Get out of bed to beat insomnia

Daniel Buysse, at the University of Pittsburgh School of Medicine, led a research team that found that a few short visits and phone calls with a nurse as part of a brief behavioural treatment helped overcome chronic insomnia among older adults.

Insomnia affects one in every five US citizens, rising to one in three among the elderly, and has been linked to a range of physical problems from accidents to hypertension. Not surprisingly, it is also detrimental to mental health.

“When you are sleeping poorly, the most important thing you can do is spend less time in bed,” Buysse said.

Three decades of research has shown that cognitive behavioural therapy is just as effective as a pill for insomnia, with fewer side effects. Yet the time and resource-intense strategy, usually involving between six and eight hour-long appointments with a clinical psychologist, is not widely available.

To see if the pill-free therapy could be shortened and simplified, Buysse and his colleagues studied 79 adults with chronic insomnia who averaged 72 years of age.

The participants were randomly assigned to receive either printed educational material about sleep or the brief behavioural treatment of one 45- to 60-minute in-person session, a 30-minute follow-up session and two 20-minute phone calls.

A mental health nurse practitioner focused the behavioural instruction on how to restrict time in bed and set regular sleep-wake schedules, while also discussing the biological reasons behind the strategy such as the body’s daily cycle of mental, physical and behavioural changes.

“This (therapy) has the effect of compressing your sleep into a more solid block,” Buysse said.

“More consolidated sleep is more refreshing.”

Based on questionnaires and sleep diaries, the team found that two out of every three participants receiving the behavioural intervention responded favourably by the end of four weeks, while just one out of every four receiving the printed material experienced substantial sleep improvement.

On average, for every 2.4 participants treated, one responded favourably and one overcame insomnia—improvements that were sustained for at least six months, and were backed up by data from a sleep monitor worn on the wrist or the ankle.

But when the researchers looked at information from a different, more in-depth sleep monitoring system, they failed to find significantly better outcomes with the behavioural therapy.

“A lot of insomniacs spend a lot of time lying in bed worrying about their sleep, among other things. They expect to have insomnia,” said Thomas Neylan of the University of California, San Francisco.

Though Neylan said that sometimes the best thing to do is prescribe sleeping medicine, this can cause problems from dependence to grogginess during the day.

“If you are not ready to fall asleep, don’t lie down in bed and try to force yourself to sleep. And if you wake up in the middle of the night and don’t fall back asleep easily, get out of bed,” Neylan said.

“You don’t want to have any linkage between the experience of lying in bed and being awake.”