None listed
Conditions
Brief summary
Insomnia is a common and distressing sleep disorder. Untreated insomnia is responsible for increasing health care utilisation through negatively impacting on mood (depression & anxiety), family and workplace behaviour which in turn increases a socioeconomic burden on the community (Ohayon 2002; Siebern & Manber 2010; Hilman et al., 2008). Cognitive Behavioural Therapy (CBT-i) is the most efficacious treatment for insomnia by enabling the individual to change current ineffective behaviours and challenge faulty beliefs about sleep (Morin et al., 2006). Effective behavioural sleep interventions include sleep restriction therapy (Edinger & Means, 2005) stimulus control therapy (Bootzin, 1972) paradoxical intention (Morin 1993) and sleep hygiene (Hauri, 1991). These behavioural sleep interventions have successful treatment outcomes when run by the equivalent of Practice Nurses in Scotland and do not require trained psychologists (Espie et al., 2001; Espie et al., 2007). Although CBTi has proven effectiveness, access to both sleep centres and professionals who are able to provide such services is limited in most major cities and is often absent in rural communities in Australia. More recently a “stepped care” model to treat insomnia has been proposed (Espie 2009). This model proposes a generic pyramid where the majority of patient care is undertaken at baseline with an evidence-based but less intense treatment intervention whilst “greater expertise” in both assessment and treatment is used towards the top step of the pyramid. This model has considerably validity in the treatment of insomnia patients using group CBTi which has an efficacious record in a number of different age groups and settings. For many rural families the cost of going to capital cities for an ongoing treatment intervention is not feasible. There are also the ongoing issues of social isolation and increased depression rates particularly in young men in rural communities. Treating insomnia symptoms is an effective first step to address these issues. Training Practice Nurses to undertake a predominantly Behavioural Therapy (BT) intervention will enable the provision of a treatment which is both easily accessible and has been shown to improve sleep and mood in most individuals. The primary aim of this project is to assess the outcomes of a BT intervention for insomnia when delivered by Nurse practitioners in a medical setting in rural NSW.
Interventions
Insomnia patients living in or near the Tamworth area will be referred into the study by their GP. Alternatively, patients may see a poster/flyer in the GP waiting room and contact the study coordinator directly. A total of 24 eligible and willing patients will be randomly assigned to either the sleep intervention group (N=12) or the wait-list control group (N=12).
Participants assigned to the sleep intervention group will be invited to undertake a sleep intervention following the completion o
Insomnia patients living in or near the Tamworth area will be referred into the study by their GP. Alternatively, patients may see a poster/flyer in the GP waiting room and contact the study coordinator directly. A total of 24 eligible and willing patients will be randomly assigned to either the sleep intervention group (N=12) or the wait-list control group (N=12). Participants assigned to the sleep intervention group will be invited to undertake a sleep intervention following the completion of their baseline questionnaires, with no waiting period. The sleep intervention is led by a trained Practice Nurse and it is an evidence based behavioural therapy sleep intervention with cognitive components. It consists of 4 x 1.5 hour individual sessions with each session taking place once a fortnight over a period of 7 weeks. Sessions 1: will provide the patient with information about sleep. Session 2: will provide the patient with information about clinically proven effective behavioural treatments for insomnia. These include Stimulus Control Therapy, Sleep Restriction Therapy, Paradoxical Intention and Sleep Hygiene. A discussion about what interventions are most likely to work for a particular patient will be addressed in this session. Session 3: will be about increasing patient awareness about their behaviours and thought patterns. Barriers preventing patients from starting or maintaining changes will be discussed and motivation and confidence levels will be explored. Session 4: will consolidate the information presented during the course. Future individual sleep plans for patients will be explored and discussed.
Sponsors
Centre for Integrated Research and Understanding of Sleep - Seed Funding Grant
Study design
Allocation
Randomised controlled trial
Primary purpose
Educational / counselling / training
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Any patient (over 18 years) with chronic insomnia (i.e symptoms occurring at least 3 times per week which have been present for greater than one month) will be eligible unless meeting exclusion criteria listed
Exclusion criteria
All patients will have been assessed by the General Practitioners in their area and any individual with a Major Depressive Disorder and/or psychotic disorder/ significant alcohol/drug related disorders, other major sleep disorders, shift workers or has insufficient English to understand and respond to this intervention will be excluded.
Outcome results
None listed