Insomnia in patients suffering from chronic medical illnesses: prevalence and impact of iayt

Abstract

Title: Insomnia in Patients Suffering from Chronic Medical Illnesses: Prevalence and Impact of IAYT Background: Sleep is an important lifestyle factor to be addressed in patients having chronic non-communicable diseases. Yoga has been found effective in improving sleep quality in patients with chronic medical illnesses (CMIs). Aim: To find the prevalence of insomnia in major chronic medical illnesses and to assess the effect of Integrated Approach of Yoga Therapy (IAYT) on them. Methods and Material: From the outpatients and inpatients of our integrative therapy clinics, 200 patients (116 males; 84 females) in the age range 49.57±11.71 years, who satisfied the inclusion criteria and diagnosed by the physician with any of the four major categories of CMIs: cardio-pulmonary; diabetes; musculoskeletal; and psychiatric, were screened for insomnia. Patients suffering from severe and complicated CMIs were excluded from the study. Screening was done using a validated and reliable screening tool, the Insomnia Severity Index (ISI) scale. Those found suffering from clinically significant insomnia (ISI score > 14) were admitted and a residential IAYT intervention was given for a week. Before and after the intervention, ISI and Pittsburg insomnia rating scale (PIRS) were administered to assess extent of insomnia. Data was analyzed before and after the intervention using paired t test. Results: All patients of CMIs taken together, we found that 35% suffered from clinical insomnia, out of which, 12.5% had severe and 22.5% had moderate insomnia. We also found that prevalence of clinical insomnia was highest among those suffering from psychiatric 2 illnesses (62.07%) and minimum in those having musculoskeletal disorders (28.05%). Those suffering from diabetes mellitus and cardio-pulmonary disorders reported prevalence of 32.25% and 31.94% respectively. After IAYT intervention of one week, prevalence of clinical insomnia reduced from 35% at the baseline to 8.5% in all patients of CMIs taken together. Following changes were observed in prevalence of clinical insomnia in different CMIs before and after one week of IAYT intervention: 1) In psychiatric patients, the prevalence reduced from 62.07% to 24.13%; 2) In diabetic patients the prevalence reduced from 32.2.7% to 3.0%; 3) In patients having musculoskeletal disorders the prevalence reduced from 28.05% to 8.53%; and 4) In patients having cardio-pulmonary illnesses the prevalence reduced from 31.94% to 2.7%. Conclusion: Prevalence of insomnia is higher in patients suffering from chronic medical illnesses. IAYT intervention of one week may be helpful in reducing prevalence of insomnia in this population. Future studies should focus testing the efficacy of IAYT in each category of CMI separately on using a larger sample size and randomized controlled design.