Sleep Therapy Delivered by Nurses Improves Insomnia

Insomnia, a common illness, has a detrimental impact on quality of life and incurs significant societal expenses. Insomnia affects approximately 10% of adults and increases the chance of acquiring other illnesses such as psychiatric disorders, type 2 diabetes, and cardiovascular disease. Despite its great frequency and burden, access to the recommended treatment, cognitive behavioral therapy (CBT), is exceedingly limited.

The HABIT experiment, which was published in The Lancet, included 642 adults with insomnia from 35 GP surgeries across England. Participants were randomly assigned to one of two groups and given either four sessions of brief nurse-delivered sleep restriction therapy (together with a sleep hygiene booklet) or a sleep hygiene booklet on its own (the control condition).

SRT, or sleep restriction therapy, is a nurse examining the patient’s sleep-wake cycle and assisting them in implementing a new personalized sleep schedule over a period of several weeks. The altered sleep-wake cycle results in a reduction in time spent in bed at first in order to consolidate sleep, making it deeper and more efficient. To increase sleep consistency, the treatment advises against daytime napping and maintains a fixed bed and rise time each night. These behavioral sleep schedule modifications are hypothesized to affect biological processes that govern the sleep-wake cycle.

The sleep hygiene pamphlet offered behavioral suggestions for improving sleep, such as changing one’s lifestyle or sleeping environment.

After 6 months, the group that received sleep restriction therapy had considerably lower ratings on a scale indicating the severity of insomnia. Only 42% of individuals who received the nurse intervention saw a clinically meaningful improvement in their insomnia, compared to 17% of those in the sleep hygiene control group.

At the one-year follow-up, the sleep restriction therapy group also reported significant improvements in mental health-related quality of life, depressive symptoms, work productivity, and insomnia.

The study also looked at cost-effectiveness, which took into account the expenses of training nurses in the treatment, the costs of delivering the treatment, and any changes in healthcare costs (e.g., GP appointments), as well as the effect on quality of life. Sleep restriction therapy was determined to have a high chance (95.3%) of being cost-effective from the perspective of the NHS.

The consequences of this research could be far-reaching. Training primary care nurses to treat insomnia may be an effective and scalable strategy to enhance access to evidence-based insomnia treatment.

While the study’s findings are promising, the authors do point out several caveats. The study’s participants were predominantly well-educated persons of White ethnic backgrounds, limiting generalizability to the total UK insomnia population. Data collection for several of the secondary sleep outcomes was also hampered by the pandemic.

‘Insomnia is a serious condition because it’s highly prevalent, has a significant impact on quality of life, and increases the risk of developing other physical and mental health problems,’ said Simon Kyle, Associate Professor in the Nuffield Department of Clinical Neurosciences and the study’s Chief Investigator. The main problem is that persons suffering from chronic insomnia rarely receive evidence-based treatment.

The HABIT trial demonstrates that nurses with no prior experience with sleep disorders or psychological therapy can be successfully taught to administer a brief behavioral intervention for insomnia in primary care.

Over a 12-month research period, the brief treatment required less than 1.5 hours of nurse time each week and resulted in sustained benefits in sleep, mental health, and work productivity. The treatment was also highly likely to be cost-effective from the standpoint of the NHS.’

Writing in a linked commentary, Professor van Straten and Colleagues, who were not involved in the research, said:

‘The study of Kyle and colleagues shows that SRT [sleep restriction therapy] is a simple and effective treatment for at least part of the population of people with chronic insomnia and can be carried out by nurses in primary care. This is an important contribution in tackling the public health burden of insomnia. Urgent efforts are needed to adapt treatments for underserved populations and to educate primary care staff in recognizing insomnia.’

Dr Kyle added: ‘Future research is needed to understand how the nurse-delivered programme could be implemented in the NHS, for example as part of a stepped care approach to insomnia management, and whether this may lead to reduction in prescriptions for sleep medication.’

The HABIT experiment was a partnership between researchers from the Universities of Oxford, Manchester, and Lincoln, and it was supported by the National Institute for Health and Care Research’s Health Technology Assessment Programme.

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