Improving Sleep in Nursing Homes

Condition(s) targeted: Sleep Deprivation

Intervention: Ramelteon (Drug)

Phase: Phase 4

Status: Recruiting

Sponsored by: Emory University

Official(s) and/or principal investigator(s):
Joseph G Ouslander, MD, Principal Investigator, Affiliation: Emory University, School of Medicine, Geriatric Division

Overall contact:
Deborah R Wittig-Wells, RN, PhD, Phone: 404-728-6906, Email: dwittig@emory.edu

Older people living in nursing homes do not sleep very well for many reasons. Sleep disorders such as sleep apnea (when someone briefly stops breathing during sleep), and night time urination, along with the problems caused by the nighttime environment of the nursing home, such as noise and disruptive care routines can all contribute. Poor sleep can lead to other health problems or make existing health problems worse.

This study will evaluate how well a sleep hygiene intervention and a medication for sleep (ramelteon (Rozerem)) work to improve sleep in nursing home residents with poor sleep. Ramelteon is FDA approved and has been tested in older adults living in the community, but not in older adults living in nursing homes. We expect sleep to improve on the study drug along with the sleep hygiene intervention, in comparison to placebo along with the sleep hygiene intervention. Based on adverse events reported in previous samples of older subjects, we expect the study drug to cause few side effects.

Official title: Improving Sleep in Nursing Homes

Study design: Treatment, Randomized, Double Blind (Subject, Caregiver, Investigator, Outcomes Assessor), Placebo Control, Parallel Assignment, Efficacy Study

Primary outcome: Sleep efficiency - Actigraphy measures- average percentage of time in bed at night asleep holding constant time in bed and recording time.

Secondary outcome: Other objective sleep parameters - as assessed by observations, daytime sleep, activity and behavior, PSG studies, Actigraphy Mood

Detailed description: This study evaluates how well Ramelteon works by measuring sleep at night and during the day. After consenting and final determination of eligibility, participants will complete a baseline phase to assess usual sleep, as well as daytime alertness and activity , thinking and memory, walking and balance (among those who walk and/or stand), and mood. Sleep at night and during the day will be objectively assessed with wrist actigraphs in all subjects. Approximately half will also receive polysomnography to assess nighttime sleep. Subjects who sleep more than 75% of the time they are in bed will not continue in the study. Subjects that do not have improved sleep with the sleep hygiene program will be randomized

to one of two treatment groups - one will receive the active drug along with the sleep

hygiene intervention and the other will receive a placebo along with the sleep hygiene intervention. Following randomization, subjects will complete a brief run-in phase and then enter the treatment phase. Assessment of sleep and other measures will be repeated.

The primary hypotheses to be examined in this study are as follows:

Hypothesis 1: Subjects treated with ramelteon in addition to a sleep hygiene (SHI) will have improved sleep latency, and as a consequence, a significant increase in actigraphically measured sleep efficiency, compared to subjects treated with placebo plus a SHI.

Hypothesis 2: Subjects treated with ramelteon in addition to a SHI will sleep less and spend less time in bed during the day, be more engaged in daytime activities, and have better mood than subjects treated with placebo plus a SHI.

Hypothesis 3: Changes in daytime sleep, time in bed during the day, engagement in activities, and mood will be positively correlated with improved sleep efficiency among subjects receiving ramelteon in addition to a SHI.

Minimum age: 65 Years. Maximum age: N/A. Gender(s): Both.

Criteria:

Inclusion Criteria:

- After initial screening and consenting, subjects with a 5-night average baseline

sleep efficiency of less than or equal to 75% will be included

Exclusion Criteria:

- Less than 65 yrs old

- Bedbound

- Resided in NH for less than two months

- Patients on Medicare Part A skilled Benefit(anticipated short length stay) -

Terminal Illness

- Unstable psychotropic drug regimen (addition, discontinuation, or change of dosage

of any psychotropic drug in the prior two weeks) - Use of hypnotic,

antihistamine, or benzodiazepine more than once per week during the two weeks before screening

- Use of drugs that could potentially inhibit the metabolism of Ramelteon (ie:

fluvoxamine, ketoconazole, fluconazole)

- Use of Drugs that induce the metabolism of Ramelteon (ie: rifampin)

Deborah R Wittig-Wells, RN, PhD, Phone: 404-728-6906, Email: dwittig@emory.edu

A. G. Rhodes Home, Atlanta, Georgia 30312, United States; Recruiting

Starting date: October 2007
Ending date: August 2009
Last updated: December 17, 2007