Older Adults' Perspectives on Behaviour Change Elements in Sleepwell, an Insomnia Management Intervention: an Interpretive Descriptive Study

Abstract

Background: Benzodiazepine receptor agonists (BZRA) are commonly used for insomnia in adults aged 65 years and older against current guidelines and evidence recommendations. The harms of these medications in older adults far outweigh any benefits which have shown to be negligible. Cognitive behavioural therapy for insomnia (CBTi) is an underutilized safe and effective treatment for insomnia. Aim: This project aimed to identify older adults’ perspectives on the embedded behavioural change techniques (BCT) used in Sleepwell resources (a repository of resources and evidence-based tools that have been used as a direct to consumer/patient approach for insomnia management) and explore their challenges and opportunities towards BZRA discontinuation and CBTi use. Methods: This study used an interpretive description design. Data was collected using semi-structured interviews of older adults who had previous experience with Sleepwell resources. Reflexive thematic analysis was used and the Behaviour Change Wheel, along with the Theoretical Domains Framework, were the overarching and underpinning theories regarding influences on behaviour change. Results: Two main themes were developed; 1) Sleep should not be this difficult. Participants prioritized the importance of sleep for overall health and identified the difficulty of BZRA discontinuation and the effort needed to implement CBTi. 2) Whether you know it, or learn it, drugs are bad. A dislike of medication was common among participants and was the fuel for their re-evaluation of BZRA use. Conclusion: Certain embedded BCTs in the Sleepwell booklets were identified as helpful in the journey of BZRA discontinuation and CBTi use, while others were found to be ineffective. Suggestions for changes to improve the booklets were made based on older adults’ experiences with Sleepwell, CBTi and BZRA discontinuation.