Rx Free Sleep: Improving Sleep Through Behavioral and Environmental Interventions and Pharmacy Driven Taper Recommendation of Hypnotic Sleep Medications for Assisted Living Residents
AffiliationCollege of Pharmacy, The University of Arizona
MeSH SubjectsSleep Hygiene
Health Services for the Aged
Surveys and Questionnaires
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RightsCopyright © is held by the author.
Collection InformationThis item is part of the Pharmacy Student Research Projects collection, made available by the College of Pharmacy and the University Libraries at the University of Arizona. For more information about items in this collection, please contact Jennifer Martin, Associate Librarian and Clinical Instructor, Pharmacy Practice and Science, firstname.lastname@example.org.
PublisherThe University of Arizona.
AbstractSpecific Aims: To safely reduce the use of potentially dangerous sleep medications in geriatric patients while simultaneously providing sleep hygiene techniques to improve sleep in a natural way without medications. Methods: Study participants enrolled in either sleep hygiene only or sleep hygiene and sleep medication taper track. All participants completed a Sleep Survey and IOWA Fatigue Scale (IFS) pre- and post-intervention. Student pharmacists provided an initial one-on-one educational session on sleep hygiene techniques and set individualized goals with each elder. Those enrolled in the medication taper track had a personalized taper schedule sent to their provider. Follow-up sessions were conducted 3 and 6 weeks after the initial session. Main Results: Among eight participants (mean age 74.8 years, 63% female), those with fatigue per the IFS was reduced from 6 to 3 post-intervention (p=0.375). Sleep questionnaire showed time-to-sleep was shortened by 8.3 minutes, nightly sleep increased by 0.69 hours, and coffee/tea consumption was reduced by 0.38 and 0.13 cups, respectively. While the results demonstrate no statistical improvement in the proportions of participants with fatigue, many participants subjectively reported that they noticed sleep improvements and plan to continue the behavioral changes after the study. Conclusions: Providing proper sleep hygiene education and reducing the use of sleep medications is beneficial in older assisted-living residents. This study showed no negative impacts on Elders’ quality of life and is a simple program that can be implemented at other facilities.
DescriptionClass of 2018 Abstract
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Associations Between Sleep Quality, Sleep Architecture and Sleep Disordered Breathing and Memory After Continuous Positive Airway Pressure in Patients with Obstructive Sleep Apnea in the Apnea Positive Pressure Long-term Efficacy Study (APPLES)Quan, Stuart F; Budhiraja, Rohit; Kushida, Clete A; Univ Arizona, Asthma & Airways Res Ctr (BRAZILIAN ASSOC SLEEP, 2018)Sleep architecture, sleep quality and SDB improved in the CPAP group at 6 months; performance on the Buschke and DSST improved equally in both CPAP and Sham CPAP groups. There also were no significant correlations between changes in the amount or percentage of sleep stages between baseline and the 6 months, and corresponding changes in either the Buschke or the DSST. However, when stratified by the upper quartile and lower 3 quartiles, greater changes in the Buschke occurred over 6 months in the top quartile of total sleep time (5.7±7.3 vs. 4.0±6.8, p≤0.01) and amount of N3 sleep (55.9±7.7 vs. 53.6±8.9 min, p≤0.01). Those with more %N3 at 6 months scored better on the Buschke as well (55.9±7.8 vs. 53.6±8.9, p≤0.01). Borderline improvement in the DSST over 6 months was observed in the top quartiles of amount of N3 and %N3. Those in the top quartile of the amount of REM and %REM also showed greater improvement in the Buschke after 6 months. No differences were observed for the AHI, but those in the top quartile of oxygen desaturation had worse scores on the Buschke at 6 months. CPAP/Sham CPAP adherence did not impact 6 month Buschke or DSST performance.
Sleep to Feel Better: An Investigation of the Role of Sleep in the Internalizing Symptoms of Youth with Type 1 Diabetes MellitusPerfect, Michelle M.; Frye, Sara S.; Perfect, Michelle M.; Sulkowski, Michael; Silva Torres, Graciela E. (The University of Arizona., 2017)Background and Objective: Type 1 diabetes mellitus (T1DM) is one of the most common pediatric chronic illnesses. Youth with T1DM have been shown to be at risk for internalizing problems and obtaining insufficient sleep. An emerging body of literature has demonstrated the feasibility and potential benefit of increasing sleep duration as a strategy to improve psychological outcomes in nondiabetic school age populations. The current study seeks to investigate the relationship between sleep and internalizing symptoms and empirically examine the effect of a sleep extension intervention on internalizing symptoms in youth with T1DM. Methods: The sample consisted of 106 youth with T1DM (mean age = 13.5 ± 2.1 years) who were part of a larger study recruited over a three-year period. Participants were 52.8% male and 50.9% identified as non-white. The primary outcome measure was the Behavior Assessment System for Children, Second Edition (BASC-2), both parent and self-report. Other behavioral and sleep measures included actigraphy, sleep diary, the School Sleep Habits Survey (SSHS), Pediatric Symptoms Checklist (PSC), and the Child Sleep Habits Questionnaire (CSHQ). Participants were randomly assigned to either the Sleep Extension condition (n = 50), in which they were asked to extend their sleep duration, or the Fixed Sleep Duration condition (n = 56), in which they were asked to maintain the same amount of sleep as their baseline. Results: Average sleep durations varied across measures, with all values falling in the lower range or below national recommendations. More than a third (34.5%) of the sample had elevated scores for internalizing problems based on parent report, and 17.7% were elevated based on self-report. Pearson correlations indicated that parent reported sleep duration was negatively related to self-reported anxiety, r(106) = -0.237, p = 0.018, as well as parent-reported depression, r(106) = -0.218, p = 0.028, and emotional self-control, r(106) = -0.232, p = 0.018. No other measure of sleep duration was significantly correlated with internalizing symptoms. Secondary analyses of measures of sleep quality including sleep efficiency (SE), wake after sleep onset (WASO), and sleepiness, were significantly related to internalizing problems based on both parent and self-report (all p < 0.05), whereas more variability in sleep duration (CV) was related to higher self-reported depression, r(106) = 0.210, p = 0.033. Following the sleep intervention, participants in the Sleep Extension condition increased their average sleep duration by 26.71 minutes based on actigraphy, while participants in the Fixed Sleep duration decreased by 0.14 minutes from pre- to post-intervention. Participants in the Sleep Extension condition had significantly lower scores on the BASC-2 Internalizing Problems Composite than participants in the Fixed Sleep Duration condition following the intervention, after controlling for sex and baseline internalizing symptoms, F(1, 98) = 4.18, p = 0.044. On average, the Internalizing Problems Composite score of participants in the Sleep Extension condition decreased by almost half a standard deviation (4.65 ± 6.41 points), compared to a decrease of 2.31 ± 6.59 points for participants in the Fixed Sleep Duration condition. There were no significant effects for self-report. Conclusions: Youth with T1DM obtained insufficient sleep and experienced high rates of internalizing symptoms. The results also suggest that relations between sleep and internalizing symptoms exist; however, these associations may be more driven by other aspects of sleep rather than actual sleep loss, such as nighttime sleep disturbance, daytime sleepiness, and variability of the sleep schedule. The findings further indicated that a sleep extension intervention was effective in increasing sleep duration, as well as reducing parent-reported internalizing symptoms in a sample of children and adolescents with T1DM. This intervention has the potential to be utilized as a cost effective, and relatively easy to implement method for reducing internalizing symptoms in youth with T1DM.
Effects of Total Sleep Time and Sleep Schedule Alignment on Cognitive Functioning in AdolescentsGomez, Rebecca; Winans, Shannon Marie (The University of Arizona., 2015)Recently, adolescent sleep research has produced conflicting results about the effect of sleep on cognition in this age group. Some have proposed that adolescents possess a mechanism for cognitive resiliency that allows their cognitive performance to remain stable despite restricted sleep. Others maintain that the conflicting outcomes stem from the sleep/wake parameters traditionally used in sleep research that are rarely adjusted to allow for natural adolescent sleep rhythms, which may be masking the true effect of inadequate sleep on adolescent cognitive functioning. This study aims to elucidate these two theories by comparing both sleep time and sleep rhythm alignment with cognitive functioning. We tracked 16 adolescents' sleep for one week and determined their sleep time and whether they were sleeping in alignment with their natural sleep rhythms. Both of these variables were then compared to subjects' performance on an n-back task of working memory on Monday morning. The results showed that neither sleep amount nor natural sleep rhythm alignment were able to predict any measure of the working memory test. These results support the theory of a cognitive resiliency mechanism in adolescents, and do not support sleep rhythm misalignment as a significant confounding variable in previous adolescent sleep studies.