BALTIMORE – A single session of cognitive-behavioral therapy for insomnia, given in a large group format, may effectively improve sleep conditions for many healthy adults, California researchers have found.
Nearly 90% of 363 insomnia patients who attended the session reported improvements in their sleep patterns, of whom nearly a third said their insomnia had resolved, said Dr. Dennis Hwang, director of the Sleep Disorders Center at Kaiser Permanente Fontana (Calif.) Medical Center. He reported results of a retrospective analysis from his center at the annual meeting of the Associated Professional Sleep Societies.
To offer cognitive-behavioral therapy (CBT) efficiently, Dr. Hwang and his colleagues created a 2.5-hour CBT session, taught by a physician assistant (PA) to groups of 20 patients at a time. The first 2 hours of the class discuss proper sleep hygiene, sleep beliefs, relaxation techniques, and sleep restriction, and offer patients a chance to create an individual plan of action and sleep diary. The next 15 minutes of the class, taught by a PA or pharmacist, goes over basic insomnia medication education, including how to wean off insomnia medications, and the last 15-minute section of the class, taught by a PA or physical therapist, demonstrates optimal sleep positions.
"We teach patients how to sleep better by positioning pillows in certain areas and really try to get them into a neutral spine position," Dr. Hwang said. Many patients report that doing that alone helps their insomnia, he said.
Individual telephone follow-up calls are scheduled between the PA and the participants as needed, until there is an improvement in sleep patterns or the patient declines further participation.
Dr. Hwang’s group reviewed responses from patients participating between December 2010 and December 2011. There were 230 women and 133 men with an average age of 56 years. Among them, 117 had obstructive sleep apnea, 20 had restless legs syndrome, and 20 were night-shift workers; 134 took medications for insomnia and 102 took medications for depression or anxiety.
After completing the program, 321 (88%) patients said they had at least some improvement in their insomnia, and 110 (30%) said their insomnia had resolved. Twenty-five patients said they had no improvement.
Statistically significant improvements were seen in the following sleep parameters before and after the program: sleep latency (57 vs. 26 minutes); awakenings (3 vs. 1.4); and total sleep time (5 hours vs. 6.5 hours). The patients taking sleep medications decreased their use from 6.1 to 3.9 nights/week). And there was a decrease in primary care office visits in the year following the program, compared with the year before the program, from 4.3 to 3.5, an adjusted average of 1 full visit.
Most patients completed the program within 2.5 months, needing only one follow-up telephone call, Dr. Hwang said, indicating that "the class itself is effective even without follow-up." He cautioned that he could not find a good control group to match to those in the CBT program and that the office had a 30%-40% no-show rate for sessions.
An online program and weekly/biweekly interactive voice response questionnaire have been added to the therapy program since the study was completed, he said, allowing providers to single out those in need of additional follow-up.
The study was funded by his Kaiser Permanente.