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  1. 1. Alternative Methods of Treatment in Patients with Insomnia Jason Brigham RN,C University of Wisconsin Green Bay
  2. 2. Insomnia <ul><li>Most commonly diagnosed sleep problem people face today. </li></ul><ul><li>Can have both a psychological and physiological impact </li></ul><ul><li>Insomnia is one of the most under recognized and under treated health conditions </li></ul>
  3. 3. Treatment <ul><li>Mostly a pharmacological approach, which has been effective, but not without limitations </li></ul><ul><li>limitations may include dependence, side effects, and tolerance. </li></ul><ul><li>Alternative methods such as cognitive behavioral treatment (CBT) has shown to be effective in insomnia treatment. </li></ul>
  4. 4. CBT for insomnia <ul><li>Stimulus control- designed to reassociate the bed with sleep, reestablish sleep-wake cycle </li></ul><ul><li>Sleep restriction- limits time in bed to actual sleep time, results in more efficient sleep </li></ul><ul><li>Relaxation training- reduces somatic tension or intrusive thoughts that interfere with sleep </li></ul><ul><li>Cognitive therapy- aimed at changing beliefs and attitudes about sleep and insomnia </li></ul><ul><li>Sleep hygiene education- guidelines about practices that may affect sleep </li></ul>
  5. 5. Purpose <ul><li>Review evidence based literature that support the efficacy of alternative treatments for insomnia versus the use of medications. </li></ul>
  6. 6. Question <ul><li>Can adults with insomnia show an overall improvement in sleep by using alternative treatment methods, as opposed to those that take a pharmacological approach? </li></ul>
  7. 7. Study #1 <ul><li>Systematic review of seven studies </li></ul><ul><li>All studies randomized control trials </li></ul><ul><li>Age ranges for the participants were between ages of 18-65 with a diagnosis of primary insomnia. </li></ul>
  8. 8. Study #2 <ul><li>Summary of research studies on the use of CBT in patients with insomnia </li></ul><ul><li>Narrative review using sleep logs, diaries and history to measure sleep </li></ul><ul><li>Reviews the objectives of CBT and its effectiveness in treatment for insomnia alone and with the use of hypnotics </li></ul>
  9. 9. Clinical Guidelines <ul><li>Provides a framework for the management of patients with insomnia utilizing evidence based recommendations. </li></ul><ul><li>Shows CBT is effective for patients of all ages and in chronic hypnotic users </li></ul><ul><li>CBT to be utilized as initial intervention, and is recommended as standard of care for chronic insomnia </li></ul>
  10. 10. Results of Studies <ul><li>Overall use of sleep medication was reduced </li></ul><ul><li>Total sleep time after behavioral treatment increased by an average of 30-40 minutes </li></ul><ul><li>CBT benefits include increases in sleep efficacy, sleep onset and wake after sleep onset </li></ul>
  11. 11. Overall <ul><li>Patients reported an overall sense of control over their sleep and reduction in emotional stress tied to there insomnia </li></ul><ul><li>CBT was more effective than pharmacotherapy for long term use </li></ul><ul><li>CBT can be used with or without the use of hypnotic medications </li></ul>
  12. 12. Innovation-Relaxation Groups <ul><li>Will utilize progressive muscle relaxation techniques. </li></ul><ul><li>Involves alternating contraction and relaxation of muscle groups throughout the body </li></ul><ul><li>Done in groups or individually that run 30-45 minutes, 30 minutes prior to bedtime. </li></ul><ul><li>Can be used with or without the use of hypnotics. </li></ul>
  13. 13. Implementation <ul><li>Staff to be involved: Nurses, Drs. and support staff. </li></ul><ul><li>Procedure to be updated- patients will now have the option to utilize relaxation groups as alternative to hypnotics </li></ul><ul><li>Pilot program to run 4-6 weeks </li></ul>
  14. 14. Vision Statement <ul><li>“ Evidenced Based Relaxation without Medication” </li></ul>
  15. 15. Communication of Vision <ul><li>Developing Power Point presentation on the effective use of relaxation groups. </li></ul><ul><li>Education on the appropriate methods to teach relaxation skills to patients </li></ul>
  16. 16. Action <ul><li>Select member of the team to help educate other staff members </li></ul><ul><li>Select team member to liaison with staff in order to answer questions regarding groups. </li></ul><ul><li>Set up a blog were staff members can voice issues or concerns anonymously </li></ul>
  17. 17. Short-Term <ul><li>Monitor effectiveness of sleep from the patients who participated in groups </li></ul><ul><li>Report the effectiveness of groups on sleep at unit meetings for a period of 3 months </li></ul><ul><li>Team members to complete monthly audits on use of groups, through observation and numbers of hours slept </li></ul>
  18. 18. Anchor the Change <ul><li>Consider expansion of pilot program to other units hospital wide </li></ul><ul><li>Promote a culture of change </li></ul><ul><li>Compare results of relaxation groups to similar programs in the area </li></ul>
  19. 19. References <ul><li>Buscemi et al, Manifestations Management of Chronic Insomnia in Adults. Retrieved from Agency of Healthcare Research and Quality website: </li></ul>
  20. 20. References <ul><li>Morin, C.(2004). Cognitive Behavioral Approaches to the Treatment of Insomnia. J Clin Psychiatry, 65(16), 33-40. </li></ul><ul><li>3. Schutte-Rodin, S., Brach, L., Buysee, D., Dorsey, C. & Sateia, M. (2008). Clinical Guideline for the Evaluation and Management of Chronic Insomnia in Adults. J Clin Sleep Med, 4(5),487-504. </li></ul>
  21. 21. REFERENCES <ul><li>4. Wang, M., Wang, S. & Tsai, T. (2005). Cognitive behavioral therapy for primary insomnia: a systematic review. Journal of Advanced Nursing, 50(5), 553-564. </li></ul>