Effectiveness of Non-pharmacological Interventions for Improving Sleep Quality in Patients With Chronic Medical Conditions: A Systematic Review
DOI:
https://doi.org/10.56570/jimgs.v2i2.135Keywords:
Sleep disturbance, Chronic medical conditions, Non-pharmacological therapies, Cognitive behavioural therapy (CBT), Systematic review (PRISMA, CASP)Abstract
Sleep disturbance in patients with chronic medical conditions is common, and an additional factor is significantly causing distress and delay in recovery. Pharmacological interventions led to more difficulties and reactions to medicines affecting overall health. To improve sleep quality for people with chronic medical disorders, this systematic review evaluated the effectiveness of non-pharmacological therapies. The Critical Appraisal Skills Programme (CASP) instrument was used to evaluate the review's quality, and it complied with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards. In individuals with chronic medical illnesses, this systematic review emphasises the potential efficacy of non-pharmacological therapies for improving sleep quality. The overwhelming body of research supports the inclusion of therapies such as cognitive behavioural therapy, relaxation training, and sleep restriction therapy in the comprehensive care of these patients. Three papers were found to be relevant after a thorough search through medical databases including PubMed, Springer, NCBI, ResearchGate, and WILEY Online Library. The studies included an extensive variety of non-pharmacological therapies, including cognitive behavioural therapy, relaxation techniques, and advice on good sleep hygiene. A wide variety of chronic medical conditions were the focus of these therapies. According to two of the three trials, increases in sleep quality, as determined by approved assessment methods, were statistically significant. Particularly, cognitive behavioural therapy consistently outperformed control groups in investigations, underscoring its promise as a useful treatment. The third research, however, found no appreciable benefits, highlighting the disparity in results, despite variances in results and study limitations. The findings of this analysis indicate that non-pharmacological treatments have the tendency to improve patients’ quality of sleep while managing their chronic medical problems. It recommends that further research be done using bigger sample sizes and more exacting procedures in order to increase the strength of the supporting evidence and enable a more focused therapeutic application.References
Hacer Alataş, Arslan N. Sleep, malnutrition, and quality of life in elderly hemodialysis patients: A cross-sectional study. Médecine Palliative. 2023;22(5):260-268. doi:https://doi.org/10.1016/j.medpal.2023.06.008
Alimoradi Z, Jafari E, Anders Broström, Pakpour AH. Effects of Cognitive Behavioral Therapy for Insomnia (CBT-I) on Quality of Life: A Systematic Review and... ResearchGate. Published May 2022. Accessed September 22, 2023. https://www.researchgate.net/publication/360493966_Effects_of_Cognitive_Behavioral_Therapy_for_Insom nia_CBT-I_on_Quality_of_Life_A_Systematic_Review_and_Meta -Analysis
Artom M, Wladyslawa Czuber-Dochan, Sturt J, Proudfoot H, Roberts D, Norton C. Cognitive-behavioural therapy for the management of inflammatory bowel disease-fatigue: a feasibility randomised controlled trial. Pilot and Feasibility Studies. 2019;5(1). doi:https://doi.org/10.1186/s40814-019-0538-y
Alessia Baccarani, Donnadieu S, Pellissier S, Brochard R. Relaxing effects of music and odors on physiological recovery after cognitive stress and unexpected absence of multisensory benefit. Psychophysiology. Published online January 25, 2023. doi:https://doi.org/10.1111/psyp.14251
Ann Tee-Melegrito R. What is sleep restriction therapy, and how does it work? Medicalnewstoday.com. Published May 30, 2022. Accessed September 22, 2023. https://www.medicalnewstoday.com/articles/sleep-restriction-therapy
Navya Baranwal, Yu PK, Siegel N. Sleep physiology, pathophysiology, and sleep hygiene. Progress in Cardiovascular Diseases. 2023;77:59-69. doi:https://doi.org/10.1016/j.pcad.2023.02.005
Beswick AD, Wylde V, Bertram W, Whale K. The effectiveness of non-pharmacological sleep interventions for improving inpatient sleep in hospital: A systematic review and meta-analysis. Sleep Medicine. 2023;107:243-267. doi:https://doi.org/10.1016/j.sleep.2023.05.004
Bigirumurame T, Hiu S, M. Dawn Teare, Wason J, Bryant A, Breckons M. Current practices in studies applying the target trial emulation framework: a protocol for a systematic review. BMJ Open. 2023;13(6):e070963-e070963. doi:https://doi.org/10.1136/bmjopen-2022-070963
Baglioni C, Espie CA, Riemann D. Cognitive-Behavioural Therapy for Insomnia (CBT-I) across the Life Span. John Wiley & Sons; 2022. Accessed September 22, 2023. https://www.wiley.com/en-br/Cognitive+Behavioural+Therapy+for+Insomnia+% 28CBT+I%29+Across+the+Life+Span%3A+Guidelines +and+Clinical+Protocols+for+Health+Professionals-p-9781119785132
Blackman J, Swirski M, Clynes J, Harding S, Leng Y, Coulthard E. Pharmacological and non‐pharmacological interventions to enhance sleep in mild cognitive impairment and mild Alzheimer’s disease: A systematic review. Journal of Sleep Research. 2020;30(4). doi:https://doi.org/10.1111/jsr.13229
Brown S, Shah A, Wladyslawa Czuber‐Dochan, Bench S, Stayt L. Non-pharmacological interventions for self-management of fatigue in adults: An umbrella review of potential interventions to support patients recovering from critical illness. Journal of Critical Care. 2023;75:154279-154279. doi:https://doi.org/10.1016/j.jcrc.2023.154279
Campbell R, Bridges AJ. Bedtime procrastination mediates the relation between anxiety and sleep problems. Journal of Clinical Psychology. Published online September 28, 2022. doi:https://doi.org/10.1002/jclp.23440
Chen Y, Zhang R, Lou Y, Li W, Yang H. Facilitators and barriers to the delivery of palliative care to patients with Parkinson’s disease: a qualitative study of the perceptions and experiences of stakeholders using the socio-ecological model. BMC Health Services Research. 2023;23(1). doi:https://doi.org/10.1186/s12913-023-09203-2
Fleming LW, Gillespie SC, Espie CA. The development and impact of insomnia on cancer survivors: a qualitative analysis. Psycho-oncology. 2009;19(9):991-996. doi:https://doi.org/10.1002/pon.1652
Cristini J, Weiss M, Bernat, et al. The effects of exercise on sleep quality in persons with Parkinson’s disease: A systematic review with meta-analysis. Sleep Medicine Reviews. 2021;55:101384-101384. doi:https://doi.org/10.1016/j.smrv.2020.101384
de Kock, S, Stirk L, Ross J, Duffy S, Caro Noake, Misso K. Systematic review search methods evaluated using the Preferred Reporting of Items for Systematic Reviews and Meta-Analyses and the Risk Of Bias In Systematic reviews tool. International Journal of Technology Assessment in Health Care. 2020;37(1). doi:https://doi.org/10.1017/s0266462320002135
Amir-Behghadami M. SPIDER as a framework to formulate eligibility criteria in qualitative systematic reviews. BMJ supportive & palliative care. Published online May 11, 2021:bmjspcare-003161. doi:https://doi.org/10.1136/bmjspcare-2021-003161
S. Monache, Jia D, Kamphuis D, E. Özcan. Exploring profiling and personalisation in sleep music design: towards conceptualising musical sleep aids for hospital use. Proceedings of the 17th International Audio Mostly Conference. Published 2022. Accessed September 22, 2023. https://www.semanticscholar.org/paper/Exploring-profiling-and-personalisation-in-sleep-Monache-Jia/db5e02d3bffa3396598526bafc5e475abdcee997
Efrosini Papaconstantinou, Cancelliere C, Verville L, et al. Effectiveness of non-pharmacological interventions on sleep characteristics among adults with musculoskeletal pain and a comorbid sleep problem: a systematic review. Chiropractic & Manual Therapies. 2021;29(1). doi:https://doi.org/10.1186/s12998-021-00381-6
Elliott-Sale KJ, Minahan C, Janse X, et al. Methodological Considerations for Studies in Sport and Exercise Science with Women as Participants: A Working Guide for Standards of Practice for Research on Women. Sports Medicine. 2021;51(5):843-861. doi:https://doi.org/10.1007/s40279-021-01435-8
Enomoto K, Adachi T, Fujino H, Masato Kugo, Tatsumi S, Sasaki J. Comparison of the effectiveness of cognitive behavioral therapy for insomnia, cognitive behavioral therapy for pain, and hybrid cognitive behavioral therapy for insomnia and pain in individuals with comorbid insomnia and chronic pain: A systematic review and network meta-analysis. Sleep Medicine Reviews. 2022;66:101693-101693. doi:https://doi.org/10.1016/j.smrv.2022.101693
Esposito D, Belli A, Ferri R, Bruni O. Sleeping without Prescription: Management of Sleep Disorders in Children with Autism with Non-Pharmacological Interventions and Over-the-Counter Treatments. Brain Sciences. 2020;10(7):441-441. doi:https://doi.org/10.3390/brainsci10070441
Faulkner S, Bee P, Meyer N, Derk Jan Dijk, Drake R. Light therapies to improve sleep in intrinsic circadian rhythm sleep disorders and neuro-psychiatric illness: A systematic review and meta-analysis. Sleep Medicine Reviews. 2019;46:108-123. doi:https://doi.org/10.1016/j.smrv.2019.04.012
Ginsberg JP, Raghunathan K, Gabriel Shimizu Bassi, Ulloa L. Review of Perioperative Music Medicine: Mechanisms of Pain and Stress Reduction Around Surgery. Frontiers in Medicine. 2022;9. doi:https://doi.org/10.3389/fmed.2022.821022
Goel A, Narayan S, Ramkumar Sugumaran. Neuropsychiatric features, health-related quality of life, and caregiver burden in parkinson’s disease. Annals of Indian Academy of Neurology. 2022;25(6):1147-1147. doi:https://doi.org/10.4103/aian.aian_38_22
Gombault C, Grenet G, Ségurel L, et al. Population designations in biomedical research: Limitations and perspectives. HLA: Immune Response Genetics. 2022;101(1):3-15. doi:https://doi.org/10.1111/tan.14852
Her J, Cho MK. Effect of aromatherapy on sleep quality of adults and elderly people: A systematic literature review and meta-analysis. Complementary Therapies in Medicine. 2021;60:102739-102739. doi:https://doi.org/10.1016/j.ctim.2021.102739
Hossain MdF, Uddin MdS, Uddin GMS, et al. Melatonin in Alzheimer’s Disease: A Latent Endogenous Regulator of Neurogenesis to Mitigate Alzheimer’s Neuropathology. Molecular Neurobiology. Published online June 17, 2019. doi:https://doi.org/10.1007/s12035-019-01660-3
Hurkacz M, Łukasz Dobrek, Wiela-Hojeńska A. Antibiotics and the Nervous System—Which Face of Antibiotic Therapy Is Real, Dr. Jekyll (Neurotoxicity) or Mr. Hyde (Neuroprotection)? Molecules. 2021;26(24):7456-7456. doi:https://doi.org/10.3390/molecules26247456
Sema İçel, Ceyda Başoğul. Effects of progressive muscle relaxation training with music therapy on sleep and anger of patients at Community Mental Health Center. Complementary Therapies in Clinical Practice. 2021;43:101338-101338. doi:https://doi.org/10.1016/j.ctcp.2021.101338
Idris N, Astarani K. Therapy of Effective Progressive Muscle Relaxation to Reduce Insomnia in Elderly. Strada: Jurnal Ilmiah Kesehatan. 2019;8(2):165-171. doi:https://doi.org/10.30994/sjik.v8i2.219
Inangil D, Şendir M, Kabuk A, Türkoğlu İ. The Effect of Music Therapy and Progressive Muscle Relaxation Exercise on Anxiety Before the First Clinical Practice in Nursing Students: A Randomized Controlled Study. Florence Nightingale Journal of Nursing. 2020;28(3):341-349. doi:https://doi.org/10.5152/fnjn.2020.19075
Isernia S, Sonia Di Tella, Pagliari C, et al. Effects of an Innovative Telerehabilitation Intervention for People With Parkinson’s Disease on Quality of Life, Motor, and Non-motor Abilities. Frontiers in Neurology. 2020;11. doi:https://doi.org/10.3389/fneur.2020.00846
Jensen ES, Ladegaard N, Mellentin AI, Mathiasen K. Effect of sleep disturbance symptoms on treatment outcome in blended CBT for depression: A secondary... ResearchGate. Published May 21, 2021. Accessed September 22, 2023. https://www.researchgate.net/publication/356992007_Effect_of_sleep_disturbance_symptoms_on_treatment_outcome_in_blended_CBT_for_depression_A_second ary_analysis_of_the_E-COMPARED_study_Preprint
Jiang X, Zhang L, Liu H, et al. Efficacy of non-pharmacological interventions on depressive symptoms in patients with Parkinson’s disease: a study protocol for a systematic review and network meta-analysis. BMJ Open. 2023;13(5):e068019-e068019. doi:https://doi.org/10.1136/bmjopen-2022-068019
Kaul SM, Arun JK. The Psychological Influence of a Musical Therapeutic Intervention on Hospitalized Patients. Journal for ReAttach Therapy and Developmental Diversities. 2023;6(7s):315-325. Accessed September 22, 2023. https://jrtdd.com/index.php/journal/article/view/795
Koivu, A. M., Hunter, P. J., Näsänen-Gilmore, P., Muthiani, Y., Isojärvi, J., Pörtfors, P., ... & Ashorn, P. (2021). Modular literature review: a novel systematic search and review method to support priority setting in health policy and practice. BMC Medical Research Methodology, 21(1), 1-13.
Latocha, K. M., Løppenthin, K., Jennum, P., Christensen, R., Østergaard, M., & Esbensen, B. A. (2023). Experiences of group-based cognitive behavioural therapy for insomnia among patients with rheumatoid arthritis: a qualitative study. BMJ open, 13(1), e066221.
Lee S, Ji Hyun Kim, Jae Ho Chung. The association between sleep quality and quality of life: a population-based study. Sleep Medicine. 2021;84:121-126. doi:https://doi.org/10.1016/j.sleep.2021.05.022
Lin L, Song Q, Duan JX, et al. The impact of impaired sleep quality on symptom change and future exacerbation of chronic obstructive pulmonary disease. Respiratory Research. 2023;24(1). doi:https://doi.org/10.1186/s12931-023-02405-6
Liu, H., Zhou, X., Yu, G., & Sun, X. (2019). The effects of the PRISMA statement to improve the conduct and reporting of systematic reviews and meta‐analyses of nursing interventions for patients with heart failure. International Journal of Nursing Practice, 25(3), e12729.
Long, H. A., French, D. P., & Brooks, J. M. (2020). Optimising the value of the critical appraisal skills programme (CASP) tool for quality appraisal in qualitative evidence synthesis. Research Methods in Medicine & Health Sciences, 1(1), 31-42.
Magdy Mohammed Abd Elsalam, R. (2020). Effects of Sleep Restriction Therapy versus Progressive Muscles Relaxation Technique on Sleep Quality among Older Adults. Egyptian Journal of Health Care, 11(3), 978-992.
Mangat A, Schmölzer GM, Kraft WK. Pharmacological and non-pharmacological treatments for the Neonatal Abstinence Syndrome (NAS). Seminars in fetal & neonatal medicine. 2019;24(2):133-141. doi:https://doi.org/10.1016/j.siny.2019.01.009
McLaren D, Evans JJ, Satu Baylan, Smith SA, Gardani M. The effectiveness of the behavioural components of cognitive behavioural therapy for insomnia in older adults: A systematic review. Journal of Sleep Research. 2023;32(4). doi:https://doi.org/10.1111/jsr.13843
Chen ML, Chen YE, Lee HF. The Effect of Bergamot Essential Oil Aromatherapy on Improving Depressive Mood and Sleep Quality in Postpartum Women: A Randomized Controlled Trial. Journal of Nursing Research. 2022;30(2):e201-e201. doi:https://doi.org/10.1097/jnr.0000000000000459
Miller MM, Renn BN, Chu F, Torrence N. Sleepless in the hospital: A systematic review of non-pharmacological sleep interventions. General Hospital Psychiatry. 2019;59:58-66. doi:https://doi.org/10.1016/j.genhosppsych.2019.05.0 06
Morin CM. Profile of Somryst Prescription Digital Therapeutic for Chronic Insomnia: Overview of Safety and Efficacy. Expert Review of Medical Devices. 2020;17(12):1239-1248. doi:https://doi.org/10.1080/17434440.2020.1852929
Nimmo-Smith V, Merwood A, Hank D, et al. Non-pharmacological interventions for adult ADHD: a systematic review. Psychological Medicine. 2020;50(4):529-541. doi:https://doi.org/10.1017/s0033291720000069
Ong JC, Crawford MR, Dawson SC, et al. A randomized controlled trial of CBT-I and PAP for obstructive sleep apnea and comorbid insomnia: main outcomes from the MATRICS study. Sleep. 2020;43(9). doi:https://doi.org/10.1093/sleep/zsaa041
Page MJ, Moher D, Bossuyt PM, et al. PRISMA 2020 explanation and elaboration: updated guidance and exemplars for reporting systematic reviews. BMJ. Published online March 29, 2021:n160-n160. doi:https://doi.org/10.1136/bmj.n160
Jaziar Radianti, Majchrzak TA, Fromm J, Wohlgenannt I. A systematic review of immersive virtual reality applications for higher education: Design elements, lessons learned, and research agenda. Computers & Education. 2020;147:103778-103778. doi:https://doi.org/10.1016/j.compedu.2019.103778
Taximaimaiti R, Luo X, Wang X. Pharmacological and Non-pharmacological Treatments of Sleep Disorders in Parkinson’s Disease. Current Neuropharmacology. 2021;19(12):2233-2249. doi:https://doi.org/10.2174/1570159x1966621051711 5706
Reynolds A, Coenen P, Bastien Lechat, et al. Insomnia and workplace productivity loss among young working adults: a prospective observational study of clinical sleep disorders in a community cohort. The Medical Journal of Australia. 2023;219(3):107-112. doi:https://doi.org/10.5694/mja2.52014
Brito RA, Maria S, Beatriz Amorim Beltrão, Bentes C, Meireles V, Felipe P. Pharmacological and non-pharmacological interventions to promote sleep in intensive care units: a critical review. Sleep and Breathing. 2019;24(1):25-35. doi:https://doi.org/10.1007/s11325-019-01902-7
23.Saleha TY, Cahyati Y, Triguna Y. Use of Earplugs and Eye Masks in Patients with Sleep Disorders in the ICU: Systematic Review. ResearchGate. Published April 30, 2023. Accessed September 22, 2023. https://www.researchgate.net/publication/371641834_Use_of_Earplugs_and_Eye_Masks_in_Patients_with_ Sleep_Disorders_in_the_ICU_Systematic_Review
Y. Jannati, Samadi Z, A. Hamidia, R. Mohammadpour, A. Hesamzadeh. The effect of aromatherapy with lavender essential oil on sleep quality in patients with major depression. Journal of Nursing and Midwifery Sciences. Published 2021. Accessed September 22, 2023. https://www.semanticscholar.org/paper/The-effect-of-aromatherapy-with-lavender-essential-Jannati-Samadi/ebc3617feedf3b59d995f9d3ef17b5ebf3ab330c
Santos E, Duarte C, Ferreira RO, Jose. Portuguese multidisciplinary recommendations for non-pharmacological and non-surgical interventions in... ResearchGate. Published February 20, 2021. Accessed September 22, 2023. https://www.researchgate.net/publication/349465898 _Portuguese_multidisciplinary_recommendations_for_ non-pharmacological_and_non-surgical_interventions_in_patients_with_rheumatoid_a rthritis
Saranya ML, Sreehari R, Mithun CB, P. Sangeetha. Comparative role of affective–Cognitive behavior therapy and jacobson’s progressive muscular relaxation in managing pain among patients with fibromyalgia. Indian Journal of Rheumatology. 2023;18(1):26-26. doi:https://doi.org/10.4103/injr.injr_49_21
Savard J, Filion C, Gagnon MP, Aude Caplette-Gingras, Bélanger L, Morin CM. Barriers and facilitators to implementing a stepped care cognitive-behavioral therapy for insomnia in cancer patients: a qualitative study. Supportive Care in Cancer. 2022;30(8):6689-6698. doi:https://doi.org/10.1007/s00520-022-07094-3
Sayers EW, Bolton E, J. Rodney Brister, et al. Database resources of the national center for biotechnology information. Nucleic Acids Research. 2021;50(D1):D20-D26. doi:https://doi.org/10.1093/nar/gkab1112
Selvanathan J, Pham C, Mahesh Nagappa, et al. Cognitive behavioral therapy for insomnia in patients with chronic pain – A systematic review and meta-analysis of randomized controlled trials. Sleep Medicine Reviews. 2021;60:101460-101460. doi:https://doi.org/10.1016/j.smrv.2021.101460
Shorey S, Esperanza Debby Ng. Examining characteristics of descriptive phenomenological nursing studies: A scoping review. Journal of Advanced Nursing. 2022;78(7):1968-1979. doi:https://doi.org/10.1111/jan.15244
Sietske A.M. Sikkes, Tang Y, Jutten RJ, et al. Toward a theory‐based specification of non‐pharmacological treatments in aging and dementia: Focused reviews and methodological recommendations. Alzheimers & Dementia. 2020;17(2):255-270. doi:https://doi.org/10.1002/alz.12188
Statsenko Y, Tetiana Habuza, Darya Smetanina, et al. Unraveling Lifelong Brain Morphometric Dynamics: A Protocol for Systematic Review and Meta-Analysis in Healthy Neurodevelopment and Ageing. Biomedicines. 2023;11(7):1999-1999. doi:https://doi.org/10.3390/biomedicines11071999
Stout NL, Daniel Santa Mina, Kathleen Doyle Lyons, Robb K, Silver JK. A systematic review of rehabilitation and exercise recommendations in oncology guidelines. CA: A Cancer Journal for Clinicians. 2020;71(2):149-175. doi:https://doi.org/10.3322/caac.21639
Tang, H., Chen, L., Wang, Y., Zhang, Y., Yang, N., & Yang, N. (2021). The efficacy of music therapy to relieve pain, anxiety, and promote sleep quality, in patients with small cell lung cancer receiving platinum-based chemotherapy. Supportive Care in Cancer, 29(12), 7299-7306.
Tran L, Hien N, Abdelrahman Elshafay, Dang T, Hirayama K, Nguyen Tien Huy. Quality assessment tools used in systematic reviews of in vitro studies: A systematic review. BMC Medical Research Methodology. 2021;21(1). doi:https://doi.org/10.1186/s12874-021-01295-w
31. Yuliona G, Nur Agustini, Nani Nurhaeni, Yeni Rustina. The Effect of Sleep Hygiene Education on Sleep Quality in Children with Type 1 Diabetes Mellitus: A Preliminary Study. Comprehensive child and adolescent nursing. 2019;42(sup1):189-196. doi:https://doi.org/10.1080/24694193.2019.1578440
Whale K, Dennis JA, Wylde V, Beswick AD, Gooberman-Hill R. The effectiveness of non-pharmacological sleep interventions for people with chronic pain: a systematic review and meta-analysis. BMC Musculoskeletal Disorders. 2022;23(1). doi:https://doi.org/10.1186/s12891-022-05318-5
Waller S, Williams L, Victor S.C. Fung, Qiu J, Tsui D, Griffith J. An approach to acute clinical deterioration in patients with late-stage Parkinson’s disease. AJGP. 2022;51(8):577-583. doi:https://doi.org/10.31128/ajgp-03-22-6363
Williams V, Boylan AM, Nunan D. Critical appraisal of qualitative research: necessity, partialities and the issue of bias. BMJ evidence-based medicine. 2019;25(1):9-11. doi:https://doi.org/10.1136/bmjebm-2018-111132
Xiao CX, Lin Y, Lin RM, Liu AN, Zhong G, Lan CF. Effects of progressive muscle relaxation training on negative emotions and sleep quality in COVID-19 patients. Medicine. 2020;99(47):e23185-e23185. doi:https://doi.org/10.1097/md.0000000000023185
S. Mirzanah, Yona S, D. Dahlia. Effect Of Progressive Muscle Relaxation On Sleep Quality Among Patients With Chronic Diseases: A Literature Review. Published 2020. Accessed September 22, 2023. https://www.semanticscholar.org/paper/Effect-Of-Progressive-Muscle-Relaxation-On-Sleep-A-Mirzanah-Yona/94daf4a39ea20c57ad742064fb46a5527459471b
