Sleep health and insomnia treatment options
A look at three studies relating to sleep health, insomnia and cognitive behavioural therapy as a primary care intervention
This research digest looks at three studies relating to sleep health, insomnia and cognitive behavioural therapy as a primary care intervention
Sleep is essential for all aspects of health and well-being (Akay et al 2019), and the average adult requires eight hours of sleep (Hirshkowitz et al 2015).
Learning points
- Perceptions of the time it takes to get to sleep influence thoughts of insomia
- Understanding the type of insomnia can determine treatment options
- Cognitive behavioural therapy can assist in alleviating some types of insomnia
Exploration of potential objective and subjective daily indicators of sleep health in normal sleepers
Sleep needs to be considered as a multi-dimensional construct, with greater importance given to perceptions of sleep latency, a study aiming to identify the indicators of poorer sleep health among normal sleepers shows.
This study assessed 83 adults without a history of sleep disorder or physical or mental health issues, which are high risks for sleep disorder.
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Participants completed questionnaires and kept a two-week sleep diary. They were monitored for two nights in a sleep lab and for two weeks of gross motor activity using wearable technology.
Almost one third, or 28.2 %, of participants’ sleep health variance related to a perceived increase in the time it takes to transition from wakefulness to sleep, called sleep latency. The subjective perceptions of participants who were normal sleepers were found to be a significant indicator of poorer sleep health.
Insomnia disorder subtypes derived from life history and traits of affect and personality
The onset of different types of insomnia varies across the age span, and awareness of insomnia subtypes can assist in deciding on treatment options, this large-scale, six-year study found.
It aimed to identify insomnia subtypes from biologically based traits and life history. The first stage included a series of studies to survey traits, sleep, life events and health history using validated questionnaires to group variables and generate insomnia subtypes. In stage two a new cohort was recruited via a sleep registry and assessed over several years to test the generated insomnia subtypes for validity and clinical relevance.
The three traits of insomnia – poor sleep latency, difficulty maintaining sleep and early morning awakening – were similar across all subtypes, but onset was different across the lifespan.
Five distinct insomnia subtypes were identified. This is clinically relevant to determine high-risk groups, such as those with depression, and to enable person-centred, specific interventions and treatments, including meditation for those with pre-sleep arousal, cognitive behavioural therapy, or trauma-informed therapy for others. Pharmacology in sleep maintenance was only effective for some groups.
A systematic review of cognitive behavioural therapy for insomnia implemented in primary care and community settings
There is a growing evidence base for cognitive behavioural therapy (CBT) as a first-line treatment for insomnia (CBT-I), as research in primary care settings indicates.
A systematic literature search on 12 randomised control trials chosen from 840 articles analysed the post-treatment effect between intervention and control groups.
The outcome measures reported were sleep efficiency, sleep questionnaires and subjective sleep diaries. Face-to-face interactions as part of individual or group sessions of CBT-I were used in 11 of the studies.
There was variation in the level of practitioner training and the duration of intervention in sessions. Post-treatment assessment varied but demonstrated insomnia reduction, with participants reporting marked improvement getting to sleep and reduced early morning awakening, although the findings were not significant regarding total sleep time.
References
- Akay A, Martinsson P, Ralsmark H (2019) I can’t sleep! Relative concerns and sleep behaviour. Economics and Human Biology. 33, 1-14.
- Hirshkowitz M, Whiton K, Albert S et al (2015) National sleep foundation’s sleep time duration recommendations: methodology and results summary. Sleep Health 1. 1, 40-43.
Compiled by Pam Hodge, lecturer in practice learning, Middlesex University
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