Ann Bowden, Ava Lorenc, Nicola Robinson
Journal: Primary health care research & development 2012;13(2):175-85
PMID: 21787446
Insomnia, which may include difficulty falling asleep, waking up frequently and feeling un-refreshed on waking, is a common problem and is often associated with anxiety. Current NICE guidelines for treating insomnia in primary care recommend that behavioural approaches should be considered before prescribing medication. Autogenic Training (AT) is a stress management technique which has been shown to improve sleep problems, anxiety and depression. This prospective cohort study examined the effectiveness of AT as a self-management, non-drug approach to sleep disorders within an NHS outpatient clinic in patients with chronic ill health. 153 participants who completed an 8 week AT course with weekly 2h group sessions, which had no specific focus on sleep, and daily home practice. Primary outcome assessed was impact on sleep, secondary outcomes were symptoms and wellbeing (measured by Measure Your Medical Outcome Profile, MYMOP, questionnaire) and anxiety and depression (measured by the Hospital Anxiety and Depression Scale, HADS). Outcomes were measured 2.5 months prior to AT course, at the start and at the end of the AT course; and at follow-up. 73% of participants reported sleep problems. Significant improvements were seen for time taken to fall asleep, difficulty getting back to sleep, energy levels, dream recall and feeling refreshed upon waking, between before and at the end of AT. Anxiety/depression was reported by 64% of participants as their most important current health problem, and significant improvements seen in both anxiety and depression. Overall wellbeing, as assessed by MYMOP, also increased significantly. The authors conclude that AT can improve sleep patterns in patients with a wide range of health conditions and may reduce depression and anxiety, which can both result from and cause insomnia, and may offer an alternative to drug treatment.
BACKGROUND
Insomnia is commonly associated with chronic health problems. Behavioural and cognitive factors often perpetuate a vicious cycle of anxiety and sleep disturbance, leading to long-term insomnia. National Institute for Health and Clinical Excellence currently recommends behavioural approaches before prescribing hypnotics. Behavioural approaches aim to treat underlying causes, but are not widely available. Research usually includes patients diagnosed with insomnia rather than secondary, co-morbid sleep- related problems.
AIM
To examine the effectiveness of autogenic training (AT) as a non-drug approach to sleep-related problems associated with chronic ill health.
DESIGN
Prospective pre- and post-treatment cohort study.
SETTING
AT centre, Royal London Hospital for Integrated Medicine, University College London Hospitals NHS Foundation Trust.
METHODS
All patients referred for AT from April 2007 to April 2008 were invited to participate. Participants received standard 8-week training, with no specific focus on sleep. Sleep questionnaires were administered at four time points, 'Measure Your Medical Outcome Profile' (MYMOP) and Hospital Anxiety and Depression Scale, before and after treatment. Results before and after treatment were compared. Camden and Islington Community Local Research and Ethics Committee approved the study.
RESULTS
The AT course was completed by 153 participants, of whom 73% were identified as having a sleep-related problem. Improvements in sleep patterns included: sleep onset latency (P = 0.049), falling asleep quicker after night waking (P < 0.001), feeling more refreshed (P < 0.001) and more energised on waking (P = 0.019). MYMOP symptom, well-being, anxiety and depression scores significantly improved (all P < 0.001).
CONCLUSION
This study suggests that AT may improve sleep patterns for patients with various health conditions and reduce anxiety and depression, both of which may result from and cause insomnia. Improvements in sleep patterns occurred despite, or possibly due to, not focusing on sleep during training. AT may provide an approach to insomnia that could be incorporated into primary care.
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