A mailed, self-guided intervention led to nearly 50% of older adults in the Your Answers When Needing Sleep in New Brunswick-1 group reducing or discontinuing long-term sedative use, according to a recent study.
The Your Answers When Needing Sleep in New Brunswick (YAWNS NB) randomized clinical trial, published in JAMA Network, assessed the impact of mailed, direct-to-patient interventions on reducing sedative use and improving sleep among older adults using benzodiazepine receptor agonists (BZRAs). The trial included 565 participants aged ≥ 65 years from New Brunswick, Canada, with long-term BZRA use for insomnia.
The average age of participants was 72.1 years (standard deviation [SD] = 5.7), with an average duration of BZRA use of 11.4 years (SD = 9.1). Female participants made up 64.1% of the study population, totaling 362 participants. The participants were randomized into three groups: those receiving the Sleepwell package (YAWNS-1), updated booklets from the Eliminating Medications Through Patient Ownership of End Results study (YAWNS-2), and treatment as usual (TAU).
For the primary outcomes, BZRA discontinuation or dose reduction of at least 25% occurred in 46.6% of participants in the YAWNS-1 group (50 discontinuations and 39 dose reductions), 34.8% in the YAWNS-2 group (38 discontinuations and 27 dose reductions), and 20.3% in the TAU group (14 discontinuations and 24 dose reductions). The number needed to mail to achieve one BZRA discontinuation was 5.3 for YAWNS-1 and 7.8 for YAWNS-2.
The participants adopted new CBTI techniques at an average rate of 3.1 per participant in the YAWNS-1 group, 2.4 in the YAWNS-2 group, and 1.01 in the TAU group. Additionally, the participants receiving YAWNS-1 reported increased use of cognitive behavioral therapy for insomnia (CBTI) techniques and modest improvements in sleep outcomes, including reductions in insomnia severity and daytime sleepiness, compared with those in the YAWNS-2 or TAU groups.
Among the participants who discontinued BZRA use, 33% (n = 45/136) of them reported experiencing withdrawal symptoms, with insomnia being the most frequently reported symptom, affecting 29.4% of those who ceased use. Among all participants, 36.7% consulted either their physician or pharmacist about sedative use, whereas 9.2% spoke with both health care professionals.
Full disclosures can be found in the published study.