Comparing the Effects of Single- and Multiple-Component Therapies for Insomnia on Sleep Outcomes.
Souraya Sidani, Dana R Epstein, Mary Fox and 1 others
PMID 31165577WHAT IT FOUND
Sleep restriction therapy had the lowest post-test perceived insomnia severity, but the group difference was small.
Stimulus control and sleep restriction had better remission than sleep education and hygiene or the combined therapy.
Key findings
01Sleep restriction therapy had the lowest post-test perceived insomnia severity among the four therapies, and the between-group difference was small.
02Stimulus control and sleep restriction had higher remission rates and better post-test sleep onset latency, awakenings, and time awake after sleep onset than sleep education and hygiene and the combined therapy.
03Total sleep time increased in all therapy groups, but sleep quality did not differ between groups at post-test.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
Allocation was partly by preference, so the groups may not have been comparable at baseline, although pre-test differences were adjusted in the analysis. Group sizes were unbalanced, with far more participants receiving multi-component therapy than the single-component therapies. Outcomes were self-report only and were measured shortly after treatment, so longer-term effects were not shown. Participants' adherence to the therapies was not measured, so it may explain some differences in improvement. People with sleep apnea or cognitive impairment were excluded, so the results may not apply to those groups. The therapists were not identified as nurses, so nurse-delivered implementation is not directly tested in this study.
The easy way to misread this
Do not conclude that the combined therapy is ineffective. It improved total sleep time and several sleep parameters. The main finding was that stimulus control and sleep restriction had higher remission rates, while the insomnia severity difference was small.