Dept of Medicine, Division of Geriatrics & Gerontology, Emory University, Atlanta, GA 30329, USA.
Dept of Veterans Affairs Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Birmingham, AL & Atlanta, GA, USA.
Age Ageing. 2022 Feb 2;51(2). doi: 10.1093/ageing/afac024.
Nocturia and chronic insomnia disorder are common conditions that frequently coexist in older adults. Existing medication treatments for each condition have risks, particularly in older adults. While treatment guidelines recommend starting with behavioural therapy for each condition, no existing program simultaneously addresses nocturia and insomnia. Existing behavioural interventions for nocturia or insomnia contain concordant and discordant components. An expert panel (including geriatricians with sleep or nocturia research expertise, sleep psychologists and a behavioural psychologist) was convened to combine and reconcile elements of behavioural treatment for each condition. Concordant treatment recommendations involve using situational self-management strategies such as urge suppression or techniques to influence homeostatic drive for sleep. Fluid modification such as avoiding alcohol and evening caffeine and regular self-monitoring through a daily diary is also appropriate for both conditions. The expert panel resolved discordant recommendations by eliminating overnight completion of voiding diaries (which can interfere with sleep) and discouraging routine overnight voiding (a stimulus control strategy). The final product is an integrated cognitive behavioural treatment that is delivered by advanced practice providers weekly over 5 weeks. This integrated program addresses the common scenario of coexisting nocturia and chronic insomnia disorder.
夜尿症和慢性失眠症是老年人中常见的病症，且常同时存在。针对每种病症的现有药物治疗都存在风险，尤其是在老年人中。虽然治疗指南建议针对每种病症首先采用行为疗法，但目前尚无同时针对夜尿症和失眠症的方案。现有的针对夜尿症或失眠症的行为干预措施包含一致和不一致的内容。一个专家小组（包括具有睡眠或夜尿症研究专业知识的老年病学家、睡眠心理学家和行为心理学家）被召集起来，将每种病症的行为治疗的元素结合并调和起来。一致的治疗建议包括使用情境自我管理策略，如抑制冲动或影响睡眠稳态驱动力的技术。液体调节，如避免夜间饮酒和摄入咖啡因，以及通过每日日记进行定期自我监测，对这两种病症也同样适用。专家小组通过消除夜间完成排尿日记（这可能会干扰睡眠）和不鼓励常规夜间排尿（一种刺激控制策略）来解决不一致的建议。最终的产品是一种综合的认知行为治疗，由高级执业医生每周提供一次，共 5 周。这个综合方案解决了同时存在的夜尿症和慢性失眠症的常见情况。
