USING NEW TECHNOLOGY TO GET A BETTER NIGHT’S SLEEP
A whole new approach to getting a good night’s sleep is now just a click away. A new study from the University of Oxford and Northwestern Medicine has found treating insomnia with digital programs can improve symptoms. In a year-long study involving 1,711 people, researchers found online cognitive behavioural therapy (CBT) improved not only insomnia symptoms but also functional health, psychological well-being and sleep-related quality of life.
A major limitation of insomnia treatments is the lack of providers to deliver CBT, but this study used an online platform that made it easily accessible to users. It also automated and tailored the treatment based on the user’s sleep patterns. Study co-author Jason Ong said there is a four-to-six month wait for an insomnia patient to get an appointment in his sleep clinic. “We can reach many more patients with insomnia by using a digitally based program,” said Ong, associate professor of neurology in sleep medicine at Northwestern University Feinberg School of Medicine in Chicago (Illinois).
Insomnia has been identified as a risk factor for the development of mental health disorders, cardiovascular disease and type 2 diabetes. “Sleep ranks with air, water and food as one of the essentials of life, yet 10 to 12 per cent of the population doesn’t get enough of it due to insomnia,” said lead study author Colin Espie, Oxford University professor of sleep medicine and chief medical officer of Big Health, a provider of automated and personalised behavioural medicine programs for mental health.
He said these study findings, which were published in JAMA Psychiatry, suggest that digital medicine could be a powerful way to help millions of people not just sleep better but achieve better mental and physical well-being as a result. Though insomnia has traditionally been treated with pharmaceuticals, new guidelines published in 2016 by the American College of Physicians recommend that CBT be used first-line, ahead of sleeping pills. Study participants received treatment using the Sleepio program and an associated iOS app. Delivery was structured into six sessions lasting an average of 20 minutes each, with participants having access to the intervention for up to 12 weeks. Researchers assessed the study participants online at zero weeks (baseline), four weeks (mid treatment), eight weeks (post-treatment) and 24 weeks ( follow- up). Program content was based on CBT manuals and included behavioural, cognitive and educational components.
In the digital CBT (dCBT) group, 689 participants (80.8 per cent) logged on for at least one session, 491 participants (57.6 per cent) completed at least four sessions, and 413 participants (48.4 per cent) completed all six sessions. At each follow-up visit, dCBT was associated with significant improvement in global health and mental wellbeing
RETHINKING STATINS IN SOME OLDER ADULTS
A new Spanish study is questioning whether some older adults should be taking a statin medication for their cholesterol levels. The study does not support widespread use of statins in healthy older people to prevent heart disease. Any protective effect was limited to those with type 2 diabetes aged between 75 and 84.
In a newly published study researchers found statins are not associated with a reduction in cardiovascular disease or death in healthy people age 75 or older. The results of the study do not support the widespread use of statins in adults 75 and older, but they do support treatment in selected people, such as those aged 75-84 years with type 2 diabetes, said Spanish researchers.
Using data from the Catalan primary care system database (SIDIAP), they identified 46,864 people aged 75 years or more with no history of cardiovascular disease between 2006 and 2015. Participants were grouped into those with and without type 2 diabetes and as statin non-users or new users (anyone starting statins for the first time during the study enrolment period). Primary care and hospital records were then used to track cases of CVD (including coronary heart disease, angina, heart attack and stroke) and death from any cause (all-cause mortality) over an average of 5.6 years.
In participants without diabetes, statin treatment was not associated with a reduction in CVD or all-cause mortality in both old and very old age groups, even though the risk of CVD in both groups was higher than the risk thresholds proposed for statin use in guidelines. However, in participants with diabetes statins were associated with significantly reduced levels of CVD (24 per cent) and allcause mortality (16 per cent) in those aged 75-84 years. The study showed that this protective effect declined after age 85 and disappeared by age 90.