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Vaughan CP, Markland AD, Huang AJ, Alessi CA, Guzman A, Martin JL, Bliwise DL, Johnson II TM, Burgio KL, Fung CH. Considerations for integrated cognitive behavioural treatment for older adults with coexisting nocturia and insomnia. Age Ageing 2022; 51:6527735. [PMID: 35165690 PMCID: PMC8844541 DOI: 10.1093/ageing/afac024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Indexed: 11/14/2022] Open
Abstract
Nocturia and chronic insomnia disorder are common conditions that frequently coexist in older adults. Existing medication treatments for each condition have risks, particularly in older adults. While treatment guidelines recommend starting with behavioural therapy for each condition, no existing program simultaneously addresses nocturia and insomnia. Existing behavioural interventions for nocturia or insomnia contain concordant and discordant components. An expert panel (including geriatricians with sleep or nocturia research expertise, sleep psychologists and a behavioural psychologist) was convened to combine and reconcile elements of behavioural treatment for each condition. Concordant treatment recommendations involve using situational self-management strategies such as urge suppression or techniques to influence homeostatic drive for sleep. Fluid modification such as avoiding alcohol and evening caffeine and regular self-monitoring through a daily diary is also appropriate for both conditions. The expert panel resolved discordant recommendations by eliminating overnight completion of voiding diaries (which can interfere with sleep) and discouraging routine overnight voiding (a stimulus control strategy). The final product is an integrated cognitive behavioural treatment that is delivered by advanced practice providers weekly over 5 weeks. This integrated program addresses the common scenario of coexisting nocturia and chronic insomnia disorder.
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Affiliation(s)
- Camille P Vaughan
- Address correspondence to: Camille P. Vaughan, 1841 Clifton Road, NE, Room 533, Atlanta, GA 30329, USA. Tel: 404 728 6902.
| | - Alayne D Markland
- Dept of Veterans Affairs Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Birmingham, AL & Atlanta, GA, USA,Dept of Medicine, Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Alison J Huang
- Dept of Medicine, University of California, San Francisco, CA 94115, USA
| | - Cathy A Alessi
- Dept of Medicine, University of California, Los Angeles, CA 90095, USA,Geriatric Research, Education, and Clinical Center; Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA 90073, USA
| | - Andrew Guzman
- Dept of Medicine, University of California, Los Angeles, CA 90095, USA,Geriatric Research, Education, and Clinical Center; Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA 90073, USA
| | - Jennifer L Martin
- Dept of Medicine, University of California, Los Angeles, CA 90095, USA,Geriatric Research, Education, and Clinical Center; Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA 90073, USA
| | - Donald L Bliwise
- Sleep Program, Emory University School of Medicine, Atlanta, GA 30329, USA
| | - Theodore M Johnson II
- Dept of Medicine, Division of Geriatrics & Gerontology, Emory University, Atlanta, GA 30329, USA,Dept of Veterans Affairs Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Birmingham, AL & Atlanta, GA, USA,Dept of Medicine, Division of General Internal Medicine, Emory University, Atlanta, GA 30329, USA,Dept of Family and Preventive Medicine, Emory University, Atlanta, GA 30329, USA
| | - Kathryn L Burgio
- Dept of Veterans Affairs Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Birmingham, AL & Atlanta, GA, USA,Dept of Medicine, Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Constance H Fung
- Dept of Medicine, University of California, Los Angeles, CA 90095, USA,Geriatric Research, Education, and Clinical Center; Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA 90073, USA
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