Efficacy of Face-to-Face Delivered Cognitive Behavioral Therapy in Improving Health Status of Patients With Insomnia: A Meta-Analysis

Background: Face-to-face cognitive behavioral therapy (CBT) is one of the most widely used non-pharmacological treatment approaches for insomnia. The aim of this study is to assess the efficacy of face-to-face delivered CBT on health outcomes and to evaluate the effect of CBT components as subgroup variables to explain the efficacy of face-to-face delivered CBT on health outcomes in adults over 18 years old with insomnia.Methods: Relevant randomized controlled trial studies published in the past 22 years were searched through the electronic databases. The Physiotherapy Evidence Database (PEDro) scale was used to assess the quality of the 31 included studies. The mean difference and standard deviation of outcome variables and subgroup variables were analyzed using random effect model, and the heterogeneity among the articles was assessed with the Q-test and I2. Egger regression analysis was used to assess publication bias.Results: The meta-analysis showed a significant reduction in Insomnia Severity Index [standardized mean difference (SMD) = −2.56, 95% CI −3.81 to −1.30, p < 0.001], Pittsburgh Sleep Quality Index (SMD = −0.96, 95% CI −1.25 to −0.68, p < 0.001), sleep onset latency (SMD = −1.31, 95% CI −2.00 to −0.63, p < 0.001), wakening after sleep onset (SMD = −1.44, 95% CI −2.14 to −0.74, p < 0.001), number of awakenings (SMD = −1.18, 95% CI −2.10 to −0.26, p < 0.05), depression (SMD = −1.14, 95% CI −1.85 to −0.42, p < 0.01), and fatigue (SMD = −2.23, 95% CI −3.87 to −0.58, p < 0.01), and a significant increase in total sleep time (SMD = 0.63, 95% CI 0.28 to 0.98, p < 0.001), sleep efficiency (SMD = 1.61, 95% CI 0.92 to 2.29, p < 0.001), and physical health (SMD = 0.42, 95% CI 0.08 to 0.76, p < 0.05), in the CBT intervention group compared with the control group. There was no significant change in anxiety (SMD = −0.62, 95% CI −1.55 to 0.32, p > 0.05) and mental health (SMD = 1.09, 95% CI −0.59 to 2.77, p > 0.05) in CBT intervention group compared with control group. Group-delivered studies with larger number of intervention sessions and longer duration of single session provided a larger improvement in sleep quality.Conclusion: Face-to-face delivered CBT is effective in increasing total sleep time, sleep efficiency, and physical health, and reducing Insomnia Severity Index scores, Pittsburgh Sleep Quality Index scores, sleep onset latency, wakening after sleep onset, number of awakenings, depression, anxiety, and fatigue in patients with insomnia. Face-to-face delivered CBT is more effective when delivered through a larger number of sessions with longer duration of each session, and when delivered in groups. Face-to-face CBT is recommended to provide treatment to patients with insomnia in clinical settings.Systematic Review Registration:www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020200091, identifier: CRD4202020009.

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1071 Subjective Measures Of Hyperarousal Predict Subjective Longitudinal And Retrospective Measures Of Sleep Quality In Individuals Exposed To Trauma

SLEEP ◽

10.1093/sleep/zsaa056.1067 ◽

2020 ◽

Vol 43 (Supplement_1) ◽

pp. A408-A408

Author(s):

A Kram Mendelsohn ◽

C Daffre ◽

K I Oliver ◽

J Seo ◽

N B Lasko ◽

...

Keyword(s):

Sleep Quality ◽

Sleep Disturbances ◽

Traumatic Event ◽

Behavioral Therapy ◽

Sleep Onset ◽

Sleep Time ◽

Sleep Onset Latency ◽

Wake Time ◽

Sleep Diaries ◽

Dsm 5

Abstract Introduction Hyperarousal and disturbed sleep are intrinsic symptoms of posttraumatic stress disorder (PTSD). We explored whether self-reported indices of hyperarousal predict longitudinally measured objective, subjective, and retrospective evaluations of sleep quality in trauma-exposed individuals. Methods Individuals exposed to a DSM-5 PTSD Criterion-A traumatic event within the past two years (N=130, 91 females), aged 18-40 (mean 24.43, SD 5.30), 51.54% of whom met DSM-5 criteria for PTSD, completed 14 days of actigraphy and sleep diaries. Participants also completed the PTSD Checklist for DSM-5 (PCL-5), the Clinician-Administered PTSD Scale (CAPS-5), published Hyperarousal (HAS) and Hypervigilance (HVQ) scales, and the Pittsburgh Sleep Quality Index (PSQI) (N=108-125 for different scales). Mean total sleep time (TST), sleep onset latency (SOL), sleep efficiency (SE) and sleep midpoint were calculated from actigraphy and subjective SOL, SE, number of awakenings, and time spent awake from diaries. Simple regressions were used to predict associations of the PCL-5, HAS, and HVQ scores with measures of sleep quality. Results Hyperarousal indices predicted diary but not actigraphy measures of sleep quality. Longer diary-reported SOL was predicted by higher scores for: PCL-5 total score (R=0.290, p=0.001), PCL-5 hyperarousal items without the sleep item (R=0.261, p=0.004), and HAS without sleep items (R=0.220, p=0.016). Diary-reported number of awakenings and wake time after sleep onset were predicted by higher HAS scores without the sleep question: (R=0.373, p<0.001; r=0.352, p<0.001). Similarly, all hyperarousal indices significantly predicted PSQI global score (PCL-5: R=0.482, p<0.001; PCL-5 hyperarousal: R=0.389, p<0.001; HVQ: R=0.214, p=0.017; HAS without sleep question: R=0.415, p<0.001). Conclusion Self-reported hyperarousal measures predict subjective longitudinal (especially SOL) and retrospective measures, but not objective measurements of sleep quality. Similar discrepancies between self-reported and objective measures of sleep quality have been reported in patients with insomnia disorder. Cognitive-behavioral therapy for insomnia may be especially effective in treating post-traumatic sleep disturbances. Support R01MH109638

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Mindfulness-based therapy for insomnia for older adults with sleep difficulties: a randomized clinical trial

Psychological Medicine ◽

10.1017/s0033291721002476 ◽

2021 ◽

pp. 1-11

Author(s):

Francesca Perini ◽

Kian Foong Wong ◽

Jia Lin ◽

Zuriel Hassirim ◽

Ju Lynn Ong ◽

...

Keyword(s):

Older Adults ◽

Sleep Quality ◽

Behavioral Therapy ◽

Sleep Onset ◽

Exercise Program ◽

Severity Index ◽

Poor Sleep ◽

Sleep Onset Latency ◽

Post Intervention ◽

Insomnia Severity

Abstract Objective Poor sleep is a modifiable risk factor for multiple disorders. Frontline treatments (e.g. cognitive-behavioral therapy for insomnia) have limitations, prompting a search for alternative approaches. Here, we compare manualized Mindfulness-Based Therapy for Insomnia (MBTI) with a Sleep Hygiene, Education, and Exercise Program (SHEEP) in improving subjective and objective sleep outcomes in older adults. Methods We conducted a single-site, parallel-arm trial, with blinded assessments collected at baseline, post-intervention and 6-months follow-up. We randomized 127 participants aged 50–80, with a Pittsburgh Sleep Quality Index (PSQI) score ⩾5, to either MBTI (n = 65) or SHEEP (n = 62), both 2 hr weekly group sessions lasting 8 weeks. Primary outcomes included PSQI and Insomnia Severity Index, and actigraphy- and polysomnography-measured sleep onset latency (SOL) and wake after sleep onset (WASO). Results Intention-to-treat analysis showed reductions in insomnia severity in both groups [MBTI: Cohen's effect size d = −1.27, 95% confidence interval (CI) −1.61 to −0.89; SHEEP: d = −0.69, 95% CI −0.96 to −0.43], with significantly greater improvement in MBTI. Sleep quality improved equivalently in both groups (MBTI: d = −1.19; SHEEP: d = −1.02). No significant interaction effects were observed in objective sleep measures. However, only MBTI had reduced WASOactigraphy (MBTI: d = −0.30; SHEEP: d = 0.02), SOLactigraphy (MBTI: d = −0.25; SHEEP: d = −0.09), and WASOPSG (MBTI: d = −0.26; SHEEP (d = −0.18). There was no change in SOLPSG. No participants withdrew because of adverse effects. Conclusions MBTI is effective at improving subjective and objective sleep quality in older adults, and could be a valid alternative for persons who have failed or do not have access to standard frontline therapies.

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The effect of 4-h versus 6-h time restricted feeding on sleep quality, duration, insomnia severity and obstructive sleep apnea in adults with obesity

Nutrition and Health ◽

10.1177/02601060211002347 ◽

2021 ◽

pp. 026010602110023

Author(s):

Sofia Cienfuegos ◽

Kelsey Gabel ◽

Faiza Kalam ◽

Mark Ezpeleta ◽

Vicky Pavlou ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Sleep Quality ◽

Sleep Onset ◽

Control Group ◽

Sleep Onset Latency ◽

Restricted Feeding ◽

Wake Time ◽

Obstructive Sleep ◽

Insomnia Severity

Background: Time restricted feeding (TRF) involves deliberately restricting the times during which energy is ingested. Preliminary findings suggest that 8–10-h TRF improves sleep. However, the effects of shorter TRF windows (4–6 h) on sleep, remain unknown. Aims: This study compared the effects of 4-h versus 6-h TRF on sleep quality, duration, insomnia severity and the risk of obstructive sleep apnea. Methods: Adults with obesity ( n = 49) were randomized into one of three groups: 4-h TRF (eating only between 3 and 7 p.m.), 6-h TRF (eating only between 1 and 7 p.m.), or a control group (no meal timing restrictions) for 8 weeks. Results: After 8 weeks, body weight decreased ( p < 0.001) similarly by 4-h TRF (–3.9 ± 0.4 kg) and 6-h TRF (–3.4 ± 0.4 kg), versus controls. Sleep quality, measured by the Pittsburgh Sleep Quality Index (PSQI), did not change by 4-h TRF (baseline: 5.9 ± 0.7; week 8: 4.8 ± 0.6) or 6-h TRF (baseline: 6.4 ± 0.8; week 8: 5.3 ± 0.9), versus controls. Wake time, bedtime, sleep duration and sleep onset latency also remained unchanged. Insomnia severity did not change by 4-h TRF (baseline: 4.4 ± 1.0; week 8: 4.7 ± 0.9) or 6-h TRF (baseline: 8.3 ± 1.2; week 8: 5.5 ± 1.1), versus controls. Percent of participants reporting obstructive sleep apnea symptoms did not change by 4-h TRF (baseline: 44%; week 8: 25%) or 6-h TRF (baseline: 47%; week 8: 20%), versus controls. Conclusion: These findings suggest that 4- and 6-h TRF have no effect on sleep quality, duration, insomnia severity, or the risk of obstructive sleep apnea.

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Moderate Exercise Plus Sleep Education Improves Self-Reported Sleep Quality, Daytime Mood, and Vitality in Adults with Chronic Sleep Complaints: A Waiting List-Controlled Trial

Sleep Disorders ◽

10.1155/2011/809312 ◽

2011 ◽

Vol 2011 ◽

pp. 1-10 ◽

Cited By ~ 13

Author(s):

Carmen Gebhart ◽

Daniel Erlacher ◽

Michael Schredl

Keyword(s):

Physical Exercise ◽

Sleep Quality ◽

Controlled Trial ◽

Sleep Onset ◽

Intervention Group ◽

Waiting List ◽

Control Group ◽

Sleep Education ◽

Sleep Complaints ◽

Chronic Sleep

Research indicates that physical exercise can contribute to better sleep quality. This study investigates the six-week influence of a combined intervention on self-rated sleep quality, daytime mood, and quality of life. A nonclinical sample of 114 adults with chronic initiating and the maintaining of sleep complaints participated in the study. The intervention group of 70 adults underwent moderate physical exercise, conducted weekly, plus sleep education sessions. Improvements among participants assigned to the intervention group relative to the waiting-list control group (n=44) were noted for subjective sleep quality, daytime mood, depressive symptoms and vitality. Derived from PSQI subscores, the intervention group reported increased sleep duration, shortened sleep latency, fewer awakenings after sleep onset, and overall better sleep efficiency compared to controls. The attained scores were well sustained and enhanced over a time that lasted through to the follow-up 18 weeks later. These findings have implications in treatment programs concerning healthy lifestyle approaches for adults with chronic sleep complaints.

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Effectiveness of the Internet-based Versus Face-to-Face Interaction on Reduction of Tobacco use among Adults: A Systematic Review and Meta-Analysis

10.21203/rs.3.rs-318627/v1 ◽

2021 ◽

Author(s):

Rajesh Kumar ◽

Ravi Kant ◽

Poonam Yadav ◽

Tamar Rodney ◽

Mukesh Bairwa

Keyword(s):

Developing Countries ◽

Tobacco Use ◽

Meta Analysis ◽

Intervention Group ◽

The Internet ◽

Control Group ◽

Forest Plot ◽

Cochrane Central Register ◽

Face To Face

Abstract BackgroundThe burden of tobacco-associated disorders is prevalent worldwide. Over the years, many innovative internet-based approaches have been utilized with variable success to quit tobacco. Though the effectiveness of internet-based and face-to-face interventions on quitting smoking are very well reported in the literature, due to limitation in methodology and limited sample size, it is required to integrate and analyze these studies' findings to reach a single conclusion. The study evaluated the effectiveness of the internet as an intervention approach versus face-to-face interaction on reducing tobacco use as control among adults.MethodsA systematic search was performed through various electronic databases such as Medline, PsychInfo, PubMed, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), ResearchGate, Google Scholar, and Academia. Reference lists of the eligible articles were also screened. Full-text articles were included as per eligibility criteria (PICO framework). No ethnicity restriction was applied.ResultsA total of 13 studies were selected for meta-analysis, with 3852 and 3908 participants in intervention and control groups respectively. Forest plot favours the intervention group at one month follow up for tobacco quitting (OR: 2.37, CI: 1.86-3.02, P-0.00001, I2 =0%), at three months (OR: 1.88, CI: 1.48-2.40, P-0.00001, I2 =42%) at six months (OR: 2.02, CI: 1.64-2.50, P-0.00001, I2 =38%) and at 1 year of follow-up (OR: 1.43, CI: 1.18-1.74, P-0.00001, I2 = 36%) comparing to control group. ConclusionInternet and web-based interventions are highly useful in tobacco quitting at one month, three months, six months, and one year of follow-up compared to face-to-face interaction or no intervention, although the level of evidence was moderate. Additionally, limited availability of trials in developing countries, arising need for research of internet use in developing countries to quit tobacco. Prospero Registration number- PROSPERO 2020 CRD42020214306

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Guided Internet-delivered cognitive behavioural treatment for insomnia: a randomized trial

Psychological Medicine ◽

10.1017/s0033291713002249 ◽

2013 ◽

Vol 44 (7) ◽

pp. 1521-1532 ◽

Cited By ~ 54

Author(s):

A. van Straten ◽

J. Emmelkamp ◽

J. de Wit ◽

J. Lancee ◽

G. Andersson ◽

...

Keyword(s):

Controlled Trial ◽

Sleep Onset ◽

Intervention Group ◽

Sleep Diary ◽

The Internet ◽

Control Group ◽

Sleep Onset Latency ◽

Cognitive Behavioural ◽

Co Morbidity ◽

Significant Difference

BackgroundInsomnia is a prevalent problem with a high burden of disease (e.g. reduced quality of life, reduced work capacity) and a high co-morbidity with other mental and somatic disorders. Cognitive behavioural therapy (CBT) is effective in the treatment of insomnia but is seldom offered. CBT delivered through the Internet might be a more accessible alternative. In this study we examined the effectiveness of a guided Internet-delivered CBT for adults with insomnia using a randomized controlled trial (RCT).MethodA total of 118 patients, recruited from the general population, were randomized to the 6-week guided Internet intervention (n = 59) or to a wait-list control group (n = 59). Patients filled out an online questionnaire and a 7-day sleep diary before (T0) and after (T1) the 6-week period. The intervention group received a follow-up questionnaire 3 months after baseline (T2).ResultsAlmost three-quarters (72.9%) of the patients completed the whole intervention. Intention-to-treat (ITT) analysis showed that the treatment had statistically significant medium to large effects (p < 0.05; Cohen's d between 0.40 and 1.06), and resulted more often in clinically relevant changes, on all sleep and secondary outcomes with the exception of sleep onset latency (SOL) and number of awakenings (NA). There was a non-significant difference in the reduction in sleep medication between the intervention (a decrease of 6.8%) and control (an increase of 1.8%) groups (p = 0.20). Data on longer-term effects were inconclusive.ConclusionsThis study adds to the growing body of literature that indicates that guided CBT for insomnia can be delivered through the Internet. Patients accept the format and their sleep improves.

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The Effectiveness of integrating spirituality into prenatal care on Improving Sleep Quality and Insomnia Severity among Pregnant Women: A Randomized Control Trial

10.21203/rs.3.rs-1025124/v1 ◽

2021 ◽

Author(s):

azam maleki ◽

Nahid Moradi ◽

Saeedeh Zenoozian

Keyword(s):

Prenatal Care ◽

Sleep Quality ◽

Pregnant Women ◽

Controlled Trial ◽

Intervention Group ◽

Severity Index ◽

First Trimester ◽

Routine Care ◽

Control Group ◽

Insomnia Severity

Abstract Background To determine the effectiveness of integrating spirituality into prenatal care on Improving Sleep Quality and Insomnia Severity among Pregnant Women. Methods This randomized controlled trial was carried out on 40 pregnant women recruited at five health centers of zanjan, Iran, 2020. The eligible women were allocated into two intervention and control groups according to the randomized design. Group counselling with spiritual content was carried out in eight sessions, two times a week at 16 to 20 weeks of gestation. The control group only received routine care. Data were collected using the Pittsburgh Sleep Quality Index (PSQI) and the Insomnia Severity Index (ISI) questionnaires in three stages, before the intervention, at 28 and 36 weeks of gestation. Statistical analysis was performed using the SPSS 16.0 software (SPSS Inc., Chicago, IL, USA). Results The results showed that comparing the mean score of insomnia severity, sleep quality and its components in the pre-intervention phase was not statistically significant between the two groups(p>0.05). Comparison of the insomnia severity, sleep quality, and its components scores decreased statistically in the second and third trimesters compared to the first trimester in the intervention group than the control group(p<0.05). The effect of the intervention (Eta score) was 64%. Conclusion The results showed that counselling with spiritual content could effectively ameliorate sleep quality and reduce insomnia severity in pregnant women. It seems that the approach is an acceptable basis to design intervention programs in this field that can be considered by midwives.

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Efficacy of Micronized Progesterone for Sleep: A Systematic Review and Meta-analysis of Randomized Controlled Trial Data

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/clinem/dgaa873 ◽

2020 ◽

Author(s):

Brendan J Nolan ◽

Bonnie Liang ◽

Ada S Cheung

Keyword(s):

Systematic Review ◽

Randomized Controlled Trials ◽

Effect Size ◽

Meta Analysis ◽

Sleep Onset ◽

Sleep Time ◽

Controlled Trials ◽

Sleep Onset Latency ◽

Randomized Controlled ◽

Micronized Progesterone

Abstract Context Preclinical data has shown progesterone metabolites improve sleep parameters through positive allosteric modulation of the γ-aminobutyric acid type A receptor. We undertook a systematic review and meta-analysis of randomized controlled trials to assess micronized progesterone treatment on sleep outcomes. Evidence Acquisition Using preferred reporting items for systematic review and meta-analysis guidelines, we searched MEDLINE, Embase, PsycInfo, and the Cochrane Central Register of Controlled Trials for randomized controlled trials of micronized progesterone treatment on sleep outcomes up to March 31, 2020. This study is registered with the International Prospective Register of Systematic Reviews, number CRD42020165981. A random effects model was used for quantitative analysis. Evidence Synthesis Our search strategy retrieved 9 randomized controlled trials comprising 388 participants. One additional unpublished trial was found. Eight trials enrolled postmenopausal women. Compared with placebo, micronized progesterone improved various sleep parameters as measured by polysomnography, including total sleep time and sleep onset latency, though studies were inconsistent. Meta-analysis of 4 trials favored micronized progesterone for sleep onset latency (effect size, 7.10; confidence interval [CI] 1.30, 12.91) but not total sleep time (effect size, 20.72; CI -0.16, 41.59) or sleep efficiency (effect size, 1.31; CI -2.09, 4.70). Self-reported sleep outcomes improved in most trials. Concomitant estradiol administration and improvement in vasomotor symptoms limit conclusions in some studies. Conclusions Micronized progesterone improves various sleep outcomes in randomized controlled trials, predominantly in studies enrolling postmenopausal women. Further research could evaluate the efficacy of micronized progesterone monotherapy using polysomnography or validated questionnaires in larger cohorts.

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0524 Web-Delivered CBT for Insomnia Intervention Improves Sleep Among Adults with Insomnia and Depressive Symptoms

SLEEP ◽

10.1093/sleep/zsaa056.521 ◽

2020 ◽

Vol 43 (Supplement_1) ◽

pp. A200-A201

Author(s):

P J Batterham ◽

H Christensen ◽

F P Thorndike ◽

L M Ritterband ◽

R Gerwien ◽

...

Keyword(s):

Depressive Symptoms ◽

Sleep Quality ◽

Large Scale ◽

Behavioral Therapy ◽

Controlled Trial ◽

Sleep Onset ◽

Sleep Diary ◽

Sleep Onset Latency ◽

Sleep Diaries

Abstract Introduction Cognitive behavioral therapy for insomnia (CBT-I) is the first line recommended treatment for adults with chronic insomnia. In a prior randomized controlled trial (RCT), data showed web-delivered CBT-I (SHUTi) reduced insomnia severity as well as symptoms of depression, among adults with insomnia and elevated depressive symptoms. The present study aimed to further evaluate the effectiveness of web CBT-I to improve sleep outcomes as measured by prospectively entered sleep diaries in this same sample. Methods A large-scale RCT (N=1149) of Australian adults with insomnia and depressive symptoms compared a 9-week, web CBT-I therapeutic with an attention-matched web program at baseline, posttest and 6-, 12-, and 18-month follow-ups. Although depression outcomes have been presented previously, the online sleep-diary derived variables have not yet been presented, including sleep-onset latency (SOL), wake after sleep onset (WASO), sleep efficiency (SE), number of awakenings, sleep quality, and total sleep time (TST). Sleep diaries were entered online for 10 days at each assessment period. Results Data showed web CBT-I participants demonstrated greater reductions from baseline to posttest compared with control for the following sleep variables: SOL (LS mean difference [95% CI]=-22.3 min [-29.2, -15.3]; p<.0001), WASO (-17.8 min [-23.4, -12.3]; p<.0001), and number of awakenings (-0.38 [-0.68, -0.09]; p=.0113). Web CBT-I also showed greater improvements in SE (9.18% [7.25%, 11.10%]; p<.0001) and sleep quality (0.41 [0.30, 0.53]; p<.0001) from baseline to posttest compared with control. TST was not significantly different between groups at posttest or 6-month follow-up, although it improved over baseline at 12 (18.73 min [7.39, 30.07]; p=.0013) and 18 months (23.76 min [9.15, 38.36]; p=.0015) relative to control. All other significant sleep treatment effects were maintained in the treatment arm at 6, 12, and 18-month follow-up. Conclusion Data showed web CBT-I produced lasting improvements in sleep outcomes among adults with insomnia and elevated depressive symptoms. Support Clinical trial ACTRN12611000121965 was funded by the Australian National Health and Medical Research Council. The statistical analysis described here was funded by Pear Therapeutics, Inc and conducted by Provonix.

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Effect of Auricular Acupressure on Sleep and Pruritus in Patients Undergoing Hemodialysis

Journal of Korean Academy of Fundamentals of Nursing ◽

10.7739/jkafn.2020.27.2.141 ◽

2020 ◽

Vol 27 (2) ◽

pp. 141-152 ◽

Cited By ~ 1

Author(s):

Yun Yi Bang ◽

Hyojung Park

Keyword(s):

Sleep Quality ◽

Sleep Onset ◽

Experimental Period ◽

Sleep Time ◽

Nursing Intervention ◽

Sleep Onset Latency ◽

Auricular Acupressure ◽

Significant Difference ◽

Improve Sleep Quality ◽

Evidence Based Nursing

Purpose: The aim of this study was to evaluate the effects of auricular acupressure on sleep quality and pruritus in patients undergoing hemodialysis and to propose an effective and evidence-based nursing intervention.Methods: This was a single-blind, nonequivalent, group comparison study with 42 participants. The experimental period was a total of 8 weeks, and five different acupressure sites were applied in each group. Dependent variables were measured before the intervention, at the 4th week of the intervention, and at the 8th week of the intervention.Results: There were significant differences in the Pittsburgh sleep quality index, total sleep time, sleep efficiency, sleep onset latency, light sleep, deep sleep, number of awakenings, serum melatonin levels, subjective pruritus and skin hydration. No significant difference was found in skin pH between the two groups. Conclusion: Auricular acupressure was found to be an effective nursing intervention to improve sleep quality and to reduce pruritus in patients undergoing hemodialysis.

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