Refresh. Restriction For Reorganising Sleep Habit: A randomised controlled trial of simplified sleep restriction for primary insomnia in the primary care setting

Rationale: Insomnia is a common health problem for patients in primary care. A literature review conducted by the author concluded that cognitive behavioural therapy for insomnia (CBT-I) is effective but its use has been limited by the time and expense required for delivery. Sleep restriction, or restricting the time in bed, is one component of CBT-I, which could be delivered as a brief intervention during primary care consultations. A systematic review of sleep restriction as a stand-alone treatment for insomnia showed some benefit, but concluded that more evidence was required. Objective: To assess the effectiveness of simplified sleep restriction to improve sleep in primary insomnia. Design, Setting, and Participants: A randomised controlled trial involving adult patients with persistent primary insomnia recruited from general practice clinics in Auckland, New Zealand between 2009 and 2012. Intervention: Intervention patients received 20 minutes of sleep hygiene advice and “simplified sleep restriction” instructions at an initial visit with a general practitioner and 14 minutes of advice and a “sleep self-adjustment algorithm” at two weeks. Control patients received sleep hygiene advice alone at both visits. Main outcomes: The primary outcomes were change in sleep quality at six months as measured by the Pittsburgh Sleep Quality Index (PSQI), the Insomnia Severity Index (ISI), and sleep efficiency. Proportion reaching a pre-defined “treatment response” was calculated using PSQI and sleep efficiency. Secondary outcomes included sleepiness, fatigue, sleep-onset latency, wakefulness after sleep onset, total sleep time, depression and anxiety. Potential adverse events (excessive sleepiness, accidents, hospitalisations, physiological parameters) were monitored. Results: Ninety-seven patients were recruited and 94 (97%) completed the study. Simplified sleep restriction led to significantly improved PSQI scores (6.2 vs 8.4, p < 0.001), ISI scores (8.6 vs 11.1, p = 0.001); sleep efficiency (difference between mean changes 2.2%, p = 0.006) and sleep onset latency (difference between mean changes -6.1 minutes, p = 0.04) as measured by actigraphy; and a reduction in fatigue (difference between mean changes -2.3 units, p = 0.04) compared with control. Simplified sleep restriction also produced higher rates of “treatment response” (67% [28/42] vs 41% [20/49]), with an adjusted odds ratio of 2.7 (95% CI, 1.1 to 6.5; p = 0.03). There were no significant differences in other outcomes or adverse effects. Conclusions and Relevance: Simplified sleep restriction is a practical, effective intervention for chronic insomnia in adults suitable for the primary care setting.

Name thesis:degree_name

PhD

Level thesis:degree_level

Doctoral

Grantor dc:publisher

ResearchSpace@Auckland

Year dc:date.issued

2014

Author dc:creator

• Falloon, Karen

Advisors dc:contributor.advisor

• Arroll, B
• Elley, C

Statement dc:rights

• Items in ResearchSpace are protected by copyright, with all rights reserved, unless otherwise indicated. Previously published items are made available in accordance with the copyright policy of the publisher.

Licence dc:rights.uri

• https://researchspace.auckland.ac.nz/docs/uoa-docs/rights.htm

Handle dc:identifier.uri

https://hdl.handle.net/2292/22116

OAI identifier oai:identifier

oai:researchspace.auckland.ac.nz:2292/22116