Sleep Medicine and Psychophysiology (수면정신생리)

KOREAN ACADEMY OF SLEEP MEDICINE (대한수면의학회)
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The Effects of a Brief Intervention for Insomnia on Community Dwelling Older Adults

지역 사회 노인을 대상으로 한 불면증 단기 치료 프로그램의 효과

  • Oh, Eui Sun (Department of Psychiatry and Institute of Behavioral Science in Medicine, Yonsei University College of Medicine) ;
  • Park, Kyung Mee (Department of Psychiatry and Institute of Behavioral Science in Medicine, Yonsei University College of Medicine) ;
  • An, Suk Kyoon (Department of Psychiatry and Institute of Behavioral Science in Medicine, Yonsei University College of Medicine) ;
  • Namkoong, Kee (Department of Psychiatry and Institute of Behavioral Science in Medicine, Yonsei University College of Medicine) ;
  • Shim, Da-hye (Department of Psychiatry and Institute of Behavioral Science in Medicine, Yonsei University College of Medicine) ;
  • Lee, Eun (Department of Psychiatry and Institute of Behavioral Science in Medicine, Yonsei University College of Medicine)
  • 오의선 (연세대학교 의과대학 정신과학교실 및 의학행동과학연구소) ;
  • 박경미 (연세대학교 의과대학 정신과학교실 및 의학행동과학연구소) ;
  • 안석균 (연세대학교 의과대학 정신과학교실 및 의학행동과학연구소) ;
  • 남궁기 (연세대학교 의과대학 정신과학교실 및 의학행동과학연구소) ;
  • 심다혜 (연세대학교 의과대학 정신과학교실 및 의학행동과학연구소) ;
  • 이은 (연세대학교 의과대학 정신과학교실 및 의학행동과학연구소)
  • Received : 2018.11.14
  • Accepted : 2018.12.09
  • Published : 2018.12.31
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Abstract

Objectives: Insomnia is one of the major concerns in the elderly population. Cognitive behavioral treatment for insomnia is the first line treatment option, but there are some limitations including time and cost burdens and the requirement for sufficient cognitive resources to obtain a proper treatment effect. The Brief intervention for insomnia (BII) is a treatment that focuses on behavioral aspects of insomnia in primary care practices. The purpose of this study was to evaluate the effects of BII in community-dwelling older adults. Methods: A total of 47 older adults with insomnia were enrolled from community centers between May 2016 and January 2018. They participated in the BII program for three weeks. We gathered sleep-related participant information with using the Pittsburgh sleep quality index (PSQI), the Sleep hygiene index, and a sleep diary. Clinical efficacy was evaluated by comparing total sleep time (TST), sleep latency (SL), waking after sleep onset (WASO), and sleep efficiency (SE) before and after the treatment. Results: There was significant improvement in sleep-related features after BII. Global score and sleep quality from the PSQI, freshness, and WASO from the sleep diary showed statistically significant improvement. Conclusion: We found BII showed positive clinical efficacy in community dwelling older adults, especially from the perspective of subjective sleep quality and WASO. This finding implies that BII can be effectively applied for the managment of elderly insomnia patients in a community setting.

목 적 : 한국 사회의 고령화와 동반되어 노인 인구의 불면증은 증가되는 추세이나 이로 인해 초래되는 개인 및 사회경제적 손실에 비해 적절한 치료를 받는 환자의 수는 많지 않다. 불면증 인지행동치료가 부작용을 최소화할 수 있는 일차적인 치료로서 추천되고 있으나, 시간 및 경제적 제약, 인지적인 자원이 필요한 부담으로 인해 치료에 대한 접근성이 제한된 실정이다. 불면증 단기 치료 프로그램은 이러한 부담을 최소화할 수 있는 대안이 될 수 있을 것이다. 본 연구의 목적은 지역사회 거주 노인을 대상으로 불면증 단기 치료 프로그램의 효과를 검증하는 것이다. 방 법 : 2016년 5월부터 2018년 1월까지 서울 소재 3개의 노인 종합복지관을 방문한 65세 이상의 불면증을 호소하는 노인들 47명을 대상으로 3주에 걸쳐 불면증 단기 치료 프로그램을 시행하였다. 프로그램의 전, 후의 수면의 질을 측정하는 피츠버그 수면의 질 지수(Pittsburgh sleep quality index, PSQI), 수면 위생 척도, 정서 관련 평가를 실시하였으며 치료 기간 중 매일 수면 일지를 작성하도록 지시하였다. 임상적 효과는 치료 전후의 총 수면 시간, 수면 잠재기, 수면 후 각성 시간 및 수면 효율로 평가하였다. 치료 전, 후의 변화를 비교하기 위해 비모수검정 방법인 윌콕슨 부호 순위 검증(Wilcoxon's signed-ranks test)을 이용하여 분석을 시행하였다. 결 과 : 불면증 단기 치료 프로그램을 시행한 뒤, 치료 전보다 대상자들의 PSQI 총점이 감소하였으며 PSQI 로 측정한 주관적 수면의 질이 유의하게 호전되었다. 치료 전후에 시행한 수면 일지를 비교한 결과에서도 개운함 및 수면 후 각성 시간에 대해서 유의한 수준의 호전을 보였다. 결 론 : 개발된 불면증 단기 치료 프로그램은 지역 사회 노인의 불면증에 대해 긍정적인 치료 효과를 보이는 것으로 나타났다 기존의 불면증 인지행동치료에 비해 시간적, 인지적 자원 부담이 적음을 고려하였을 때 불면증 단기 치료 프로그램은 지역 사회 내에서 노인 불면증 치료에 대한 접근성을 확대하는 데 사용할 수 있을 것이다.

Keywords

Table 2. Change of the PSQI global score after the brief intervention for insomnia

DSMOBC_2018_v25n2_74_t0001.png 이미지

Table 1. Sociodemographic characteristics of participants

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Table 3. Change of the sleep diary after the brief intervention for insomnia

DSMOBC_2018_v25n2_74_t0003.png 이미지

Table 4. Change of the psychological characteristics after the brief intervention for insomnia

DSMOBC_2018_v25n2_74_t0004.png 이미지

References

  1. Abler RM. Cognitive/behavioral and relational/interpersonal group counseling: Effects of an eight-week approach on affective status among independent-living elderly adults. Dissertation Abstract International 1990;51:969B.
  2. Ahn S, Choi H, Kim H, Kim J. Prevalence of insomnia and associated factors among community-dwelling Korean elderly. J Korean Geriatr Psychiatry 2015;19:32-39.
  3. Alessi CA, Martin JL, Webber AP, Cynthia Kim E, Harker JO, Josephson KR. Randomized, controlled trial of a nonpharmacological intervention to improve abnormal sleep/wake patterns in nursing home residents. J Am Geriatr Soc 2005;53:803-810. https://doi.org/10.1111/j.1532-5415.2005.53251.x
  4. Ancoli-Israel S, Ayalon L, Salzman C. Sleep in the elderly: normal variations and common sleep disorders. Harv Rev Psychiatry 2008;16:279-286. https://doi.org/10.1080/10673220802432210
  5. Avidan AY. Sleep disorders in the older patient. Prim Care 2005;32:563-586. https://doi.org/10.1016/j.pop.2005.03.001
  6. Brabbins C, Dewey M, Copeland J, Davidson I, McWilliam C, Saunders P, et al. Insomnia in the elderly: prevalence, gender differences and relationships with morbidity and mortality. Int J Geriatr Psychiatry 1993;8:473-480. https://doi.org/10.1002/gps.930080604
  7. Buysse DJ, Germain A, Moul DE, Franzen PL, Brar LK, Fletcher ME, et al. Efficacy of brief behavioral treatment for chronic insomnia in older adults. Arch Intern Med 2011;171:887-895. https://doi.org/10.1001/archinternmed.2010.535
  8. Buysse DJ, Reynolds CF, 3rd, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res 1989;28:193-213. https://doi.org/10.1016/0165-1781(89)90047-4
  9. Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987;40:373-383. https://doi.org/10.1016/0021-9681(87)90171-8
  10. Cho M, Bae J, Suh G, Hahm B, Kim J, Lee D et al. Validation of geriatric depression scale, Korean version (GDS) in the assessment of DSM-III-R major depression. J Korean Neuropsychiatr Assoc 1999;38:1.
  11. Cho Y, Kim E. Psychometric properties of the Korean version of the anxiety control questionnaire. Kor J Clin Psychol 2004;23:503-518.
  12. Espie CA. "Stepped care": a health technology solution for delivering cognitive behavioral therapy as a first line insomnia treatment. Sleep 2009;32:1549-1558. https://doi.org/10.1093/sleep/32.12.1549
  13. Espie CA, Inglis SJ, Tessier S, Harvey L. The clinical effectiveness of cognitive behaviour therapy for chronic insomnia: implementation and evaluation of a sleep clinic in general medical practice. Behav Res Ther 2001;39:45-60. https://doi.org/10.1016/S0005-7967(99)00157-6
  14. Foley DJ, Monjan AA, Brown SL, Simonsick EM, Wallace RB, Blazer DG. Sleep complaints among elderly persons: an epidemiologic study of three communities. Sleep 1995;18:425-432. https://doi.org/10.1093/sleep/18.6.425
  15. Hamblin JE. Insomnia: an ignored health problem. Prim Care 2007; 34:659-674, viii. https://doi.org/10.1016/j.pop.2007.05.009
  16. Mastin DF, Bryson J, Corwyn R. Assessment of sleep hygiene using the sleep hygiene index. J Behav Med 2006;29:223-227. https://doi.org/10.1007/s10865-006-9047-6
  17. Mintz J, Steuer J, Jarvik L. Psychotherapy with depressed elderly patients: research considerations. J Consult Clin Psychol 1981;49:542-548. https://doi.org/10.1037/0022-006X.49.4.542
  18. Morin CM. Insomnia: Psychological Assessment and Management, Guilford Press;1993.
  19. Ohayon MM. Epidemiology of insomnia: what we know and what we still need to learn. Sleep Med Rev 2002;6:97-111. https://doi.org/10.1053/smrv.2002.0186
  20. Riemann D, Spiegelhalder K, Espie C, Pollmacher T, Leger D, Bassetti C, et al. Chronic insomnia: clinical and research challenges--an agenda. Pharmacopsychiatry 2011;44:1-14. https://doi.org/10.1055/s-0031-1275303
  21. Schutte-Rodin S, Broch L, Buysse D, Dorsey C, Sateia M. Clinical guideline for the evaluation and management of chronic insomnia in adults. J Clin Sleep Med 2008;4:487-504.
  22. Seo W-S. Behavior therapy and light therapy of insomnia. Sleep Med Psychophysiol 2003;10:20-25.
  23. Smith MT, Perlis ML, Park A, Smith MS, Pennington J, Giles DE, et al. Comparative meta-analysis of pharmacotherapy and behavior therapy for persistent insomnia. Am J Psychiatry 2002;159:5-11. https://doi.org/10.1176/appi.ajp.159.1.5
  24. Troxel WM, Germain A, Buysse DJ. Clinical management of insomnia with brief behavioral treatment (BBTI). Behav Sleep Med 2012;10:266-279. https://doi.org/10.1080/15402002.2011.607200
  25. Verbeek IH, Konings GM, Aldenkamp AP, Declerck AC, Klip EC. Cognitive behavioral treatment in clinically referred chronic insomniacs: group versus individual treatment. Behav Sleep Med 2006;4:135-151. https://doi.org/10.1207/s15402010bsm0403_1
  26. Vitiello MV, McCurry SM, Rybarczyk BD. The future of cognitive behavioral therapy for insomnia: what important research remains to be done? J Clin Psychol 2013;69:1013-1021. https://doi.org/10.1002/jclp.21948
  27. Yesavage JA, Brink TL, Rose TL, Lum O, Huang V, Adey M, et al. Development and validation of a geriatric depression screening scale: a preliminary report. J Psychiatr Res 1982;17:37-49. https://doi.org/10.1016/0022-3956(82)90033-4