ผลของโปรแกรมการจัดการการนอนไม่หลับต่อความรุนแรงของการนอนไม่หลับและคุณภาพการนอนหลับในผู้สูงอายุที่มีภาวะหัวใจล้มเหลว

Abstract

Insomnia is the most common problem among older persons with heart failure. Insomnia has a negative impact on older persons with heart failure in various aspects. Cognitive and behavioral therapy for insomnia (CBT-I) is a combination of multiple components for management of insomnia. It can reduce the severity of insomnia and improve sleep quality. The purpose of this quasiexperimental study was to examine the effects of an insomnia management program developed from the CBT-I concepts of Morin (Morin, 1993) and a literature review on insomnia severity and sleep quality. The subjects were older persons with heart failure, aged between 60-75 years, receiving outpatient treatment from January to June 2021. A total of 48 subjects were purposive selected and assigned into a control group and an experimental group equally, with 24 in each group; however, one participant from the experimental group withdrew from the study due to the COVID-19 situation. The research instruments consisted of 1) the Insomnia Severity Index (ISI), 2) the Thai-Pittsburgh Sleep Quality Index (Thai-PSQI), 3) an Insomnia Management Program for older persons with heart failure which consisted of education, finding sleep stimuli and dysfunctional thoughts, cognitive therapy, behavioral therapy (including sleep stimulus control and sleep hygiene), progressive muscle relaxation, and monitoring for practices, 4) an Insomnia Management Program Manual, 5) a sleep diary, and 6) a progressive muscle relaxation video. McNemar’s test and Chi-square test were used to analyze the data. The results of this study revealed that: 1. The proportion of older persons with heart failure receiving the insomnia management program had lower insomnia severity levels at weeks 6 and 10 than the group receiving usual care (p < .05). 2. The proportion of older persons with heart failure after 6 and 10 weeks of receiving the insomnia management program had lower insomnia severity levels than before receiving the program (p < .05). 3. The proportion of older persons with heart failure receiving the insomnia management program had better sleep quality at weeks 6 and 10 than the group receiving usual care (p < .05). 4. The proportion of older persons with heart failure after 6 and 10 weeks of receiving the insomnia management program had better sleep quality than before (p < .05). The findings demonstrated that the insomnia management program could reduce the severity of insomnia and improve sleep quality. Therefore, an insomnia management program should be used as a nursing intervention for other older people with other chronic diseases.