In 35 general practices in England, brief nurse-delivered sleep restriction therapy was more effective than sleep hygiene interventions alone for insomnia, an open-label study shows. Provision of this therapy by nurses “is likely to be cost-effective and has the potential to be widely implemented as a first-line treatment for insomnia disorder,” the authors conclude.
In the pragmatic, superiority, 12-month controlled trial, 642 adults with insomnia disorder were randomized to either 4 sessions of nurse-delivered sleep restriction therapy plus a sleep hygiene booklet or a sleep hygiene booklet only. Based on a primary endpoint of the insomnia severity index (ISI) at 6 months and cost-effectiveness based on the U.K. National Health Service and personal social services perspective, the study showed: “Mean age was 55.4 years (range 19–88), with 489 (76.2%) participants being female and 153 (23.8%) being male. 580 (90.3%) participants provided data for at least one outcome measurement. At 6 months, mean ISI score was 10.9 (SD 5.5) for sleep restriction therapy and 13.9 (5.2) for sleep hygiene (adjusted mean difference –3.05, 95% CI –3.83 to –2.28; P <0.0001; Cohen’s d –0.74), indicating that participants in the sleep restriction therapy group reported lower insomnia severity than the sleep hygiene group. The incremental cost per [quality-adjusted life year (QALY)] gained was £2076, giving a 95.3% probability that treatment was cost-effective at a cost-effectiveness threshold of £20,000. Eight participants in each group had serious adverse events, none of which were judged to be related to intervention.”