Weighted Quilts and Their Effect on Sleep in Patients with Depression, Anxiety or Bi-polar Disorder: A Pilot Study

Transcription

1 Weighted Quilts and Their Effect on Sleep in Patients with Depression, Anxiety or Bi-polar Disorder: A Pilot Study Jolene Laurence, RNC, MS Marjie Gruenberg, RN, MS Michael Schmitz, Psy.D., LP, CBSM Sue Sendelbach, PhD, RN, CCNS Abbott Northwestern Hospital Pamela Jo Johnson, MPH, PhD Neha Ghildayal, BSB Center for Healthcare Innovation Allina Hospitals and Clinics We would like to thank the Minnesota Nurses Association Foundation for the generous support of this study.

2 BACKGROUND Nursing interventions for insomnia frequently focus on obtaining a medication order Adverse effects of medications may include: Daytime sedation Possible drug tolerance and dependence when used as a long-term solution Increased body mass index Daytime sedation may diminish: Involvement in therapies Social interaction Learning of adaptive coping skills.

3 AIMS Specific aim #1: Examine the effects of weighted quilts on sleep-related measures. Specific aim #2: Describe the characteristics of those for whom weighted quilts improved sleep. Specific aim #3: Assess the feasibility of using (and conducting research on) weighted quilts in an inpatient, behavioral health unit of a tertiary care hospital.

4 WEIGHTED QUILT Deep touch pressure is a type of somatosensory information carried by the dorsal columns system to higher levels in the thalamus and the reticular formation en route to the sensory areas in the parietal lobe of the cerebral cortex, limbic system, hippocampus and the reticular activating system 1,2 1 Grandin T. Calming effects of deep touch pressure in patients with autistic disorder, college students and animals. Journal of Child and Adolescent Psychopharmacolgy 1992;2. 2 VandenBerg NL. The use of a weighted vest to increase on-task behavior in children with attention difficulties. The American Journal of Occupational Therapy November/December 2001;55:

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6 WEIGHTED QUILT Research of deep pressure shows a resultant calmness due to sensory modulation in studies including adults and children 1-4 Theoretical assumption is that increased somatosensation can alter the non-conscious, sensory background that affects arousal 2 Based on current research, weight promotes calmness; therefore, would weight promote sleep 1 Champagne T, Stromberg N. Sensory approaches in inpatient psychiatric settings: Innovative alternatives to seclusion and restraint. Journal of Psycholsocial Nursing 2004;42: Grandin T. Calming effects of deep touch pressure in patients with autistic disorder, college students and animals. Journal of child and Adolescent Psychopharmacolgy 1992;2. 3 Mullen B, Champagne T, Krishnamurty S DD, Gao R. Exploring the safety and therapeutic effects of deep pressure stimulation using a weighted blanket. Occupational Therapy in Mental Health 2008;24: Robinson S, Benton G. Warmed blankets: an intervention to promote comfort for elderly hospitalized patients. Geriatr Nurs 2002;23:320-3.

7 METHODS Study design Quasi-experimental design with convenience sample Sample Inclusion: age > 18 years, depression, anxiety, and/or bi-polar diagnosis with insomnia; and a physician s medical clearance Exclusion: non-english speaking patients or those with a dementia, schizophrenia, borderline personality, psychosis, on a court ordered hold, depression with excessive sleep, suicidal ideation with or without a plan, post traumatic stress disorder (PTSD) diagnosis with current treatment, and pregnant women, individuals on the ETOH (alcohol) withdrawal protocol and/or patients scheduled for ECT Time period September 19, 2010 March 10, 2011 IRB Study was approved by the Allina Institutional Review Board

8 DATA COLLECTION METHODS Demographic data, history of sleep patterns, and perceptions of sleep (with usual care and weighted quilt) were obtained from a self-administered survey Data collection form: HS vital signs; every 15 minute checks (weighted quilt night); start/stop times Sleep measured via actigraphy (Actiwatch 2 ) and analyzed by a psychologist with CBSM (Certification in Behavioral Sleep Medicine)

9 MEASURES Dependent variable: Sleep Subjective measure of sleep Patient perception I slept great last night (1 = Strongly disagree < - - > 5 = Strongly agree) Objective measures of sleep - ActiWatch Sleep latency (minutes) Wake after sleep onset (minutes) Total sleep time (hours) Sleep efficiency (%) Number of awakenings Independent variable: Weighted quilt One night weighted quilt; One night usual care

10 ANALYSIS Descriptive statistics Characteristics of patients Mean changes in sleep outcomes by quilt status Paired T-tests

11 Results and Discussion

12 SAMPLE CHARACTERISTICS Demographics Predominantly female, white, and over 30 years SES All patients had post-secondary education Other socioeconomic characteristics suggest great diversity Count % Sex Male % Female % Age years % years % 40 years % Race White % Black % Educational attainment Some college % Bachelor's degree % Marital status Married % Co-habitating 1 6.7% Divorced/Separated % Never married % Employment status 35+ hrs/wk % <35 hrs/wk % Homemaker 1 6.7% Other % Income <$40, % $40,000-$54, % $55,000-$74, % $75,000 or more %

13 RESULTS: Subjective Measure (N = 15) Patient perception of sleep I slept great last night (1 = Strongly disagree < - - > 5 = Strongly agree) Patients using a weighted quilt rated their sleep quality higher on average than patients not using a weighted quilt 3.6 versus 3.0, p = 0.199

14 RESULTS: Objective Measures (N = 13) Sleep outcomes for weighted quilt compared to usual care, were in the anticipated direction for three measures: Sleep latency 22.4 minutes versus 25.5 minutes, p = Sleep efficiency 89.4% versus 89.1 %, p = Number of awakenings 25.9 versus 30.2, p =.145 However, they were not statistically significant

15 RESULTS: Objective Measures (N = 13) Sleep outcomes for weighted quilt compared to usual care, were in the opposite direction for two measures: Total sleep time 8.4 hours versus 8.6 hours, p = Waking after sleep onset 26.7 minutes versus 31.5 minutes, p = These differences were not statistically significant

16 RESULTS: Summary of Sleep Measures Weighted Quilt Usual Care Difference Mean SD Mean SD Diff SE T-value P-value Self Rated Sleep Sleep Latency (mins) Wake After Sleep Onset (mins) Total Sleep (hours) Sleep Efficiency (%) Number of Awakenings

17 CONCLUSIONS Patients perceived no statistical difference in his/her sleep with a weighted quilt versus usual care. Patients experience no statistical difference in objective measures of sleep with a weighted quilt versus usual care. Although not statistically significant, there was a trend towards a more positive perception of sleep; a decreased amount of time to fall asleep, better sleep efficiency, and decrease number of awakenings with the weighted quilt as opposed to usual care. It was feasible to conduct a nursing research study in the in-patient behavioral health patient care unit.

18 LIMITATIONS Small sample size Exclusion criteria too broad Convenience sample Subjects may not be representative of all behavioral health patients Results may not be generalizable Confounding variables Medications that may have impacted sleep patterns

19 FUTURE RESEARCH Further study with larger sample size Include other behavioral health patient populations Identify what patients characteristics respond more positively to the weighted quilts Randomization of patients Monitor medication use during study Cumulative effect of quilt