eszopiclone are 2 commonly prescribed strategies for insomnia. In the current study, the effect of the combined application of the 2 methods on sleep disorders in ICU transferred out patients was assessed.Twenty-nine insomnia patients receiving combined treatment of CBT-I and eszopiclone and a corresponding number of patients treated with eszopiclone were collected. The incidence of discomfort experiences in ICU was recorded. Polysomnogram (PSG), Pittsburgh Sleep Quality Index (PSQI), self-rating anxiety scale (SAS), self-rating depression scale (SDS), and treatment emergent symptom scale (TESS) were used to assess the treatment efficacy and side effects.Hospitalization for over 7 days, use of benzodiazepines, and experiencing anxiety, insomnia, and mechanical ventilation increased chances of sleep disorders. The sleep latency, awakening time, and total sleep time were further improved in patients treated with the combined therapy than patients treated with eszopiclone (t = -2.334, -2.412, 2.383, P < .05). Similar changing pattern was observed for PSQI score (t = -2.262, P < .05). The improvement effect of the combined therapy on the sleep efficacy, SWS phase III, and rapid eye movement sleep was also significantly stronger (t = 2.112, 2.268, 2.311, P < .05). Moreover, the SAS and SDS scores in patients treated with the combined therapy decreased more than those of patients treated with eszopiclone.The efficacy of CBT-I combined with eszopiclone in the treatment of sleep disorders in ICU transferred out patients was better than eszopiclone.
Collapse
Affiliation(s)
- Ying Zhang
- Department of Medical Psychosomatic, Hangzhou Seventh People's Hospital
| | - Jun Su
- Department of Intensive Care Unit, Hangzhou First People's Hospital, Hangzhou
| | - Jingquan Wang
- Department of Intensive Care Unit , Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei, China
| | - Guangzhang Tang
- Department of Medical Psychosomatic, Hangzhou Seventh People's Hospital
| | - Wei Hu
- Department of Intensive Care Unit, Hangzhou First People's Hospital, Hangzhou
| | - Jinghong Mao
- Department of Medical Psychosomatic, Hangzhou Seventh People's Hospital
| | - Wanwen Ren
- Department of Medical Psychosomatic, Hangzhou Seventh People's Hospital
| | - Yi Liu
- Department of Medical Psychosomatic, Hangzhou Seventh People's Hospital
| | - Zhenghe Yu
- Department of Medical Psychosomatic, Hangzhou Seventh People's Hospital
| |
Collapse
|
34
|
Koffel E, Bramoweth AD, Ulmer CS. Increasing access to and utilization of cognitive behavioral therapy for insomnia (CBT-I): a narrative review. J Gen Intern Med 2018; 33:955-962. [PMID: 29619651 PMCID: PMC5975165 DOI: 10.1007/s11606-018-4390-1] [Citation(s) in RCA: 159] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 01/26/2018] [Accepted: 02/15/2018] [Indexed: 01/22/2023]
Abstract
The American College of Physicians (ACP) recently identified cognitive behavioral therapy for insomnia (CBT-I) as the first-line treatment for insomnia. Although CBT-I improves sleep outcomes and reduces the risks associated with reliance on hypnotics, patients are rarely referred to this treatment, especially in primary care where most insomnia treatment is provided. We reviewed the evidence about barriers to CBT-I referrals and efforts to increase the use of CBT-I services. PubMed, PsycINFO, and Embase were searched on January 11, 2018; additional titles were added based on a review of bibliographies and expert opinion and 51 articles were included in the results of this narrative review. Implementation research testing specific interventions to increase routine and sustained use of CBT-I was lacking. Most research focused on pre-implementation work that revealed the complexity of delivering CBT-I in routine healthcare settings due to three distinct categories of barriers. First, system barriers result in limited access to CBT-I and behavioral sleep medicine (BSM) providers. Second, primary care providers are not adequately screening for sleep issues and referring appropriately due to a lack of knowledge, treatment beliefs, and a lack of motivation to assess and treat insomnia. Finally, patient barriers, including a lack of knowledge, treatment beliefs, and limited access, prevent patients from engaging in CBT-I. These findings are organized using a conceptual model to represent the many challenges inherent in providing guideline-concordant insomnia care. We conclude with an agenda for future implementation research to systematically address these challenges.
Collapse
Affiliation(s)
- Erin Koffel
- Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System, Minneapolis, MN, USA. .,University of Minnesota Medical School, Minneapolis, MN, USA.
| | - Adam D Bramoweth
- Center for Health Equity Research and Promotion, Mental Illness Research, Education and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - Christi S Ulmer
- Durham VA Health Services Research and Development, Durham, NC, USA.,Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA
| |
Collapse
|
35
|
Merz EL, Tomfohr-Madsen L. Sleep Disruption in Pediatric Cancer Survivors: Conceptual Framework and Opportunities for Clinical Assessment and Behavioral Treatment. Am J Lifestyle Med 2016; 12:311-323. [PMID: 32063816 DOI: 10.1177/1559827616681725] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2016] [Revised: 10/31/2016] [Accepted: 11/09/2016] [Indexed: 12/18/2022] Open
Abstract
Sleep disruption is a commonly reported consequence of cancer and its treatment in pediatric patients and survivors. This review summarizes common sleep concerns in this population and introduces a multidimensional framework of risk factors specific to childhood cancer that may interact to develop and maintain disrupted sleep. Based on the extant literature, parameters of the cancer and its treatment, physical and social environmental conditions both during and after treatment, changes to family behavior and norms, psychological factors and traumatic stress, and reduced physical activity are hypothesized to be the most pertinent risk factors for disrupted sleep in this population. Potential clinical assessment strategies and behavioral interventions relevant to these considerations are discussed, with reference to the behavioral model of insomnia. The review concludes by offering directions for research and clinical practice, including developing and testing comprehensive assessment tools, intervention effectiveness studies in both oncology and primary care clinics, and efforts to increase patient-provider communication about sleep in pediatric oncology.
Collapse
Affiliation(s)
- Erin L Merz
- Department of Psychology, California State University, Dominguez Hills, Carson, California (ELM).,Department of Psychology, University of Calgary and Department of Pediatrics, Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada (LTM)
| | - Lianne Tomfohr-Madsen
- Department of Psychology, California State University, Dominguez Hills, Carson, California (ELM).,Department of Psychology, University of Calgary and Department of Pediatrics, Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada (LTM)
| |
Collapse
|
36
|
Aricò D, Raggi A, Ferri R. Cognitive Behavioral Therapy for Insomnia in Breast Cancer Survivors: A Review of the Literature. Front Psychol 2016; 7:1162. [PMID: 27536265 PMCID: PMC4971442 DOI: 10.3389/fpsyg.2016.01162] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Accepted: 07/20/2016] [Indexed: 12/16/2022] Open
Abstract
Background: Insomnia is a common sleep disorder in patients with breast cancer and studies show a higher frequency than in the general population but it appears to be understudied and the treatment seems to be a neglected problem. There is a growing body of evidence about the efficacy of cognitive behavioral therapy for insomnia (CBT-I) in breast cancer survivors (BCS). The aim of this review is to examine the best available scientific evidence related to CBT-I and insomnia in patients with breast cancer and to assess the effect of CBT-I on their psychosocial functioning, sleep, quality of life, and mood. Methods: Empirical articles published in peer-reviewed journals from the earliest reports available until August 2015 were considered. The research on PubMed generated 18 papers, three of which did not meet the inclusion criteria. Another paper was retrieved by screening the reference list of the previously selected papers. Results: A total of 16 studies were found that evaluated the effects of CBT-I in breast cancer patients. CBT-I appears to be an effective therapy for insomnia in BCS, improving mood, general and physical fatigue, and global and cognitive dimensions of quality of life. CBT-I may also reduce menopausal symptoms, such as hot flushes and night sweat problems, frequency of medicated nights, level of depression, and anxiety. Conclusions: CBT-I seems to be an eligible intervention for improving sleep in BCS. Improvements concerning insomnia and sleep quality are durable (usually up to 12 months) and statistically significant.
Collapse
Affiliation(s)
- Debora Aricò
- Department of Neurology, Oasi Institute for Research on Mental Retardation and Brain Aging Troina, Italy
| | - Alberto Raggi
- Unit of Neurology, G. B. Morgagni- L. Pierantoni Hospital Forlì, Italy
| | - Raffaele Ferri
- Department of Neurology, Oasi Institute for Research on Mental Retardation and Brain Aging Troina, Italy
| |
Collapse
|
37
|
Yamadera W, Sato M, Harada D, Iwashita M, Aoki R, Obuchi K, Ozone M, Itoh H, Nakayama K. Comparisons of short-term efficacy between individual and group cognitive behavioral therapy for primary insomnia. Sleep Biol Rhythms 2013; 11:176-184. [PMID: 24098091 PMCID: PMC3787783 DOI: 10.1111/sbr.12019] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2013] [Indexed: 02/04/2023]
Abstract
The purpose of this study was to compare the efficacy of individual and group cognitive behavioral therapy for insomnia (CBT-I) in outpatients with primary insomnia diagnosed by DSM-IV-TR. The participants were 20 individually treated (I-CBT-I) and 25 treated in a group therapy format (three to five patients per group) (G-CBT-I), which showed no significant difference regarding demographic variables between groups. The same components of CBT-I stimulus control therapy, sleep restriction therapy, cognitive therapy, and sleep hygiene education were applied on both groups. The short-term outcome (4 weeks after treatment) was measured by sleep logs, actigraphy, the Pittsburgh Sleep Quality Index (PSQI), and the Dysfunctional Beliefs and Attitudes about Sleep Scale (DBAS), and was compared between I-CBT-I and G-CBT-I. The results indicated that CBT-I was effective in improving subjective and objective sleep parameters and subjective sleep evaluations for both individual and group treatment. However, I-CBT-I resulted in significantly better improvements over G-CBT-I, in (i) objective and subjective sleep onset latency time, (ii) objective sleep efficacy and moving time during sleeping, (iii) overall sleep quality and duration of actual sleep time in PSQI, (iv) consequences of insomnia, control and predictability of sleep, sleep requirement expectation, and sleep-promoting practices in DBAS. The present study suggested the superiority of I-CBT-I over G-CBT-I in clinical settings, and further evaluations are necessary.
Collapse
Affiliation(s)
- Wataru Yamadera
- Department of Psychiatry, Jikei University School of MedicineTokyo, Japan
| | - Miki Sato
- Department of Psychiatry, Jikei University School of MedicineTokyo, Japan
| | - Daisuke Harada
- Department of Psychiatry, Jikei University School of MedicineTokyo, Japan
| | - Masayuki Iwashita
- Department of Psychiatry, Jikei University School of MedicineTokyo, Japan
| | - Ryo Aoki
- Department of Psychiatry, Jikei University School of MedicineTokyo, Japan
| | - Keita Obuchi
- Department of Psychiatry, Jikei University School of MedicineTokyo, Japan
| | - Motohiro Ozone
- Department of Psychiatry, Jikei University School of MedicineTokyo, Japan
| | - Hiroshi Itoh
- Department of Psychiatry, Jikei University School of MedicineTokyo, Japan
| | - Kazuhiko Nakayama
- Department of Psychiatry, Jikei University School of MedicineTokyo, Japan
| |
Collapse
|