title: "I'd eat a bucket of nails if you told me it would help me sleep:" perceptions of insomnia and its treatment in patients with stable heart failure.
abstract: BACKGROUND
  Poor sleep, including insomnia, is common among patients with heart failure (HF). However, little is known about the efficacy of interventions for insomnia in this population. Prior to developing interventions, there is a need for better understanding of patient perceptions about insomnia and its treatment.
  
  
  OBJECTIVE
  To evaluate HF patients' perceptions about 1) insomnia and its consequences; 2) predisposing, precipitating, and perpetuating factors for insomnia; 3) self-management strategies and treatments for insomnia; and 4) preferences for insomnia treatment.
  
  
  METHODS
  The study, guided by the "3 P" model of insomnia, employed a parallel convergent mixed methods design in which we obtained qualitative data through focus groups and quantitative data through questionnaires (sleep quality, insomnia severity, dysfunctional beliefs and attitudes about sleep; sleep-related daytime symptoms and functional performance). Content analysis was used to evaluate themes arising from the focus group data, and descriptive statistics were used to analyze the quantitative data. The results of both forms of data collection were compared and synthesized.
  
  
  RESULTS
  HF patients perceived insomnia as having a negative impact on daytime function and comorbid health problems, pain, nocturia, and psychological factors as perpetuating factors. They viewed use of hypnotic medications as often necessary but disliked negative daytime side effects. They used a variety of strategies to manage their insomnia, but generally did not mention their sleep concerns to physicians whom they perceived as not interested in sleep.
  
  
  CONCLUSIONS
  HF patients believe insomnia is important and multi-factorial. Behavioral treatments, such as cognitive behavioral therapy, for insomnia may be efficacious in modifying perpetuating factors and likely to be acceptable to patients.
authors.affiliation: Yale University School of Nursing, 100 Church St. South, New Haven, CT 06536, USA. laura.andrews@yale.edu
authors.forename: Laura Kierol
authors.initials: LK
authors.lastname: Andrews
authors.forename: Jessica
authors.initials: J
authors.lastname: Coviello
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Hurley
authors.forename: Leonie
authors.initials: L
authors.lastname: Rose
authors.forename: Nancy S
authors.initials: NS
authors.lastname: Redeker
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015984:Causality; D015928:Cognitive Behavioral Therapy / Q000379:methods; D003469:Culture; D005260:Female; D017144:Focus Groups; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D012648:Self Care; D007319:Sleep Initiation and Maintenance Disorders / Q000209:etiology / Q000523:psychology* / Q000628:therapy; D011795:Surveys and Questionnaires
chemical_list: D006993:Hypnotics and Sedatives
keywords: Cognitive behavioral therapy for insomnia; Heart failure; Hypnotics; Insomnia; Sleep