Advise non-pharmacological therapy as first line treatment for chronic insomnia

Soong, Christine; Burry, Lisa; Greco, Maria Cecília; Tannenbaum, Cara

doi:10.1136/bmj.n680

Cited by 20 publications

(15 citation statements)

References 35 publications

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“…For all these reasons, the American Geriatrics Society has included BZRA on the potentially inappropriate medications list [14] and the Screening Tool of Older Persons' Prescriptions (STOPP) list version 2 recommends limiting their use to 4 weeks [15]. Moreover, several organisations such as the Canadian deprescribing network or Choosing Wisely recommend that deprescribing be offered to older adults who take BZRA [16,17]. Deprescribing is the process of "withdrawal of an inappropriate medication, supervised by a healthcare professional with the goal of managing polypharmacy and improving outcomes" [18].…”

Section: Introductionmentioning

confidence: 99%

Barriers and enablers for deprescribing benzodiazepine receptor agonists in older adults: a systematic review of qualitative and quantitative studies using the theoretical domains framework

Evrard

Pétein

Beuscart³

et al. 2022

Implementation Sci

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Background Many strategies aimed at deprescribing benzodiazepine receptor agonists (BZRA) in older adults have already been evaluated with various success rates. There is so far no consensus on which strategy components increase deprescribing the most. Yet, despite an unfavourable benefit-to-risk ratio, BZRA use among older adults remains high. We systematically reviewed barriers and enablers for BZRA deprescribing in older adults. Methods Two reviewers independently screened records identified from five electronic databases—Medline, Embase, PsycINFO, CINAHL and the Cochrane library—and published before October 2020. They searched for grey literature using Google Scholar. Qualitative and quantitative records reporting data on the attitudes of older adults, caregivers and healthcare providers towards BZRA deprescribing were included. Populations at the end of life or with specific psychiatric illness, except for dementia, were excluded. The two reviewers independently assessed the quality of the included studies using the mixed-methods appraisal tool. Barriers and enablers were identified and then coded into domains of the theoretical domains framework (TDF) using a combination of deductive and inductive qualitative analysis. The most relevant TDF domains for BZRA deprescribing were then identified. Results Twenty-three studies were included 13 quantitative, 8 qualitative and 2 mixed-method studies. The points of view of older adults, general practitioners and nurses were reported in 19, 9 and 3 records, respectively. We identified barriers and enablers in the majority of TDF domains and in two additional themes: “patient characteristics” and “BZRA prescribing patterns”. Overall, the most relevant TDF domains were “beliefs about capabilities”, “beliefs about consequences”, “environmental context and resources”, “intention”, “goals”, “social influences”, “memory, attention and decision processes”. Perceived barriers and enablers within domains differed across settings and across stakeholders. Conclusion The relevant TDF domains we identified can now be linked to behavioural change techniques to help in the design of future strategies and health policies. Future studies should also assess barriers and enablers perceived by under-evaluated stakeholders (such as pharmacists, psychiatrists and health care professionals in the hospital setting). Trial registration This work was registered on PROSPERO under the title “Barriers and enablers to benzodiazepine receptor agonists deprescribing”. Registration number: CRD42020213035

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Section: Introductionmentioning

confidence: 99%

Barriers and enablers for deprescribing benzodiazepine receptor agonists in older adults: a systematic review of qualitative and quantitative studies using the theoretical domains framework

Evrard

Pétein

Beuscart³

et al. 2022

Implementation Sci

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“…Individuals resort to medication since insomnia creates stress and anxiety in individuals. However, in this process, it will be a more effective method to determine the cause of insomnia, take precautions, eliminate the cause, make necessary arrangements for sleep, plan the nursing care accordingly, and use medication as a last resort[ 2 , 18 , 19 ]. The ability of a nurse to solve this problem is associated with his/her ability to evaluate sleep and the appropriateness of the measurement tools used.…”

Section: Introductionmentioning

confidence: 99%

Hospital-acquired insomnia scale: A validity and reliability study

Çiftçi¹,

Yıldız²,

Yildiz³

2023

World J Psychiatry

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BACKGROUND Sleep breathing, one of the basic human needs, is a physiological need that affects cardiac functions, body temperature, daily vitality, muscle tone, hormone secretion, blood pressure, and many more. In the international literature, studies reported that patients have had sleep problems in the hospital since the 1990s, but no measurement tool has been developed to determine the causes of hospital-acquired insomnia in individuals. These findings suggest that sleep remains in the background compared to activities such as nutrition and breathing. Although patients generally experience hospital-acquired sleep problems, there is no measurement tool to determine hospital-acquired sleep problems. These features show the originality of the research. AIM To develop a measurement tool to determine the sleep problems experienced by patients in the hospital. METHODS A personal information form, hospital-acquired insomnia scale (HAIS), and insomnia severity index (ISI) were used to collect research data. The study population consisted of patients hospitalized in the internal and surgical clinics of a research hospital in Turkey between December 2021 and March 2022. The sample consisted of 64 patients in the pilot application stage and 223 patients in the main application stage. Exploratory factor analysis and confirmatory factor analysis (CFA) analyses were performed using the SPSS 20 package program and the analysis of moment structure (AMOS) package program. Equivalent forms method used. RESULTS The HAIS consisted of 18 items and 5 subscales. The Cronbach alpha values of the subscales ranged between 0.672 and 0.842 and the Cronbach alpha value of the overall scale was 0.783. The scale explained 58.269% of the total variance. The items that constitute the factors were examined in terms of content integrity and named as physical environmental, psychological, safety, socioeconomic, and nutritional factors. CFA analysis of the 5-factor structure was performed in the AMOS package program. The fit indices of the obtained structure were examined. It was determined that the values obtained from the fit indices were sufficient. A significant correlation was determined between the HAIS and the ISI, which was used for the equivalent form method. CONCLUSION The HAIS is a valid and reliable measurement tool for determining patients’ level of hospital-acquired insomnia. It is recommended to use this measurement tool to determine the insomnia problems of patients and to adapt it in other countries.

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“…[18][19][20] CBT-I has been demonstrated to be effective in improving insomnia when delivered by trained therapists and/or self-help automated programs or delivered in individual, group, telephone, or computerized formats. 2,[21][22][23] As the standard management for insomnia in the general population, 24,25 CBT-I also appears to have better effects on insomnia in cancer patients. [26][27][28][29] There is a report 30 that evaluated the efficacy of CBT-I on insomnia in cancer patients in 2016, but the size of the trials (eight trials) is rather limited.…”

Section: Introductionmentioning

confidence: 99%

Cognitive behavior therapy for insomnia in cancer patients: a systematic review and network meta‐analysis

Gao

Liu

Yao

et al. 2022

J Evidence Based Medicine

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Objective The aim of this study was to examine the most effective delivery format of cognitive behavioral therapy for insomnia (CBT‐I) on insomnia in cancer patients. Methods We searched five databases up to February 2021 for randomized clinical trials that compared CBT‐I with inactive or active controls for insomnia in cancer patients. Outcomes were insomnia severity, sleep efficiency, sleep onset latency (SOL), wake after sleep onset (WASO), and total sleep time (TST). Pairwise meta‐analyses and frequentist network meta‐analyses with the random‐effects model were applied for data analyses. Results Sixteen unique trials including 1523 participants met inclusion criteria. Compared with inactive control, CBT‐I could significantly reduce insomnia severity (mean differences [MD] = −4.98 points, 95% confidence interval [CI]: −5.82 to −4.14), SOL (MD = −12.29 min, 95%CI: −16.48 to −8.09), and WASO (MD = −16.58 min, 95%CI: −22.00 to −11.15), while increasing sleep efficiency (MD = 7.62%, 95%CI: 5.82% to 9.41%) at postintervention. Compared with active control, CBT‐I could significantly reduce insomnia severity (MD = −2.75 points, 95%CI: −4.28 to −1.21), SOL (MD = −13.56 min, 95%CI: −18.93 to −8.18), and WASO (MD = −6.99 min, 95%CI: −11.65 to −2.32) at postintervention. These effects diminished in short‐term follow‐up and almost disappeared in long‐term follow‐up. Most of the results were rated as “moderate” to “low” certainty of evidence. Network meta‐analysis showed that group CBT‐I had an increase in sleep efficiency of 10.61%, an increase in TST of 21.98 min, a reduction in SOL of 14.65 min, and a reduction in WASO of 24.30 min, compared with inactive control at postintervention, with effects sustained at short‐term follow‐up. Conclusions CBT‐I is effective for the management of insomnia in cancer patients postintervention, with diminished effects in short‐term follow‐up. Group CBT‐I is the preferred choice based on postintervention and short‐term effects. The low quality of evidence and limited sample size demonstrate the need for robust evidence from high‐quality, large‐scale trials providing long‐term follow‐up data.

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Advise non-pharmacological therapy as first line treatment for chronic insomnia

Cited by 20 publications

References 35 publications

Barriers and enablers for deprescribing benzodiazepine receptor agonists in older adults: a systematic review of qualitative and quantitative studies using the theoretical domains framework

Barriers and enablers for deprescribing benzodiazepine receptor agonists in older adults: a systematic review of qualitative and quantitative studies using the theoretical domains framework

Hospital-acquired insomnia scale: A validity and reliability study

Cognitive behavior therapy for insomnia in cancer patients: a systematic review and network meta‐analysis

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