Patient Self-Guided Interventions to Reduce Sedative Use and Improve Sleep: The YAWNS NB Randomized Clinical Trial

Area of Science:

• Gerontology
• Sleep Medicine
• Behavioral Science

Background:

• Long-term benzodiazepine receptor agonist (BZRA) use in older adults is associated with significant harms.
• Transitions to non-pharmacological insomnia treatments like cognitive behavioral therapy for insomnia (CBTI) are challenging.
• Direct-to-patient interventions may facilitate BZRA discontinuation and improve sleep outcomes.

Purpose of the Study:

• To compare two mailed, direct-to-patient behavior change interventions against treatment as usual (TAU) for older adults using BZRAs.
• To assess the impact on BZRA use, CBTI uptake, sleep quality, and other health outcomes.
• To evaluate the feasibility of scalable, low-contact interventions for insomnia management.

Main Methods:

• A 3-arm, pragmatic, randomized clinical trial (Your Answers When Needing Sleep in New Brunswick - YAWNS NB study) involving adults aged 65+ with long-term BZRA use.
• Interventions included two different mailed packages (YAWNS-1 and YAWNS-2) or TAU.
• Primary outcome was BZRA use at 6 months; secondary outcomes included CBTI use, sleep parameters, and safety.

Main Results:

• The YAWNS-1 intervention led to the highest rates of BZRA discontinuation or dose reduction (46.6%) compared to YAWNS-2 (34.8%) and TAU (20.3%).
• YAWNS-1 demonstrated superior uptake of CBTI techniques and improved sleep efficiency (4.1% change) versus YAWNS-2 (-1.7% change).
• Compared to TAU, YAWNS-1 significantly reduced insomnia severity and daytime sleepiness.

Conclusions:

• The YAWNS-1 intervention is an effective, scalable, direct-to-patient method for reducing BZRA use in older adults.
• This approach has the potential to significantly improve sleep outcomes and transform insomnia care at a population level.
• Minimum-contact, mailed interventions can successfully facilitate transitions to evidence-based insomnia treatments.