Nurse-delivered sleep restriction therapy may be effective for insomnia
Brief, nurse-delivered sleep restriction therapy in primary care reduced insomnia symptoms and appeared cost-effective, an English trial found.
Participants who received nurse-delivered sleep restriction therapy, defined as “systematically restricting and regularizing time in bed to consolidate and stabilize sleep,” reported less severe insomnia than those given a booklet on sleep hygiene, a study found.
To assess the clinical and cost-effectiveness of sleep restriction therapy, researchers conducted a pragmatic, superiority, open-label, randomized controlled trial of sleep restriction therapy versus sleep hygiene. Adults with insomnia disorder were recruited from 35 general practices across England and randomly assigned 1:1 to either four sessions of nurse-delivered sleep restriction therapy plus a sleep hygiene booklet or to a sleep hygiene booklet only. Sleep restriction sessions were conducted once a week for four weeks, with two in-person sessions and two over the phone. Usual care was not restricted for either group.
The primary endpoint was self-reported insomnia severity at six months as measured with the insomnia severity index (ISI). Secondary outcomes were health-related quality of life, sleep-related quality of life, depressive symptoms, work productivity, sleep effort, and presleep arousal. The primary analysis included participants who contributed at least one outcome measurement. Cost-effectiveness was expressed in terms of incremental cost per quality-adjusted life-year (QALY) gained. Results were published Aug. 10 by The Lancet.
From August 2018 to March 2020, 321 patients were randomly assigned to the sleep restriction therapy and 321 were assigned to sleep hygiene. Mean age was 55.4 years (range, 19 to 88 years), and 489 (76.2%) were women. At six months, mean ISI score was significantly lower in the sleep restriction therapy group, at 10.9 (SD, 5.5) versus 13.9 (SD, 5.2) for sleep hygiene (adjusted mean difference, –3.05 [95% CI, –3.83 to –2.28]; P<0.0001). The incremental cost per QALY gained was £2,076, giving a 95.3% probability that treatment was cost-effective at a cost-effectiveness threshold of £20,000. Eight participants in each group had serious adverse events, none of which were related to the intervention.
The researchers noted that while multicomponent cognitive-behavioral therapy is the recommended first-line treatment for insomnia, access to it is very limited, and sleep restriction therapy could be delivered as a brief single-component intervention by generalists in primary care.
“The trial shows that nurses without previous clinical experience of sleep disorders or sleep intervention can be successfully trained to deliver sleep restriction therapy in a brief and manualised manner, and with high levels of fidelity,” the authors wrote. “Results indicate superiority of nurse-delivered sleep restriction therapy over sleep hygiene in reducing insomnia symptoms at all timepoints.” In addition, sleep restriction therapy was associated with improvements in depressive symptoms, mental health-related quality of life, sleep-related quality of life, and work productivity, they noted.