Treating Insomnia

Insomnia is a common and troubling condition, with many people reporting increasing problems sleeping as they age.  Rick reveals in this week's podcast that many if not most of his older patients report sleep problems.  And the consequences of long term disrupted sleep can be severe enough to be called disabling or even life-threatening.  Now a study published online in Archives of Internal Medicine provides a ray of hope with employment of a technique called 'brief behavioral treatment.'

BBTI is the acronym of choice for the authors of this study, adding to the alphabet soup of acronyms already employed in medicine.  BBTI stands for brief behavioral treatment of insomnia.  A total of 79 older adults with a mean age of almost 72 and who had chronic insomnia were recruited to the study.  Subjects were randomly assigned to either BBTI or simply receipt of printed educational materials related to insomnia.

BBTI consisted of two intervention sessions and two telephone calls delivered by a specially trained nurse.  In contrast to another popular type of intervention known as cognitive behavioral therapy, BBTI emphasized behavioral rather than cognitive approaches; specific ways to try to deal with one's insomnia rather than trying to develop an intellectual understanding of it. 

Subjects who were treated with BBTI showed both clinical and statistical improvements in insomnia.  After six months of follow up, 64% of treated subjects no longer met the criteria for insomnia disorder.  This is a remarkable and durable outcome without use of medications and is of especial benefit to older folks.  That's because drugs may linger and cause daytime sleepiness and a high likelihood of falls, and we're all familiar with the solid line relationship between falling, hip fracture and death in the elderly.

Other cool things about this study:  it included subjects who had other medical conditions in addition to their insomnia, or what is referred to in medicine as comorbidity.  Most other studies have excluded people with more than one complaint but the fact is, most older people do have multiple medical problems.  The fact that BBTI was of benefit is even more compelling in this population.  It's also cool that the intervention was delivered by a nurse rather than a physician since it was probably much easier to schedule and less expensive, and didn't tax an already beleaguered doc with yet another intervention to deliver.  Finally, I love the fact that patients themselves are enlisted to help themselves and become educated and aware.  I wonder if BBTI is poised to become the next CBT, offering readily adoptable and practical solutions to common problems?  Sounds like a win-win in my estimation.

Other topics this week include use of a suction device in addition to compressions to improve CPR in the Lancet, the relationship between smoking and breast cancer, also in Archives, and the benefit of specialized centers in the treatment of stroke or cerebrovascular accident in JAMA.  Until next week, y'all live well.

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