Insomnia, whether long-term or shorter, is a common sleep disorder. Long term, it can pose health problems and affect mental well-being. Medical and cognitive behavioral therapies are expensive and can be hard to find in some regions. Insomnia can be exacerbated by pain, most commonly joint pain from osteoarthritis (OA). These common variables feed into a never-ending loop for some older adults, which prompted researchers to develop a targeted intervention.
Researchers at Kaiser Permanente Washington implemented a telephone program called Osteoarthritis and Therapy for Sleep (OATS) that delivers cognitive behavioral therapy (CBT). They set out to answer the question of whether the program could reduce chronic insomnia symptoms among older adults battling moderate to severe OA pain. The study included a randomized clinical trial of 327 participants age 60 and better. Participants were double-screened for insomnia and OA. The intervention was made up of six 20- to 30-minute telephone sessions provided over eight weeks. Participants were required to submit daily diaries and were assessed blindly for their pain and insomnia symptoms via a self-report measure at baseline, two months post-treatment, and 12 months post-treatment.
The CBT telephone sessions included sleep restriction, stimulus control, sleep hygiene, cognitive restructuring and homework. Researchers found that the intervention led to participants reporting significantly fewer insomnia and pain symptoms, which were sustained even a year after the study.
Findings from the study reaffirm the importance of available health care and provide a possible alternative to in-person sessions. The telephone CBT treatments may prove to be an accessible and scalable insomnia solution. During the pandemic, this program could provide access to quality health care while removing barriers such as transportation or social distancing concerns. As we have already seen, telehealth has become increasingly popular during the pandemic, and this type of treatment can offer flexibility for patients and health care workers.
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McCurry SM, Zhu W, Von Korff M, et al. Effect of Telephone Cognitive Behavioral Therapy for Insomnia in Older Adults With Osteoarthritis Pain: A Randomized Clinical Trial. JAMA Intern Med. DOI:10.1001/jamainternmed.2020.9049