Insomnia is the most common sleep problem in Korean midlife women, which may increase anxiety, depressive symptoms, and obesity and decrease the quality of life. As a nonpharmacological treatment option, the cognitive behavioral therapy for insomnia (CBT-I) has been found effective for insomnia. However, few studies evaluated the efficacy of the CBT-I that was culturally tailored to Korean middle-aged women in a community setting.
The purpose of the study was to evaluate the efficacy of the culturally tailored CBT-I on insomnia, sleep quality, depression, and quality of life of middle-aged Korean midlife women in South Korea.
Methods:
An experimental study was conducted with 44 middle-aged Korean women between 40 and 65 years old who resided in South Korea and had insomnia or poor sleep quality. The participants were recruited among those who had participated in a cross-sectional study on the factors associated with insomnia and sleep quality among Korean women in 2015. They were randomly assigned to an experimental group and a control group. Study instruments included the Insomnia Severity Index (ISI), the Pittsburg Sleep Quality Index (PSQI), the Center for Epidemiological Studies Depression Scale (CES-D), menopause-specific quality of life (MENQoL), and the Sleep Self-efficacy Scale. Four sessions of individualized CBT-I combined with sleep hygiene group education were offered to the experimental group, while one session of sleep hygiene group education was offered to the control group. A post-test survey was performed one week after the completion of the CBT-I intervention. Descriptive statistics such as means, standard deviations, frequencies, and percentages were used to verify the homogeneity of the experimental and control groups, and the analyses of covariance (ANCOVAs) were conducted to measure the efficacy of the CBT-I intervention.
Results: Homogeneity tests indicated that the two groups were not significantly different in sociodemographic and sleep related characteristics, depressive symptoms, and quality of life before the intervention (p>.05). ANCOVAs were performed with pre-test scores; after the intervention, the experimental group showed better scores in sleep latency, insomnia, sleep quality, and sleep self-efficacy than the control group (p<.05). The mean score for depressive symptoms (CES-D) was lower for the experimental group (18.25±9.87) compared with the control group (23.50±10.93), but the difference was not statistically significant (p=.053).
Conclusion:
The results indicated that the culturally tailored CBT-I was effective in decreasing insomnia, poor sleep quality, and depressive symptoms of middle-aged Korean women in South Korea. Thus, as a nonpharmacological treatment option that is safe and cost-effective, the culturally tailored CBT-I could be offered to Korean women who have been suffering from sleep problems. Yet, long-term follow-ups are needed to determine if these improvements could be maintained consistently.
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