Phone therapy helps older women get their sleep

Hutch News

Phone therapy helps older women get their sleep

New study shows significant improvement in menopausal women’s insomnia after receiving simple intervention

May 23, 2016

Illustration by Jacqueline Morgado / Fred Hutch News Service

Some menopausal women try exercise to ease their symptoms. Others go for acupuncture or pills. Still more try weird web tricks like drinking tea made of boiled bananas to get a few hours of oh-so-elusive sleep.

But a new study out of Fred Hutchinson Cancer Research Center and the University of Washington may have found a better way to handle menopause’s traditional double whammy of hot flashes and insomnia: brief behavior-changing phone chats with sleep coaches.

“We’re very excited about these findings,” said Dr. Katherine Guthrie, a public health researcher at Fred Hutch and co-author of the study. “It’s especially exciting because it’s a non-pharmacological and non-hormonal approach. It’s low-cost, non-invasive and there’s a low-time commitment.”

Published Monday in JAMA Internal Medicine, the study showed that keeping a nightly sleep diary and receiving counseling about smart sleep habits from a sleep coach helped women reduce their insomnia and improve sleep quality through all stages of menopause. The study also showed that this cognitive behavioral approach significantly reduced the degree to which hot flashes interfered with women’s daily functioning.

Led by clinical psychologist and research professor Dr. Susan McCurry of the University of Washington’s School of Nursing, the study involved 106 heathy Seattle-area women between the ages of 40 and 65, all of whom suffered moderate insomnia and experienced at least two hot flashes a day.

The randomized clinical trial found significant improvement in just eight weeks for women who’d changed their sleep habits or “sleep hygiene” per their coach’s advice. Even better, when researchers followed up with these women 24 weeks later, they were still sleeping well.

A non-pharma approach for a common problem

Most women experience problems sleeping and nighttime hot flashes (or night sweats) at some point during the menopause transition, said Guthrie, as do many breast cancer patients who go hit by early menopause due to chemotherapy or hormonal therapies like tamoxifen which suppress the body’s estrogen.   

But losing sleep doesn’t just make you fuzzy-headed the next morning: it can lead to serious health risks.

“Poor sleep leads to daytime fatigue, negative mood and reduced daytime productivity,” said Guthrie. “[And] when sleep problems become chronic — as they often do — there are also a host of negative physical consequences, including increased risk for weight gain, diabetes and cardiovascular disease.”

While there are plenty of over-the-counter and prescription sleeping pills, not everyone wants to go that route.

“Many women don’t want to use sleeping medications or hormonal therapies to treat their sleep problems because of concerns about side effects and other health risks,” said Guthrie. “For these reasons, having effective, non-pharmacological options to offer them is important.”

The study, believed to be the first and the largest of its kind, was conducted via MsFLASH, a research network funded by the National Institute on Aging that conducts randomized clinical trials focused on relieving the most common, bothersome symptoms of menopause. Guthrie serves as principal investigator of the Fred Hutch-based MsFLASH Data Coordinating Center.

All of the study's participants were asked to keep sleep diaries and to document the quantity, frequency and severity of their hot flashes.  They also all talked to a sleep coach via telephone six times over an eight-week period, receiving information on hot flashes and basic sleep hygiene and talking over the sleep diaries together.

Half the women, however, received detailed personalized advice and tools to tweak their sleep habits, including information on proper sleep hygiene, maintaining a good “sleep window,” and how to practice “constructive worry” when ruminating thoughts keep them awake at night. The other women received only general advice from their sleep coaches with no special tools, recommendations or personalized advice. 

Dr. Katherine Guthrie

Dr. Katherine Guthrie's latest MsFLASH study points to an easy, cost-effective way to help women reduce menopausal symptoms like insomnia: phone therapy.

Photo by Robert Hood / Fred Hutch News Service

Not just talk, but tools

Guthrie said having a control group that participated in a phone conversation with a coach was important so they could show that it wasn’t just the act of talking to someone about sleep problems, but the tools that person passed along that ultimately helped.

“The coaches for our cognitive behavior therapy group told them to go to bed at this time, get up at this time, ‘Don’t do this in bed, do do this’,” said Guthrie. “And those results were tracked via a daily sleep diary that the coach had access to so they could direct them the next time."

“It’s not just about support, although I think that does help,” she said. “It’s the tools.”

Rather than sleep specialists, the study utilized a social worker and psychologist who went through a day of training in cognitive behavioral therapy techniques. During the phone chats, they encouraged the intervention group to use good “sleep hygiene,” which includes the following:

  • Creating bedtime routines and a sleep environment that’s conducive to sleep
  • Turning off electronics 30 minutes before bedtime
  • Cutting back on caffeine or alcohol after dinner
  • Keeping the bedroom at a slightly cool temperature

The coaches also emphasized that the bed was meant only for sleep or sex:  not for TV watching or answering emails or texting or surfing the web or lying awake worrying for hours on end.

The intervention group also used an adjustable bedtime and rising schedule, known as a “sleep window.” The goal of the therapy was to get the women to the point where they were asleep at least 85 percent of the time they were in bed.  

“You want to improve your sleep efficiency, the amount of time you’re asleep over the amount of time you’re in bed, as a proportion,” said Guthrie. “We used a process called ‘sleep restriction’ which initially creates a state of mild sleep deprivation so when the woman goes to bed at night she’s more likely to fall asleep quickly and stay asleep.  Gradually increasing the sleep window over time allows a woman to find the perfect balance between how long she needs to be in bed to get the amount of sleep that is right for her.”

Hot flashes weren’t as annoying

While the frequency and severity of the women’s hot flashes did not change, women in the intervention group did report that after the therapy, their symptoms interfered less with their daily functioning.

Guthrie said this might be due to the fact they were better rested so the flashes didn’t bother them as much.

“We saw small improvements in terms of depressive symptoms, like eating too much, eating too little or feeling bad about [themselves],” she said. “We also used a perceived stress scale and saw improvements in that compared to the control group. I think the women felt better overall. They were getting better sleep so there were many ways in which they felt better and their quality of life was improved.”

Guthrie said delivering this kind of therapy by phone — a model similar to phone-based smoking-cessation programs that have proven to be effective — potentially allows it to be an efficient, cost-effective way to reach large populations of women seeking treatment for midlife sleep problems.

She also said that the phone coaching approach could benefit breast cancer patients who’ve been impacted by early menopause, or what’s sometimes referred to as “chemopause.”

“I don’t see any reason why anyone couldn’t use some of these approaches unless they have serious sleep problems like apnea,” she said.

Diane Mapes is a staff writer at Fred Hutchinson Cancer Research Center. She has written extensively about health issues for NBC News, TODAY, CNN, MSN, Seattle Magazine and other publications. A breast cancer survivor, she also writes the breast cancer blog doublewhammied.com. Follow her on Twitter @double_whammied. Email her at dmapes@fredhutch.org.

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