A Study to Evaluate the Efficacy of a Sleep Hygiene Behavior Intervention in Elderly With Insomnia

Globally, the older population is increasing rapidly, and between 2015 and 2050, it is expected that the proportion of the world's population over 60 years will nearly double, from 12% to 22% (World Health Organization 2022).Untreated insomnia and other sleep disorders can have major health consequences (e.g., cardiovascular and metabolic disease, impaired cognitive functioning, and increased risk of psychiatric disorders, as well as an increased risk of accidents Studies have also shown that poor sleep is associated with increased risk of falls in the elderly Poor sleep quality has been shown to be associated with decline in cognitive function, impaired quality of life (QOL), excessive daytime sleepiness, fatigue, depression, increased mortality, economic burden, and possibly early institutionalization.

Insomnia is defined as "difficulty initiating sleep, difficulty maintaining sleep, morning awakening, or sleep that is chronically non-restorative or poor in quality, associated with daytime impairment such as fatigue, memory impairment, social or vocational dysfunction, or mood disturbance." There are several objective and subjective assessment tools for measuring sleep disorders, among which polysomnography (PSG) is the gold standard. Considering the time-consuming nature of PSG, associated expense and poor availability of it to most clinicians, it is generally not routinely used in the assessment of insomnia.

Studies have shown that people with insomnia engage in specific poor sleep hygiene practices, which may perpetuate insomnia. However, studies examining the effect of sleep hygiene practices on insomnia, illness severity and cognition are lacking in elderly patients. Sleep hygiene techniques can serve as a relatively inexpensive lifestyle intervention in elderly patients with insomnia. Sleep hygiene recommendations may be delivered using a variety of media and measures (print based, in person discussions, telephonic conversations, etc), resulting in increased access. In addition to being commonly used and readily available, sleep hygiene education does not necessarily require the direct involvement of a clinician and therefore can be widely disseminated, even to elderly persons or their caregivers, who may not seek medical treatment for their sleep problems.

Estimated required sample size:

n1 = 43 n2 = 43 n1 + n2 = 86