Wellness Check: Sleep

Auricular acupressure may improve sleep quality in elderly populations

1. In this randomized, single-blinded, pretest-posttest study, auricular acupressure provided improved sleep quality and objective polysomnography measures amongst elderly people with osteoarthritis who live in nursing homes, compared to placebo.

2. Additionally, auricular acupressure intervention reduced pain symptoms and objectively increased melatonin levels in the elderly cohort.

Evidence Rating Level: 2 (Good)

Elderly populations are commonly faced with increased incidences of sleep disorders and adjacent osteoarthritis. Although pharmacological and non-pharmacological interventions have been investigated for pain and sleep improvements, little is known regarding appropriate interventions in the elderly population. Auricular acupressure (AA) is a therapy that has been studied to improve sleep and reduce pain by applying pressure to auricular points. This study sought to evaluate its effectiveness as an extended intervention course in an elderly population with sleep disorders and osteoarthritis.

This study conducted a randomized, single-blinded, placebo-controlled study in South Korea that included patients 65 years or older who had osteoarthritis and lived in a nursing home. Participants were excluded if they were using alternative therapies to improve sleep or improve pain, took sleeping pills, or had severe neurological disorders or cognitive impairment.  Participants were randomized to either a placebo group (n=26) or treatment group (n=26). The treatment was an 8-week program of AA whereases the placebo group received comparable pressure therapy but on non-auricular pressure points. Participants all underwent polysomnography and completed subjective sleep quality and pain scales.

Overall, this study showed decreased subjective sleep scores after four weeks of the intervention, suggesting improved subjective sleep. There were statistically significant differences after 8 weeks in subjective sleep quality. Furthermore, objective measurements of sleep using polysomnography analysis and actigraphy suggest reduced duration and number of awakenings in the intervention group, compared to control. Finally, subjective pain was reported as significantly lower in the intervention group compared to control, suggesting AA may reduce pain. However, this study was certainly limited by its small participant number in both study arms, as well as self-reporting bias. Nonetheless, this study was significant in suggesting that accurate AA reflexology methods may have a beneficial effect on sleep and pain.

 Sleep deprivation is not an effective treatment for major depressive episodes

1. In this systematic review and meta-analysis, there was no difference in changes to depressive symptoms between interventions with adjunct sleep deprivation technique verses interventions without adjunct sleep deprivation techniques.

2. Furthermore, there were very few cases of adverse events with the application of sleep deprivation techniques in treating major depressive episodes.

Evidence Rating Level: 1 (Excellent)

Sleep deprivation (SD) is an accepted treatment for major depressive episodes (MDE) which may impose wakefulness. Often, SD is used in conjunction with other therapy modalities such as bright light therapy. The mechanism of SD is unclear; however, it is postulated that extended wakefulness can increase cortical excitability. The study looked to assess SD in comparison to other interventions in terms of its efficacy, acceptability, and tolerability.

This study conducted a systematic review and meta-analysis in accordance with PRISMA guidelines. Only randomized controlled trials (RCTs) that compared treatments with SD versus those without SD were included in the study. Both sexes (without age restriction) with a current bipolar or unipolar major depressive episode were included. The primary outcomes included reduction in depressive symptoms and any adverse events. Risk of bias was independently reviewed. Mean difference or standardized mean difference was calculated for continuous outcomes, with an odds ratio being calculated for dichotomous outcomes.

Overall, this study included 29 trials in qualitative analysis and 18 studies for quantitative analysis. There was no difference found in interventions that include SD versus those without SD at any time interval. Most studies also highlighted no adverse events; however, there were four cases of hypomania and increased suicidality in three patients. Further sensitivity analysis highlighted that although SD has been thought to be beneficial in MDE, it may be the adjunct therapies themselves that are beneficial, as SD is commonly added to a group of interventions. However, this study was limited by its small number of studies and overall low quality of included studies. Furthermore, there is an inherent inability to blind participants to the treatment group of sleep deprivation. Nonetheless, this study provides evidence that SD may not be useful in the treatment of MDE.

Group-administered recovery programme may help burn-out, fatigue, and poor sleep

1. In this randomized control trial, newly graduated nurses received a cognitive-behavioural therapy (CBT)-based programme on improving sleep and recovery strategies, which improved somatic symptoms such as headaches and back pain.

2. Additionally, there was less burn-out and fatigue symptoms in participants post intervention; however, these effects did not last 6 months post-intervention.

Evidence Rating Level: 2 (Good)

New healthcare workers are at risk of experiencing high levels of stress as they enter the workforce. This can affect sleep due to homeostatic imbalance and circadian disruption, especially in the context of healthcare shift work. There is a paucity of literature examining interventions which promote recovery other than sleep. Supporting recovery may be beneficial for unwinding from stress, handling fatigue, and promoting sleep. This randomized control trial (RCT) sought to determine whether a group-administered recovery programme based on cognitive behavioural therapy could prevent sleep problems, fatigue, burn-out and somatic symptoms.

This study conducted an RCT which randomly allocated participants to the recovery programme intervention (n=99) and a non-intervention control group (n=108). Newly registered nurses (RNs) with less than 12 months of experience across eight hospitals in Sweden were recruited. The intervention group received three, 2.5-hour long group sessions focused on proactive strategies to improve sleep and recovery from shift work as well as work stress. After the intervention, subjective questionnaires for sleep, burn-out, work fatigue, and somatic symptoms were given to participants. At 6 months, these questionnaires were repeated at a follow-up session with the study participants.

Overall, this study demonstrated that the intervention group reported less somatic, burn-out, and insomnia symptoms. At the 6 month-follow up, only somatic symptoms remained decreased in the intervention group. Perceived stress and subjective tension were not improved with the intervention. However, this study was limited by self-selection bias towards nurses with motivation to participate. The study may also not be able to be extrapolated to other healthcare professionals. Nonetheless, this study provides evidence that a group-administered recovery programme may be helpful to prevent somatic symptoms and reduce burn-out symptoms amongst newly graduated RNs.

Image: PD

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