- Paul Thomlinson, PhD, Psychologist, Executive Director, Research, Compass Health Network, Springfield, MO
- Cynthia Hollis-Keene, DNP, Psychiatric Nurse Practitioner, Emo-Logic Clinic, Branson, MO
Background/Rationale: This quality improvement project aimed to improve the quality of care for behavioral health patients experiencing sleep disturbances through implementation of the most recent American Academy of Sleep Medicine Practice Guidelines, which recommend routine screening of patients for sleep problems followed by sleep hygiene education and/or cognitive-behavioral therapy (CBT) as first-line treatments. The evaluation question was: What is the effect of implementation these guidelines on the quality of sleep and sleep pattern problems as measured by the Pittsburgh Sleep Quality Index over a period of eight weeks? Description of sample: During an eight-week evaluation window at a rural behavioral health clinic, patients who indicated problems with sleep were given the Pittsburgh Sleep Quality Index (PSQI). Of the 35 patients screening positive for sleep problems who were evaluated in this project, 15 (42.9%) identified as male and 20 (57.1%) identified as female. The average age was 39.3 (SD = 13.4) years old with a range of 19 to 71. The most common reasons for not sleeping were racing thoughts (n = 6, 17.2%), stress (n = 5, 14.3%) and pain (n = 4, 11.4%). Study design: The design included a pretest-posttest assessment of sleep quality (PSQI) for all those indicating problems with sleep, with no control group. Procedures and measures: All participants screening positive for sleep problems received completed sleep hygiene handouts and education. Most participants (66%) completed eight weekly sessions of CBT targeting insomnia, and the remainder did not. The tool for screening and outcome evaluation was the PSQI, a well-established reliable (Cronbach’s alpa = .83) and valid instrument often used in clinical and non-clinical settings for the screening of sleep dysfunction. Lower scores on the PSQI indicate better sleep quality. Key results and conclusions: The Wilcoxon sign-rank test was run on the pre- and posttest PSQI scores for all participants, and there was a statistically significant difference between the global pretest median PSQI score (26.60) and posttest median (19.50), Z = -2.328, p = 0.020. This indicates significantly improvements in the quality of sleep for the patients evaluated in this quality improvement project. Although there are many uncontrolled threats to internal validity, this QI study demonstrated the feasibility and acceptability of screening for sleep problems in behavioral health patients, and excellent outcomes for patients receiving sleep hygiene education and/or CBT for insomnia as an alternative to a pharmacological sleep aid.
- Analyze the significant effects of poor sleep quality on health and behavioral health functioning, particularly among those with behavioral health disorders.
- Explain the reasons why sleep disturbances are often inadequately assessed and treated in integrated healthcare settings.
- Describe the significant outcomes of a quality improvement process implementing evidence-based screening and treatment of sleep problems in a behavioral health setting.