Nurse delivered Sleep Restriction Therapy for adults with Insomnia Disorder: process evaluation
Stephanie ArmstrongJulie PattinsonA Niroshan SiriwardenaSimon D. KylePeter BowerLy‐Mee YuYaling YangEmma OgburnNargis BegumLeonie MaurerBarbara RobinsonCaroline GardnerVictoria LeeDimitri GavriloffColin A. EspiePaul Aveyard
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Abstract:
Background Sleep restriction therapy (SRT) is a behavioural therapy for insomnia. Aim To conduct a process evaluation of a randomised controlled trial comparing SRT delivered by primary care nurses plus a sleep hygiene booklet with the sleep hygiene booklet only for adults with insomnia disorder. Design and setting A mixed-methods process evaluation in a general practice setting. Method Semi-structured interviews were conducted in a purposive sample of patients receiving SRT, the practice nurses who delivered the therapy, and also GPs or practice managers at the participating practices. Qualitative data were explored using framework analysis, and integrated with nurse comments and quantitative data, including baseline Insomnia Severity Index score and serial sleep efficiency outcomes to investigate the relationships between these. Results In total, 16 patients, 13 nurses, six practice managers, and one GP were interviewed. Patients had no previous experience of behavioural therapy, needed flexible appointment times, and preferred face-to-face consultations; nurses felt prepared to deliver SRT, accommodating patient concerns, tailoring therapy, and negotiating sleep timings despite treatment complexity and delays between training and intervention delivery. How the intervention produced change was explored, including patient and nurse interactions and patient responses to SRT. Difficulties maintaining SRT, negative attitudes towards treatment, and low self-efficacy were highlighted. Contextual factors, including freeing GP time, time constraints, and conflicting priorities for nurses, with suggestions for alternative delivery options, were raised. Participants who found SRT a positive process showed improvements in sleep efficiency, whereas those who struggled did not. Conclusion SRT was successfully delivered by practice nurses and was generally well received by patients, despite some difficulties delivering and applying the intervention in practice.Keywords:
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Previous studies examining the associations between sleep hygiene practices and insomnia have produced inconsistent results. This study further investigates this issue by examining different domains of sleep hygiene separately. One hundred and six insomnia patients and 89 good sleepers participated in the study. Their sleep hygiene, sleep quality and insomnia severity were assessed with subjective rating scales. Among good sleepers, almost all domains of sleep hygiene correlated significantly with their sleep ratings. However, in insomnia patients, only the arousal-related behavior correlated with sleep ratings. The findings suggest that strategies in prevention and treatment of sleep disturbance may be different accordingly.
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Insomnia is more common in older people. There are multiple causes of insomnia including medical and psychiatric illness, medications, specific sleep disorders, environmental and behavioural factors and age-related changes in sleep quality and sleep patterns.This article reviews the causes of insomnia, assessment issues and management approaches, to provide the reader with a practical approach to the problem. A comprehensive assessment often reveals reversible factors. Non pharmacological approaches include sleep hygiene measures, increasing sunlight exposure and acupuncture. Only after use of these approaches should short term hypnosedative treatment be commenced.With appropriate management, most older people with insomnia will experience improved sleep.
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Objectives
To estimate self-reported sleep health of shift workers and construct plans to minimise harm of the shiftwork.Methods
A cross-sectional survey was conducted by using structured questionnaires on workers who were employed in a steel company. They divided into 3 groups (daytime workers, 4 teams 3 shifts, and other shifts). The survey contains questionnaires about demographic characteristics, sleep hygiene, condition of their work place, Insomnia Severity Index (ISI) and the Epworth Sleepiness Scale (ESS) to evaluate workers' sleep disorder and daytime sleepiness. Among shift-workers, 'insomnia group' is compared to 'normal sleep group' with chi-square test. The multiple logistic regression analysis was performed to explore risk factors of 'severe insomnia'.Results
Workers with severe insomnia were 6.7% in other shifts group, and 2.3% in 4 teams 3 shifts group. There was no severe insomnia in daytime workers. Among 4 teams 3 shifts group, 12.9% workers complained severe daytime sleepiness. With the practice of sleep hygiene, generally the items for improving environment to sleep well showed higher rate in 'severe insomnia group' than 'normal sleep group'. It might be that the workers who suffered from insomnia tried to overcome it. The items which disrupt sleep were concordantly higher in 'insomnia group' than in 'normal sleep group', suggesting that such kind of adverse sleep habits are negatively affect sleep of shift workers.Conclusion
The results of present study suggest relationship between sleep hygiene and sleep disorders among shift workers. To minimise shift worker's sleep problem, proper sleep hygiene is necessary.Sleep
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Abstract Sleep hygiene education is a basic component of behavioral treatment for chronic insomnia, yet the actual sleep hygiene practices of people with insomnia have not been well documented. In this descriptive secondary analysis, midlife women ages 41–55 years with either chronic insomnia ( n = 92) or good sleep ( n = 29) kept diaries of sleep perceptions and sleep hygiene practices during 6 nights of somnographic monitoring at home. In both groups few reported smoking cigarettes (<10%), most drank caffeine (>80%), and many averaged 30 min of exercise per day (∼50%). Very few in either group (<10%) had regular (<30 min variation) bedtimes or getting‐up times. Compared to women with good sleep, those with insomnia reported drinking less caffeine per day, being more abstinent from alcohol, and having smaller variations in day‐to‐day alcohol intake and bedtimes. Although some women with insomnia limit or refrain from caffeine and alcohol intake, many have not optimized behaviors believed to help prevent or modulate insomnia. © 2004 Wiley Periodicals, Inc. Res Nurs Health 27:225–236, 2004
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Background: Insomnia is one of the most common problems in the old adults. Sleep disorder increases with age and it is caused by, among many, physiological, psycho-sociological, and pharmacological factors. This study was performed to compare sleep hygiene, sleepiness, and insomnia in elderly men and women.
Methods: A cross-sectional study was carried out with statistical population of all men and women older than 60 years. Totally, 598 subjects were selected using randomly clustered sampling method. Sleep Hygiene Index (SHI), Epworth Sleepiness Scale (ESS) and Insomnia Severity Index (ISI) were used to collect data. The data were analyzed using Chi-square and Mann-Whitney tests.
Results: The mean scores of sleep health, sleepiness, and severity of insomnia in male participants were 29.01, 7.79, and 8.43, respectively. These figures in the female participants were 28.48, 7.39, and 9.86, respectively. The results showed that there was a significant difference between the elderly men and women regarding the severity of insomnia while there was no significant difference in terms of the rate of sleepiness and sleep hygiene score (P greater than 0.05).
Conclusion: The results showed that insomnia was significantly more common in elderly women than elderly males. Sleep hygiene and sleepiness in elderly men and women were not significantly different.
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본 연구는 불면증을 호소하는 과민대장증후군 대학생의 불면증 증상 현황과 수면 전 각성, 수면위생 수행도를 파악하는데 목적이 있다. 이를 위해 2017년 9월부터 11월까지 D시와 U시 소재 4개 대학교 대학생 중 불면증을 호소하는 과민대장증후군 대상자 138명의 자료를 분석하였다. 자료분석은 SPSS Statistics 21.0 프로그램을 사용하여 불면증 증상과 수면 전 각성, 수면위생 수행도 척도에 대한 기술통계, 불면증 증상별 수면 전 각성, 수면위생 수행도 척도의 문항에 대한 피어슨 상관분석을 하였다. 연구결과는 다음과 같다. 첫째, 과민대장증후군이 공존하는 불면증 대학생의 불면증 증상은 입면 지연, 수면분절, 조기 기상 순으로 나타났다. 둘째, 입면 지연은 수면 전 과도한 인지적 각성과 가장 높은 상관성이 있었다. 셋째, 수면 분절은 수면 전 과도한 인지적 각성뿐만 아니라 신체적 각성과도 높은 상관성이 있었다. 본 연구 결과를 바탕으로 불면증을 호소하는 과민대장증후군 대학생을 대상으로 구체적인 불면증 중재 방안을 논하였다.
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Objective To investigate the prevalence rate of insomnia and its influence factor in adults from Bozhou region, and determine the correlation of sleep hygiene with insomnia in adult population. Methods Eight hundred and three subjects were recruited in the study by multi-stage stratified random sampling from people aged 18 years or more than 18 years. Athens Insomnia Scale （AIS） and sleep hygiene practices scale were used to evaluate the insomnia and its related factors. Results One hundred and ninety-two adults （23.9%） were identified as insomnia with dissatisfaction of sleep quality, shortage of sleep time （〈56.5 h/night） and earlier wake-up than expectation as its main manifestations; and the prevalence rate of insomnia in females （98/354, 27.7 %） was significantly higher as compared with that in males （94/449, 20.9%, P〈0.05）; prepared military personnel enjoyed the highest insomnia rate （37/99, 37.3%）, followed byfreelance/temporaries （55/181, 30.4%） with significant difference between these 2 groups （P〈0.05）. The correlation analysis between the total scores of AIS and problems of sleep hygiene indicated that such factors as prescription of sleep medication, hunger at bed, drinking in purpose of helping sleeping, and worry about insomnia beofore sleep or at daytime were positively related to the total scores of AIS （P〈0.05）; nap or snooze was negatively related to the total scores of AIS （P〈0.05）. Conclusion There is a high proportion of insomnia in prepared military personnel and freelance/temporaries from Bozhou region; poor sleep hygiene habits as prescription of sleep medication, hunger at bed, drinking in purpose of helping sleeping, and worry about insomnia beofore sleep or at daytime can induce insomnia.
Key words:
Insomnia; Adult population; Cross-sectional study
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