Simple intervention helps older adults with insomnia

In-person and telephone counseling with a nurse practitioner that had no prior training in sleep medicine improved seniors' sleep for up to six months, study findings indicate.

“We found that brief behavioral treatment is a simple, efficacious and durable intervention for chronic insomnia in older adults that has potential for dissemination across medical settings,” Daniel J. Buysse, MD, of the University of Pittsburgh School of Medicine and colleagues wrote in Archives of Internal Medicine.

The researchers randomly assigned 79 adults mean age 71.7 years, who had chronic insomnia and common comorbidities including psychiatric disorders, chronic pain and cancer, to either the behavioral treatment or an education-based sleep intervention.

Treatment group participants (n=39) received a single 45- to 60-minute individual counseling session with a master's level mental health nurse practitioner. Thirty-minute follow-up phone calls were conducted two weeks following the initial intervention, and two more 20-minute phone interviews took place one week and three weeks after the initial session.

Control group participants (n=40) were randomly assigned to read three publications of the American Academy of Sleep Medicine, which contained much of the same content, but did not feature personal instruction.

At four weeks, the researchers found that more patients responded to behavioral treatment than informational reading (67% vs. 25%; P<0.001), and insomnia resolved more often in with counseling (55% vs. 13%; P<0.001).

The behavioral treatment group also had significantly better outcomes in self-reported sleep and health, sleep diaries, and actigraphy (P<0.001), but not in polysomnography.

After six months, 84% of the 25 patients in the treatment group with available follow-up data either met criteria for remission or response and 64% no longer met criteria for insomnia.

Despite these positive findings, Thomas C. Neylan, MD, of the University of California and the Veterans Affairs Medical Center, both in San Francisco, noted that cognitive behavioral treatments like these are usually limited to specialized sleep centers and are rarely implemented in primary care settings.

“Several sleep specialists have suggested a stepped model of care in which initial treatment can be offered to relatively uncomplicated patients with insomnia much in the same way that depression is often first handled in the primary care setting,” Neylan wrote in an accompanying editorial. “Referrals to sleep specialists would be considered in more complicated patients or in those who were not responsive to initial treatment.”

Clinics that specialize in elder care may be able to spearhead implementation, Neylon suggested.

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