Nurse-delivered sleep restriction therapy effective for treatment of chronic insomnia

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1. Sleep restriction therapy was superior to sleep hygiene for the management of chronic insomnia.

2. There were no treatment-related adverse events.

Evidence Rating Level: 1 (Excellent)

Study Rundown: Insomnia is a chronic disorder affecting 10% of people worldwide. Although cognitive behavioural therapy (CBT) remains the primary treatment for insomnia, access to this is scarce. Instead, patients are often counselled on sleep hygiene and prescribed hypnotic medications in certain circumstances. This randomized controlled trial aimed to assess the clinical and cost-effectiveness of nurse-delivered sleep restriction therapy for the treatment of insomnia. The primary outcome was severity of self-reported insomnia at 6 months, measured using the Insomnia Severity Index (ISI), while key secondary outcome was cost-effectiveness based on the incremental cost per quality-adjusted life year (QALY) gained. According to study results, patients in the sleep restriction therapy group had decreased insomnia severity than those in the sleep hygiene group. Although this study was well done, it was limited by an open-label design, thus affecting the validity of the results.

Click to read the study in The Lancet

Relevant Reading: Intensive Sleep Deprivation and Cognitive Behavioral Therapy for Pharmacotherapy Refractory Insomnia in a Hospitalized Patient

In-depth [randomized-controlled trial]: Between Aug 29, 2018, and Mar 23, 2020, 3171 patients were screened for eligibility across 35 clinical sites in England. Included were patients ≥ 18 years old with a DSM-5 diagnosis of insomnia disorder and sleep efficiency < 85% over the past month. Altogether, 642 patients (321 each in sleep restriction therapy and sleep hygiene group) were included in the final analysis. The mean age of patients was 55.4 years, and the majority (76.2%) were female. The primary outcome of self-reported insomnia severity at 6 months was significantly lower in the sleep restriction therapy group compared to the sleep hygiene group (mean ISI score 10.9 vs. 13.9, adjusted mean difference -3.05, 95% confidence interval [CI] -3.83 to -2.28, p<0.0001). Compared to the sleep hygiene group, the incremental cost per QALY gained in the intervention group was £2076. There were no treatment-related adverse events. Findings from this study suggest that nurse-delivered sleep restriction therapy in primary care effectively reduces insomnia symptoms and is likely to be cost-effective.

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