Impact of Insomnia Management Programme on Insomnia Severity in Older Persons with Heart Failure
Keywords:management programme, cognitive and behavioural therapy, older persons with heart failure, insomnia
Objective: To examine the impact that an insomnia management programme had on insomnia severity in older persons with heart failure
Design: Two-group quasi-experimental study with a pretest and posttest
Methodology: The subjects were 48 male and female older persons with heart failure, aged between 60-75 years, treated in the outpatient department of a tertiary hospital from January to June 2021. The subjects were purposively sampled and equally assigned to a control group (24) and experimental group (24); however, one of the experimental group members withdrew from the study due to the Covid-19 situation. Whilst the control group received standard nursing care, the experimental group received both standard nursing care and the insomnia management programme, which had been developed by the researchers based on the concept of cognitive and behavioural therapy for insomnia and based on reviewed literature. The data collection tools consisted of a personal information record form and the Insomnia Severity Index (ISI). The ratio of older persons with heart failure was determined using McNemar’s Test, based on a comparison of their insomnia severity degrees before the intervention and in weeks 6 and 10 after the intervention. The ratio of heart failure incidence in older persons in the control group and the experimental group before the intervention and in weeks 6 and 10 after the intervention was determined using Fisher’s Exact Test.
Results: The degrees of insomnia severity in weeks 6 and 10 after the intervention were significantly lower in the subjects participating in the insomnia management programme than in those receiving only standard care (p < .05), and also significantly lower than all of the subjects’ average pre-intervention insomnia severity degree (p < .01).
Recommendations: Nurses and healthcare professionals are advised to receive special behavioural therapy training in order to apply this programme to caring for older persons with sleep problems. Further studies based on this or any similar framework should be designed to measure other related aspects, for example, performance of daytime functions, fatigue, quality of life, and sleep-related beliefs and attitudes.
Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE, Jr., Drazner MH, et al. 2013 ACCF/AHA guideline for the management of heart failure: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. Circulation. 2013;128(16): 1810-52.
Diez-Villanueva P, Alfonso F. Heart failure in the elderly. J Geriatr Cardiol. 2016;13(2):115-7.3. Ministry of Public Health. Major NCDs Morbidity Report: cardiovascular disease rates per population in Fiscal Year of 2018. 2018 [Available from:https://hdcservice.moph.go.th/hdc/reports/report.php source=formated/ncd.php&cat_id=6a1fdf282fd28180eed7d1cfe0155e11& id=14f43de323e8ba70da1cb724cf64a98c](inThai)
Kanno Y, Yoshihisa A, Watanabe S, Takiguchi M, Yokokawa T, Sato A, et al. Prognostic significance of insomnia in heart failure. Circ J. 2016;80(7):1571-7.
American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Arlington,VA: American Psychiatric Association Publishing; 2013. 361-422
Redeker NS, Jeon S, Muench U, Campbell D, WalslebenJ, Rapoport DM. Insomnia symptoms and daytime function in stable heart failure. Sleep. 2010;33(9): 1210-6.
Chimluang J., Aungsuroch Y., Jitpanya C. Descriptors of insomnia among patients with heart failure. J Med Assoc Thai.2017;100(4):403-9. (in Thai)
Rials SJ, Hatlestad JD, Smith A, Pubbi D, Slotwiner DJ, Boehmer JP. Night time elevation angle in heart failure patients indicates orthopnea and paroxysmal nocturnal dyspnea. J Card Fail. 2017;23(8).
Suzuki K, Miyamoto M, Hirata K. Sleep disorders in the elderly: diagnosis and management. J Gen Fam Med. 2017;18(2):61-71.
Tsuchihashi-Makaya M, Matsuoka S. Insomnia in heart failure. Circ J. 2016;80(7):1525-6.
Andrews LK, Coviello J, Hurley E, Rose L, Redeker NS. “I’d eat a bucket of nails if you told me it would help me sleep:” perceptions of insomnia and its treatment in patients with stable heart failure. Heart Lung. 2013; 42(5):339-45.
Spielman AJ. Assessment of insomnia. Clin Psychol Rev. 1986; 6:11-25.
Morin CM, Barlow DH. Insomnia. Psychological assessment and management: Guilford Press New York; 1993. XVII, 238.
Morin CM, Bootzin RR, Buysse DJ, Edinger JD, Espie CA, Lichstein KL. Psychological and behavioral treatment of insomnia: update of the recent evidence (1998-2004). Sleep. 2006 29(11):1398-414.
Aunjitsakul W, Udomratn P. Cognitive behavioral therapy for insomnia. Journal of Psychiatric Association of Thailand. 2016;61(1):89-106. (in Thai)
Perlis ML, Jungquist C, Smith MT, Posner D. Cognitive behavioral treatment of insomnia: a session-by-session guide. Berlin: Springer Science & Business Media; 2006.p. 12-104.
Redeker NS, Jeon S, Andrews L, Cline J, Pacelli J, Jacoby D. Cognitive behavioral therapy for insomnia has sustained
effects on daytime symptoms and hospitalization in patients with stable heart failure. Sleep. 2013; 36: A297
Redeker NS, Knies AK, Hollenbeak C, Klar Yaggi H, Cline J, Andrews L, et al. Cognitive behavioral therapy for insomnia in stable heart failure: protocol for a randomized controlled trial. Contemp Clin Trials. 2017;55:16-23.
Choojit K, Jitpanya C, Chimluang J. The effect of sleep behavioral modification program on insomnia in heart failure patients. Journal of The Royal Thai Army Nurses.2018;19:184-92. (in Thai)
Hemrungrojn S. Montreal cognitive assessment (MOCA)Thai version 2007; 2011 [cited 2019 July 1] Available from website: http://www.mocatest.org/pdf_files/test/ MoCA-Test-Thai.pdf. (in Thai)
Department of Mental Health, Ministry of Public Health.Depression and suicidal risk screening test [Internet]. 2017 [cited 2017 Feb 2]. Available from: http://www.dmh.go.th/test/download/files/2Q%209Q% 208Q%20(1).pdf. (in Thai)
Faul F, Erdfelder E, Lang AG, Buchner A. G*Power 3:a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods. 2007;39(2):175-91.
Gray JR, Grove SK, Sutherland S. Burns & grove’s the practice of nursing research: appraisal, synthesis, and generation of evidence. 8th ed. St. Louis: Elsevier; 2017. 329-62.
Keawphang P, Jitpanya C. Relationship between selected factors related to insomnia in adult cancer patients. Journal of Nursing Science Chulalongkorn University.2006;18(2):33-46. (in Thai)
Department of Psychiatry. Department of Psychiatry, Faculty of Medicine, Chulalongkorn University: stress relief techniques. 2017; Retrieved from https://www.youtube.com/watch?v=LGhvHGJ8j1c.(inThai)
Heenan A, Pipe A, Lemay K, Davidson JR, Tulloch H. Cognitive behavioral therapy for insomnia tailored to patients with cardiovascular disease: a pre-post study. Behav Sleep Med. 2020;18(3):372-85.
Elmoneem H. A., Fouad A. I. The effect of a sleep hygiene program on older adults. IOSR-JNHS. 2017; 6(1):40-51.
Redeker NS, Jeon S, Andrews L, Cline J, Mohsenin V, Jacoby D. Effects of cognitive behavioral therapy for insomnia on sleep-related cognitions among patientswith stable heart failure. Behav Sleep Med. 2019; 17(3):342-54.
Seyedi CP, Gholami M, Azargoon A, Hossein Pour AH,Birjandi M, Norollahi H. The effect of progressive muscle relaxation on the management of fatigue and quality of sleep in patients with chronic obstructive pulmonary disease: a randomized controlled clinical trial.Complement Ther Clin Pract. 2018;31:64-70.
How to Cite
Copyright (c) 2022 Thai Journal of Nursing Council
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.