CBT-I works when delivered to older adults over the phone

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Sleep Treatments | Sleep Review

Insomnia can be made worse by osteoarthritis, the most common form of arthritis that causes joint pain. While there are effective therapies for treating insomnia in older adults, many people cannot get the treatment they need because they live in areas with limited access to health care, either in person or through the internet.

With phones being nearly universal in the elderly, researchers from the University of Washington and the Kaiser Permanente Washington Health Research Institute wanted to see if therapy could be used over a phone connection to dramatically improve access to insomnia treatment.

In a study of patients on the Kaiser Permanente Washington system – the Osteoarthritis and Therapy for Sleep (OATS) study published February 22nd in JAMA Internal Medicine – researchers found that effective treatment for insomnia was achieved with a few short phone calls can. Telephone therapy, which consisted of guided and insomnia management training, also helped reduce fatigue and pain associated with osteoarthritis.

“It’s very exciting,” says Susan M. McCurry, PhD, lead author and research professor at the UW School of Nursing, in a press release, “because when people have insomnia, it’s miserable.” Our study showed that this treatment can be done over the phone and that it lasts for up to a year. “

According to McCurry, who is also an affiliate investigator with Kaiser Permanente, the study results also mean that people who live in rural or other areas with limited access to the internet and health care, especially sleep clinics, could potentially be reached and supported.

“If people can be relieved of their sleep problems,” she says, “they will function better during the day. You will feel better emotionally, be less irritable, and think more clearly. “

The study tracked 327 people over the age of 60 with moderate to severe insomnia from 2016 to 2018. Patients were interviewed six times for 20 to 30 minutes over a period of eight weeks. About half of the patients received materials and instructions on cognitive behavioral therapy for insomnia (CBT-I).

The remaining patients belonged to a control group who received unexplained phone calls that did not contain the CBT-I. The control group was important, says McCurry, in making sure the positive effects of the phone calls weren’t due to “the fact that you have someone who calls you smart and pleasant every week.”

The main role of the therapy sessions was to guide the patients through routines, information and self-monitoring in order to maintain their homeostatic sleep drive, which is the internal sleep drive which is broken down at night and builds up during the day and is circadian rhythms that are complex and innate cycles of biochemical, physiological, and behavioral processes that work together to keep the patient asleep at night and awake during the day.

Telephone therapy also helped patients reduce anxiety about insomnia.

“People can expect to have a bad night when they go to bed. The bed becomes a scary place for them, ”says McCurry. “We help them develop cognitive tools that they can use to do something other than worry about what tomorrow will be like if they don’t sleep well.”

[RELATED: Digital Cognitive Behavioral Therapy for Insomnia Comparison Guide]

While previous phone-based studies using similar techniques improved sleep, these studies were limited by their small number of participants and only included patients from specialized insomnia clinics. The OATS study was a large study of a nationwide population of older adults with chronic osteoarthritis who were randomly assigned to either treatment or a control group.

“Although osteoarthritis-related insomnia is a very common condition in older adults, finding people with the condition and including them in a clinical trial can be challenging. Our ability to work with Kaiser Permanente Washington’s extensive electronic health records has enabled the identification and recruitment of more than 300 patients over 60 years of age with moderate to severe osteoarthritis pain and insomnia across Washington state, “said Kai Yeung, PharmD, PhD, co-author and research fellow at Kaiser Permanente Washington Health Research Institute in a press release.

The study’s authors concluded that the telephone treatment benefits for insomnia were “large, robust,” and lasted for a year, even in patients with more severe insomnia and pain symptoms. The study also found a reduction in these pain symptoms, although the pain reduction did not last a full year.

While the study results may offer hope to those suffering from insomnia and osteoporosis-related pain, the study authors say that patients may not yet have access to a phone-based treatment system. However, you can still speak to your doctor to see what treatment options are currently available to you.

“The bottom line is that no one should sleep badly,” said Michael V. Vitiello, PhD, co-author and professor of psychiatry and behavioral science at the University of Washington School of Medicine, in a press release. “We have ways of solving sleep problems. Older adults don’t have to suffer. We can do better. “

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