MINNEAPOLIS—A four-session sleep intervention program appears to improve subjective and objective measures of sleep among elderly veterans, according to research presented at the 28th Annual Meeting of the Associated Professional Sleep Societies. The intervention may reduce insomnia severity and improve sleep quality, but these outcomes may not be maintained at four months.
Researchers effectively delivered the intervention within an adult day health care program at a Veterans Affairs Medical Center. The study population was particularly focused on living independently and, unlike other patients with insomnia, might have underreported the severity of its symptoms, said Jennifer Martin, PhD, Assistant Professor of Geriatric Medicine at the David Geffen School of Medicine in Los Angeles. Some of the intervention’s less pronounced effects on self-reported sleep quality may result from these patient characteristics, she added.
Behavioral Intervention Versus Sleep Education
Dr. Martin and her colleagues enrolled 72 participants in a VA adult day health care program in a study of the four-week sleep intervention, and 42 people were randomized. The researchers randomized 21 participants to the sleep intervention program, and 21 to a nondirected sleep education control. The main outcome measures for self-reported sleep were the Pittsburgh Sleep Quality Index (PSQI) and the Insomnia Severity Index (ISI) total score. In addition, participants wore an actigraph for three 24-hour periods before and after treatment and at four months. Follow-up data were obtained for all participants at the end of the trial and for 81% of treatment subjects and 71% of control subjects at four months.
The first session of the sleep intervention program was devoted to sleep education, including basic principles of stimulus control, and sleep compression. During the second session, the health educator adjusted participants’ time in bed and encouraged them to structure or eliminate their naps. The educator adjusted participants’ time in bed again during the third session, introduced a bedtime routine, encouraged participants to increase their physical activity and outdoor light exposure, and gave tailored sleep hygiene recommendations. The fourth session included a review of which measures had improved participants’ sleep and provided information about coping with future sleep disturbances in the future, specifically those resulting from major health events.
The informational control program provided participants with general information about sleep, aging, lifespan development, and sleep hygiene. The most important difference between the study groups is that participants in the control group received no individualized recommendations, said Dr. Martin.
Sleep Improvements May Not Persist
The study population’s average age was 77, and most participants were male. Approximately 71% of participants were non-Hispanic Caucasians, and 79% had more than a high school education. The population’s average score on the Mini-Mental State Examination was approximately 26. The average score on the Patient Health Questionnaire 9 was six, which indicated significant symptoms of depression. The researchers observed no differences between the study groups at baseline.
The ISI total score was lower for participants who received the sleep intervention program than for controls after treatment, but not at four months. Scores for the daytime disturbances subscale of the PSQI were lower for participants who received the intervention program, compared with controls, at four months, but not at post-treatment.
“The findings for actigraphy were more robust than the findings for self-report measures,” said Dr. Martin. Total sleep time post-treatment was significantly greater among participants who received the intervention than among controls. The difference between the two groups was not significant at four months, however. The number of minutes awake during the night was significantly smaller post-treatment among participants who received the intervention than among controls. This difference was insignificant at four months.
—Erik Greb