INSOMNIA: The AASM gets more patient-centered on treatments for insomnia

On March 13, the American Academy of Sleep Medicine (AASM) announced new efforts to more actively unite sleep physicians and their insomnia patients toward a more successful partnership. This new process-outcome effort could be a boost for hundreds of thousands of insomniacs who have struggled for years with sleeplessness or potential misdiagnoses or cycled through numerous failed drug and behavioral treatments. It could also create a more standard, nationwide healthcare approach to diagnosing and treating insomnia in the years ahead.

The Affordable Care Act (ACA), which focuses largely on patient-centered outcomes and more cost-effective healthcare, prompted the AASM to pull together specific ways for sleep physicians to measure diagnoses and therapies on a broad scale in order to answer the critical question,

“What insomnia assessment and treatment processes lead
to the best outcomes at the least cost per average patient?” 

It's an answer demanded not only by the ACA, but by thousands of insomnia patients and sleep physicians. Insomnia is considered a high prevalence sleep disorder with significant health and cost impacts for both patients and healthcare providers. However, insomnia and its various treatments have not been studied closely enough on a large scale to show conclusive evidence of positive outcomes for specific therapies. Insomnia is a complex sleep disorder that involves medical, behavioral and pharmacological review, but without standardized protocol for researching, diagnosing or treating it, both physicians and patients are often left on their own to look for solutions. These new efforts hope to change this.

The following processes will be implemented in the future by AASM-accredited healthcare providers in an effort to better answer this question:

1. Assessment of sleep quality
   This means that staff at sleep clinics and centers may be tasked with doing more to determine an insomnia patient's overall sleep quality (including efficiency of sleep). Patients may be required to answer more questions about their sleep habits.
2. Delivery of evidence-based treatment
   This means that staff at sleep clinics and centers will be tasked with doing more to deliver (and keep better records of) evidence-based treatment. Providers may be required to follow more specific treatment protocols based on evidence-backed scientific data.
3. Assessment of daytime functioning
   This means that staff at sleep clinics and centers may be tasked with doing more to determine the level of an insomnia patient's daytime functioning (memory, problem solving, job performance, physical performance, etc.). Patients may be required to answer questions about their daytime activities, job performance, and/or cognitive functioning.
4. Assessment of side effects of treatments
   This means that staff at sleep clinics and centers may be tasked with keeping better records of treatments and their side effects. More careful collection of data accessible to larger electronic record databases could help researchers crunch more accurate numbers related to real-world insomnia diagnoses and therapies than can otherwise be found in a small-range study. 

Meanwhile, the following patient outcomes have been defined as goals for achieving answers to the same fundamental question cited above:

1. Provision of accurate insomnia diagnosis
   This means that staff at sleep clinics and centers may be tasked with doing more to prove a conclusive and accurate diagnosis. This can mean working harder to achieve a differential diagnosis to make sure a patient with insomnia isn't experiencing their symptoms due to another hidden disorder.
2. Improvement of sleep satisfaction or quality
   This means that staff at sleep clinics and centers may be tasked with working harder to help the insomnia patient achieve measurably better sleep quality. There could be much more communication between the patient and the clinic during treatment to ensure patients are committed and adherent to their therapies, for instance.
3. Improve of daytime functioning
   This means that staff at sleep clinics and centers may be tasked with working harder to help the insomnia patient achieve measurably improved daytime function. This may mean more communication between the patient and the clinic to see if job performance, memory or cognitive function has improved.
4. Minimization of treatment-related adverse effects 
   This means that staff at sleep clinics and centers may be tasked with working harder to help the insomnia patient better manage their medications and side effects. Patient may be asked to report side effects regularly and may have their entire drug list reviewed to ensure no drug interactions or improper dosing has occurred.

While these are efforts that physicians' clinics make (or should be making) already, these new directives could mean more proof of their implementation in a way that can help show more reliable evidence when treatments succeed or fail, as patient outcomes will depend on both patient cooperation and more standardized approaches to diagnosis and treatment. These proposed measures are complex and require the earnest participation of not only the patient and their physician, but all of the core healthcare workers involved in any single appointment.

The AASM hopes these new efforts will constitute a fresh starting point for discovering new and better technologies for diagnosis insomnia and therapies for its treatment, plus more comprehensive record keeping and improvements to healthcare settings that benefit both patients and their providers. Once patients cycle through this new system, outcomes should be more effectively measured, lighting the way for more accurate diagnoses, improved insomnia management and the facilitation of important, conclusive process-outcome research needed to get to the bottom of one of America's most common sleep disorders.

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Source

"Quality measures for the care of patients with insomnia." Edinger JD, Buysse DJ, Deriy L, Germain A, Lewin DS, Ong JC, Morgenthaler TI. Journal of Clinical Sleep Medicine 2015;11(3):311–334.