Self-guided sleep intervention reduced sedative use, improved quality rest
A mailed direct-to-patient intervention reduced use of long-term benzodiazepines and increased use of cognitive behavioral therapy by older adults being treated for insomnia, a Canadian trial found.
Transitioning older adults with insomnia away from long-term sedative use and toward cognitive behavioral therapy (CBT) can be achieved with a direct-to-patient approach, a study found.
To learn whether direct-to-patient mailed interventions reduce sedative use and improve sleep outcomes, researchers conducted a three-arm, randomized clinical trial of 565 adults ages 65 years and older who were using benzodiazepines for insomnia. The Your Answers When Needing Sleep in New Brunswick (YAWNS NB) study began in November 2020 and ended in June 2022. Participants were randomized to one of two mailed interventions or to no intervention. Results were published Sept. 18 in JAMA Psychiatry.
The Sleepwell package, a knowledge mobilization and behavior change intervention (YAWNS-1), consisted of a cover letter and two booklets, while the other package (YAWNS-2) included updated versions of the booklets. The primary outcome measure was benzodiazepine use at six months, while secondary measures included CBT use, sleep, insomnia, daytime sleepiness, safety, anxiety, frailty, and quality of life.
Mean patient age was 72.1 years, mean duration of benzodiazepine use was 11.4 years, and 64.1% of patients were female. Benzodiazepine discontinuations and dose reductions of 25% or greater were highest with YAWNS-1 (46.6%) compared with YAWNS-2 (34.8%; P=0.02) and no intervention (20.3%; P<0.001). Those assigned to YAWNS-1 also had better uptake of CBT techniques and sleep outcomes versus those assigned to YAWNS-2, as well as less severe insomnia and daytime sleepiness compared with no intervention (insomnia severity index change, −2.0 vs. 0.3 [P<0.001]; Epworth Sleepiness Scale change, −0.8 vs. 0.3 [P=0.001]). The number needed to mail to have one person discontinue long-term sedative use was 5.3 with YAWNS-1 and 7.8 with YAWNS-2.
The study authors observed that as a simple, scalable, direct-to-patient intervention, YAWNS-1 substantially reduced benzodiazepine use and improved sleep outcomes and could be used to transform insomnia care for older adults at the population level. “Stopping [benzodiazepines] was not associated with a decline in sleep or other health measures, and withdrawal experiences were mostly absent or mild,” the authors wrote, adding that direct-to-patient interventions represent an effective, sustainable, and equitable approach to insomnia.