Effective treatment for insomnia can be delivered in a few short phone calls, according to clinical trial findings published Feb. 22, 2021, in JAMA Internal Medicine.
The study, conducted by researchers at the University of Washington and Kaiser Permanente Washington Health Research Institute (KPWHRI) found that a therapy using only a phone connection dramatically improved access to insomnia treatment for older adults with insomnia and osteoarthritis. The benefits for insomnia were “large” and “robust,” even for patients with more severe insomnia and pain symptoms, the paper states.
“It’s very exciting,” said Susan M. McCurry, PhD, lead author and research professor in the UW School of Nursing, “because when people have insomnia, it’s miserable. Our study has shown that this treatment can be delivered over the phone, and its effects are sustainable for up to a year.”
The study also found a reduction in fatigue and in pain symptoms associated with osteoarthritis, though the pain reductions did not last a full year.
“When people can get relief from their sleep problems,” said McCurry, who is also a KPWHRI-affiliated investigator, “they’re going to function better during the day. They’re going to emotionally feel better, be less irritable, and think more clearly.”
Insomnia — trouble falling asleep, staying asleep, or waking up too early — is a common condition in older adults. Such sleeplessness can be exacerbated by joint pain from osteoarthritis, the most common form of arthritis. Although there are effective therapies for treating insomnia in older adults, many people cannot get the treatment because they live in areas with limited access to the internet and in-person health care, especially sleep clinics.
But basic telephone service is nearly universal among older people. McCurry’s research underscores how people living in rural areas and medically underserved areas could potentially be reached and helped by services delivered over the telephone.
The study, known as the Osteoarthritis and Therapy for Sleep (OATS) study, tracked 327 people with moderate to severe insomnia and osteoarthritis from 2016 to 2018, all in the Kaiser Permanente Washington system, including many who live in rural and medically underserved areas.
“Although osteoarthritis-related insomnia is a very common condition among older adults, it can be a challenge to find and enroll people with this condition in a clinical trial,” said Kai Yeung, PharmD, PhD, co-author and KPWHRI assistant investigator. “Our ability to work with Kaiser Permanente Washington’s extensive electronic health records data made it possible to identify and recruit more than 300 patients across Washington state.”
All the participants received 6 phone calls of 20 to 30 minutes over an 8-week period. During these calls, about half of the patients received materials and guided training called cognitive behavioral therapy for insomnia (CBT-I), a proven and effective strategy used as the first line of treatment for insomnia. The remaining patients were in a control group, which received education-only phone calls that did not include the CBT-I therapy. The control group was important, McCurry said, to make sure the positive effects of the phone calls weren’t due to “the fact that you have someone who’s smart and pleasant calling you every week.”
The key task of the therapy sessions was to guide patients through routines, information, and self-monitoring in order to get their homeostatic sleep drive, which is the internal drive to sleep that is dissipated during the night and builds up during the day, and circadian rhythms, the complex and innate cycles of biochemical, physiological and behavioral processes, working together so that the patient will sleep at night and be wakeful during the daytime.
The phone-based therapy also helped patients reduce anxiety related to sleeplessness.
“People can become conditioned to knowing that when they get into bed, they’re going to have a bad night. The bed becomes an anxious place for them to be,” McCurry said. “We help them develop cognitive tools that can give their mind something else to do other than worry about what tomorrow is going to be like if they don’t get a good night’s sleep.”
While earlier phone-based studies using similar techniques improved sleep, these studies were limited by their small number of participants and included only patients of specialty insomnia clinics. The OATS study was the first large trial of a statewide population of older adults with chronic osteoarthritis who were randomly assigned to either the treatment or a control group.
The study results may offer hope to those suffering from insomnia and osteoarthritis-related pain, but the phone-based system of treatment is not currently offered. Patients should talk to their medical care provider to learn what treatment options are available to them now.
“The bottom line is nobody should be sleeping poorly,” said Michael V. Vitiello, PhD, the study’s senior author and professor of psychiatry and behavioral sciences at University of Washington School of Medicine. “We have ways to fix sleep problems. Older adults don’t need to suffer. We can make them better.”
Co-authors include Weiwei Zhu, MS; Michael Von Korff, ScD; Robert Wellman, MS; and Manu Thakral, PhD, of the Kaiser Permanente Washington Health Research Institute, and Charles Morin, PhD, of the Université Laval in Canada. Thakral is now a faculty member at the University of Massachusetts Boston. This research was funded by U.S. Public Health Service grant 5R01AG053221.
This news release was originally written by Jake Ellison, a public information officer at the University of Washington, for the UW News Service. It has been adapted for publication on the KPWHRI website.
Kaiser Permanente Washington Health Research Institute (KPWHRI) improves the health and health care of Kaiser Permanente members and the public. The institute has conducted nonproprietary public-interest research on preventing, diagnosing, and treating major health problems since 1983. Government and private research grants provide our main funding. Follow KPWHRI research on Twitter, Facebook, and LinkedIn, or subscribe to our free monthly newsletter.
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