Phone therapy eases insomnia for older adults
By UNIVERSITY OF WASHINGTON
By UNIVERSITY OF WASHINGTON
Just a few short phone calls can effectively treat insomnia, according to new research.
The phone-delivered therapy, which consisted of guided training and education to combat insomnia, also helped reduce fatigue as well as pain associated with osteoarthritis.
Insomnia—trouble falling asleep, staying asleep or waking up too early—is a common condition in older adults. Osteoarthritis, the most common form of arthritis causing joint pain, can exacerbate sleeplessness. While there are effective therapies for treating insomnia in older adults, many people cannot get the treatment they need because they live in areas with limited access to health care, either in person or over the internet.
With telephones nearly universal among the elderly, however, researchers wanted to find out if therapy using only a phone connection could improve access to insomnia treatment.
“It’s very exciting,” says Susan M. McCurry, research professor in the University of Washington School of Nursing and an affiliate investigator at Kaiser Permanent, “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 involved patients in the Kaiser Permanente Washington system—the Osteoarthritis and Therapy for Sleep, or OATS study. It appears in JAMA Internal Medicine,
PHONE THERAPY EASES ANXIETY AND INSOMNIA
Importantly, McCurry says, the study results also mean the therapy could potentially reach and help people living in rural or other areas with limited access to the internet and health care, especially sleep clinics.
“When people can get relief from their sleep problems,” she says, “they’re going to function better during the day. They’re going to emotionally feel better, be less irritable, and think more clearly.”
The study tracked 327 people over 60 years old with moderate to severe insomnia from 2016 to 2018. They interviewed patients six times for 20 to 30 minutes over an eight-week period. Roughly half of the patients received materials and guided training called cognitive behavioural therapy for insomnia. CBT-I is a proven and effective strategy used as the first line of treatment for insomnia.
The remaining patients in a control group, received education-only phone calls that did not include the CBT-I therapy. The control group was important, McCurry says, 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.”
“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.”
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, 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 says. “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.”
‘LARGE, ROBUST, AND LASTING’ BENEFITS
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 study was the first large trial of a statewide population of older adults with chronic osteoarthritis randomly assigned to either the treatment or a control group.
“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. 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 over age 60 with moderate to severe osteoarthritis pain and insomnia,” says coauthor Kai Yeung, assistant scientific investigator at Kaiser Permanente Washington Health Research Institute.
The researchers concludes that the phone-based treatment benefits for insomnia were “large, robust” and sustained for a year, even for patients with more severe insomnia and pain symptoms. The study also found a reduction of those pain symptoms, although the pain reductions did not last a full year.
While the study results can give hope to those suffering from insomnia and osteoporosis-related pain, the authors say patients may not yet have access to a phone-based system of treatment. However, they can still 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,” says coauthor Michael V. Vitiello, professor of psychiatry and behavioral sciences. “We have ways to fix sleep problems. Older adults don’t need to suffer. We can make them better.”
Additional coauthors of the study are from Kaiser Permanente Washington Health Research Institute and the Université Laval in Canada. The US Public Health Service funded the work.