[News] Research report on importance of having a regular bedtime

[grumpycat]

Regular Bedtime May Boost CPAP Adherence
Megan BrooksJun 03, 2013
Baltimore, Maryland — Having a regular bedtime may boost adherence to continuous positive airway pressure (CPAP) therapy, new research hints.

"Our study is the first to identify that regularity of bedtime, prior to CPAP treatment, is an important factor that influences adults' consistent use of CPAP," principal investigator Amy M. Sawyer, PhD, RN, assistant professor, Pennsylvania State University School of Nursing, University Park, told Medscape Medical News.

"Our results, not previously reported, suggest that CPAP use is associated with stable bedtime schedules; by stabilizing bedtime schedules or promoting consistency in bedtime patterns and routines prior to initiating CPAP treatment, CPAP use (ie, adherence) may improve," Dr. Sawyer said.

She will present the study findings June 5 at the SLEEP 2013: Associated Professional Sleep Societies 27th Annual Meeting.

Novel Observation

"This study is important because CPAP compliance is so important," William C. Kohler, MD, member of the American Academy of Sleep Medicine and medical director of the Florida Sleep Institute in Spring Hill, who was not involved in the study, told Medscape Medical News.

"CPAP is the main treatment for obstructive sleep apnea and if you just give the patient the machine and they don't use it, it doesn't do any good. Compliance is a problem and anything that we can do to improve compliance would be very beneficial," Dr. Kohler said.

In this study, Dr. Sawyer and colleagues aimed to determine whether variability of sleep schedule or pre-CPAP bedtime was different among CPAP adherers and nonadherers and if that influenced CPAP adherence.

They studied 97 predominantly male obese adults with newly diagnosed obstructive sleep apnea (OSA), with apnea-hypopnea index of at least 10 events/hour). CPAP adherence was defined as 4 hours per night, which is the common clinical and third-party payer definition, Dr. Sawyer said.

The study team found that variability in bedtime was a significant predictor of CPAP adherence at 1 month, with adherers having less inconsistency in their bedtime than nonadherers (49.4 vs 66.7 minutes; P = .02).

After 1 month, the likelihood of using CPAP for less than 4 hours per night was 3.7 (95% confidence interval [CI], 1.25 - 10.83) times greater for every increment of bedtime variability, or with increasing inconsistency of pretreatment bedtime.

Dr. Sawyer said a "clinically relevant question" is how much variability in bedtime is important to adherence outcomes. "We identified that the odds of nonadherence was 3.2 times greater for those whose bedtime varied by 75 minutes or more (P = .03). Furthermore, the odds of nonadherence were 1.8 times greater for every 30 minute increase in bedtime variability (P = .04)."

"Actionable" Findings

It's conservatively estimated that 5% of US adults have OSA, "with far greater incidence among overweight and obese adults," Dr. Sawyer noted. Untreated OSA contributes to significant morbidity and mortality; productivity and quality of life impairments in untreated OSA result from excessive daytime sleepiness, mood and psychological impairments, and cognitive dysfunction, she pointed out.

Nonadherence to CPAP is well recognized as a limitation of treating OSA, with approximately 50% of CPAP-treated adults identified as nonadherent to CPAP, she added. "We are very pleased to discover a potential intervention target for the promotion of CPAP use in adults newly initiated on CPAP therapy," Dr. Sawyer said.

"In this study, decreasing the variability in going to bed and getting up clearly improved adherence. This is something we can tell our patients," Dr. Kohler told Medscape Medical News.

The study was supported by a research grant by National Institutes of Health/ National Institute for Nursing Research. The authors and Dr. Kohler have disclosed no relevant financial relationships.

[SuperSleeper]

This is probably something I really need to work on... I hardly ever go to bed at the same time every night.

[JJJ]

"In this study, decreasing the variability in going to bed and getting up clearly improved adherence.

From my reading of the article I did not draw this conclusion at all. They merely discovered that people who adhered to a fixed bedtime were more compliant. The above conclusion is a post hoc ergo propter hoc fallacy. It is not only possible, but even likely, that people whose bedtimes did not vary were the kind of people who are compliant in all aspects of their life. They probably get fewer driving citations, always wash their hands before eating and never fail to say please and thank you. I take it as nothing more than a comment on their personalities. If you force someone whose personality is more aberrant to adhere to a fixed bedtime it may have no effect on their CPAP compliance.

But I only read the article, not the full study. Perhaps there were other controls.

[PaulaO2]

Exactly what I was thinking, JJJ. I don't think it has to do with going to bed at the same time but more to do with routine. Those of you who are tainted with evil and go to bed at the same time each night have established a routine and follow it. Your brain and body are used to laying down and going to sleep. The addition of the CPAP may disturb the force for a short while, but the routine is stuck in your head and the body and brain will go to sleep no matter what.

But those of us who are sane free thinkers (and therefore not evil) may not have such a rigid routine. Following good sleep hygiene guidelines is as good as the evil method but the lack of the "same time" factor may make such changes as CPAP just enough to knock out the rest of the routine.

[grumpycat]

This was a report about a presentation made at: SLEEP 2013: Associated Professional Sleep Societies 27th Annual Meeting
June 1 - 5, 2013; Baltimore, Maryland. I do not have access to the actual study results. Sorry.

[RonWessels]

The above conclusion is a post hoc ergo propter hoc fallacy.

I just can't resist being pedantic here. Actually, it's not a "post hoc ergo propter hoc" fallacy, but rather a "correlation implies causality" fallacy.

From the results described, another fallacious conclusion would be that CPAP compliance causes regular bedtimes.

[Sleepster]

I think it has to do with ability to fall asleep. Some of us have more difficulty than others falling asleep and so we wait until we're really tired before going to bed. It's a habit we formed because no one likes lying in bed and not being able to fall asleep.

So if you're good at falling asleep you're more likely to be CPAP-compliant. Duhh! The reason people aren't compliant is because they can't fall asleep with the CPAP machine.

Of course without a stable life, relatively free of excessive stress, it's difficult to maintain any kind of schedule for anything, let alone bedtime.

[Sleepin'Sam]

It seems to me that this study did NOT indicate adherence to a regular bedtime reduces AHI OR improves other CPAP stats. The study proports that a regular sleep/wake times improve the compliance of CPAP use - or the regular repeated use.

The study also clearly states they are referring to an intervention that improves compliance!

People with overall tendencies to be compliant personalities, were shown to be more compliant with their CPAP, and visa versa.

This is essentially a worthless study "Our study is the first to identify that regularity of bedtime, prior to CPAP treatment, is an important factor that influences adults' consistent use of CPAP," the writer is probably publishing an incidental portion of her thesis work or some other research.

---

My point exactly

The above conclusion is a post hoc ergo propter hoc fallacy.

I just can't resist being pedantic here. Actually, it's not a "post hoc ergo propter hoc" fallacy, but rather a "correlation implies causality" fallacy.

From the results described, another fallacious conclusion would be that CPAP compliance causes regular bedtimes.

[Zorki1c]

When I was twenty-something --especially when I was single--going to bed at a regular time would have been difficult. Now I'm 60-something, married 46 years and I don't have a whole lot of choice but to go to bed on a regular schedule.