Effectiveness evaluation of the complex medical and psychological method of treating patients with insomnia

This article presents an assessment of the effectiveness of the program for providing medical and psychological care to patients with insomnia, based on psychotherapeutic and psychophysiological approaches, including using a light lamp, biofeedback devices, taking into account clinical and psychological and socio-psychological characteristics, and also evaluates the effectiveness this program. The scientific literature does not describe analogues of the totality of the use of these methods for the contingent of patients with outpatient insomnia. The uniqueness of the developed program lies in its clear algorithmization, the absence of complex techniques of psychological (psychotherapeutic) intervention, which ensures the reproducibility of the program in practical health care institutions if there is a psychotherapist or clinical psychologist on staff who knows the skills of cognitive behavioral therapy and diaphragmatic breathing. The technique has passed clinical testing approved by the Ministry of Health of the Russian Federation (protocol 2020-37-3). The quantitative evaluation of the effectiveness of the method was carried out on seven indicators: (1) Improvement in the subjective characteristics of sleep, (2) Improvement in the quality of sleep, (3) Reduction of the insomnia severity index, (4) Reduction of daytime sleepiness, (5) Reduction of the consequences of sleep disorders, (6) Decreased anxiety, (7) Improved overall clinical impression. As part of the assessment of the achievement of the target result, in accordance with Order 46n of the Ministry of Health of the Russian Federation dated February 2, 2022 (Regulations on Clinical Approbation), a threshold of 85% was set. In terms of (1) Improvement in the subjective characteristics of sleep, (2) Improvement in the quality of sleep, (3) Decrease in the severity index of insomnia, (4) Decrease in daytime sleepiness, the target result was more than 85%, which is significantly higher compared to the control group. An assessment was made of the correspondence of the distribution of indicators to the normal law using the Kholmogorov-Smirnov criterion. Comparison of groups using methods of analytical statistics was carried out using Student's t-test for dependent samples and Mann Whitney's U-test for independent samples. The assessment of the correlation of quantitative results was carried out using the Pearson coefficient (r) for interval variables with a normal distribution. The results are considered to be significant at p<0.01. All obtained empirical values were in the zone of statistical significance. Evaluation of the data obtained in the course of clinical testing shows the effectiveness of the proposed clinical and psychological method for the treatment of insomnia.

1. Vasileva AV, Karavaeva TA. Psychosocial factors of the neurotic disorders treatment and prevention in metropolis. Obozrenie psihiatrii i medicinskoj psihologii imeni V.M. Bekhtereva. 2020;(2):95-104. (In Russ.). https://doi.org/10.31363/2313-7053-2020-2-95-104

2. Karavaeva TA, Vasileva AV, Radionov DS. Alcohol abuse in patients with social phobias: the problems of comorbidity, diagnosis, etiology, pathogenesis, and approaches to psychotherapy. Voprosy narkologii. 2022;7-8(211):27-53 (In Russ.). https://doi.org/10.47877/0234-0623_2022_7-8_27

3. Karavaeva TA, Mikhaylov VA, Vasileva AV, Poltorak SV, Polyakov AYu, Morgacheva TV, Safonova NY. A comparative study of the efficacy of personality-oriented (reconstructive) and cognitive-behavioral psychotherapy in neurotic anxiety disorders with insomnia. Zhurnal Nevrologii i Psikhiatrii imeni S.S. Korsakova. 2018;118(4-2):60-66. (In Russ.). https://doi.org/10.17116/jnevro20181184260

4. Korabel'nikova EA. Possibilities for correcting insomnia without the use of sleeping pills. Ehffektivnaya farmakoterapiya. 2013;12:30-38. (In Russ.).

5. Morozova LG, Posokhov SI, Kovrov GV. Features of subjective assessment of disturbances in the quality of sleep and wakefulness in patients with psychophysiological insomnia. Nevrologicheskii Zhurnal. 2011;16(5):30-34. (In Russ.).

6. Poluektov MG. Treatment of Insomnia in Patients with Comorbid diseeases. Effectivnaya farmakoterapiya. 2018;35:18-23. (In Russ.).

7. Poluektov MG. Sleep disorders in psychiatrists practice. Sovremennaya terapiya psikhicheskikh rasstroistv. 2012;4:11-17. (In. Russ.).

8. Poluéktov MG, Pchelina PV. Chronic insomnia: treatment methods based on the current «3P» model of insomnia. Zhurnal Nevrologii i Psikhiatrii im. S.S. Korsakova. 2015;115(12):141-147.(In Russ.). https://doi.org/10.17116/jnevro2015115112141-147

9. Poluéktov MG, Tsenteradze SL. A contemporary conception of insomnia syndrome and its treatments in view of International classification of sleep disorders. Zhurnal Nevrologii i Psikhiatrii im. S.S. Korsakova. 2014;114(11):92-97. (In Russ.).

10. Strygin KN, Poluektov MG. INSOMNIA. Meditsinskiy sovet. 2017;(1S):52-58. (In Russ.). https://doi.org/10.21518/2079-701X-2017-0-52-58

11. Tsenteradze SL, Poluektov MG. The effect of sleep disorders on health and the possibility of correction of sleep disorders. Meditsinskiy sovet. 2018;(18):30-33. (In Russ.). https://doi.org/10.21518/2079-701X-2018-18-30-33

12. Abad VC, Guilleminault C. Insomnia in Elderly Patients: Recommendations for Pharmacological Management. Drugs Aging. 2018;35(9):791-817. https://doi.org/10.1007/s40266-018-0569-8

13. Alexandros N. Vgontzas, Edward O. Bixler, Hung-Mo Lin, Paolo Prolo, George Mastorakos, Antonio Vela-Bueno, Anthony Kales, George P. Chrousos, Chronic Insomnia Is Associated with Nyctohemeral Activation of the Hypothalamic-Pituitary-Adrenal Axis: Clinical Implications, The Journal of Clinical Endocrinology & Metabolism. 2001;86(8):3787–3794. https://doi.org/10.1210/jcem.86.8.7778

14. Chakravorty S, Chaudhary NS, Brower KJ. Alcohol Dependence and Its Relationship With Insomnia and Other Sleep Disorders. Alcohol Clin Exp Res. 2016;40(11):2271-2282. https://doi.org/10.1111/acer.13217

15. Ebben MR, Spielman AJ. Non-pharmacological treatments for insomnia. J Behav Med. 2009;32(3):244-254. https://doi.org/10.1007/s10865-008-9198-8

16. Edinger JD, Arnedt JT, Bertisch SM, et al. Behavioral and psychological treatments for chronic insomnia disorder in adults: an American Academy of Sleep Medicine systematic review, meta-analysis, and GRADE assessment. J Clin Sleep Med. 2021;17(2):263-298. https://doi.org/10.5664/jcsm.8988

17. Gammack JK. Light therapy for insomnia in older adults. Clin Geriatr Med. 2008;24(1):139-viii. https://doi.org/10.1016/j.cger.2007.08.013

18. Hertenstein E, Feige B, Gmeiner T, et al. Insomnia as a predictor of mental disorders: A systematic review and meta-analysis. Sleep Med Rev. 2019;43:96-105. https://doi.org/10.1016/j.smrv.2018.10.006

19. Javaheri S, Redline S. Insomnia and Risk of Cardiovascular Disease. Chest. 2017;152(2):435-444. https://doi.org/10.1016/j.chest.2017.01.026

20. Kim WH, Joa KL, Kim CB, et al. The Effect of Bright Light Therapy on Sleep and Quality of Life in Patients With Poststroke Insomnia. Psychosom Med. 2022;84(1):123-130. https://doi.org/10.1097/PSY.0000000000001014

21. McMullan RD, Berle D, Arnáez S, Starcevic V. The relationships between health anxiety, online health information seeking, and cyberchondria: Systematic review and meta-analysis. J Affect Disord. 2019;245:270-278. https://doi.org/10.1016/j.jad.2018.11.037

22. Morin CM, Davidson JR, Beaulieu-Bonneau S. Cognitive Behavior Therapies for Insomnia I: Approaches and Efficacy In: Kryger M.H., Roth T., Dement W.C. (eds.) Principles and Practice of Sleep Medicine. 6th ed. Philadelphia: Elsevier. 2016;804-813.

23. Neckelmann D, Mykletun A, Dahl AA. Chronic insomnia as a risk factor for developing anxiety and depression. Sleep. 2007;30(7):873–880. https://doi.org/10.1093/sleep/30.7.873

24. Nutt D, Wilson S, Paterson L. Sleep disorders as core symptoms of depression. Dialogues in clinical neuroscience. 2008;10(3):329–336. https://doi.org/10.31887/DCNS.2008.10.3/dnutt

25. Pasman JA, Smit DJA, Kingma L, Vink JM, Treur JL, Verweij KJH. Causal relationships between substance use and insomnia. Drug Alcohol Depend. 2020;214:108151. https://doi.org/10.1016/j.drugalcdep.2020.10815

26. Riemann D, Baglioni C, Bassetti C, et al. European guideline for the diagnosis and treatment of insomnia. J Sleep Res. 2017;26(6):675-700. https://doi.org/10.1111/jsr.12594

27. Roth T. Insomnia: Definition, Prevalence, Etiology, and Consequences. J Clin Sleep Med 2007;3(5):7–10

28. Schenkel SK, Jungmann SM, Gropalis M, Witthöft M. Conceptualizations of Cyberchondria and Relations to the Anxiety Spectrum: Systematic Review and Meta-analysis. J Med Internet Res. 2021;23(11):e27835. https://doi.org/10.2196/27835

29. Todd J, Austin H, Clarke P, Notebaert L. Chronic Pain, Insomnia and their Mutual Maintenance: A Call for Cognitive Bias Research. J Pain. 2022;23(9):1530-1542. https://doi.org/10.1016/j.jpain.2022.03.241

30. Trauer JM, Qian MY, Doyle JS, Rajaratnam SM, Cunnington D. Cognitive Behavioral Therapy for Chronic Insomnia: A Systematic Review and Meta-analysis. Ann Intern Med. 2015;163(3):191-204. https://doi.org/10.7326/M14-2841

31. Van Maanen A, Meijer AM, van der Heijden KB, Oort FJ. The effects of light therapy on sleep problems: A systematic review and meta-analysis. Sleep Med Rev. 2016;29:52-62. https://doi.org/10.1016/j.smrv.2015.08.009

32. Zhang Y, Jiang X, Liu J, Lang Y, Liu Y. The association between insomnia and the risk of metabolic syndrome: A systematic review and meta-analysis. J Clin Neurosci. 2021;89:430-436. https://doi.org/10.1016/j.jocn.2021.05.039