Articlegreen2012

Dismantling Multicomponent Behavioral Treatment for Insomnia in Older Adults: A Randomized Controlled Trial

Dana R. Epstein · Souraya Sidani · Richard R. Bootzin · Michael J. Belyea

127 citations0/0 files storedSLEEP

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Abstract

STUDY OBJECTIVE: Recently, the use of multicomponent insomnia treatment has increased. This study compares the effect of single component and multicomponent behavioral treatments for insomnia in older adults after intervention and at 3 months and 1 yr posttreatment. DESIGN: A randomized, controlled study. SETTING: Veterans Affairs medical center. PARTICIPANTS: 179 older adults (mean age, 68.9 yr ± 8.0; 115 women [64.2%]) with chronic primary insomnia. INTERVENTIONS: Participants were randomly assigned to 6 wk of stimulus control therapy (SCT), sleep restriction therapy (SRT), the 2 therapies combined into a multicomponent intervention (MCI), or a wait-list control group. MEASUREMENTS AND RESULTS: Primary outcomes were subjective (daily sleep diary) and objective (actigraphy) measures of sleep-onset latency (SOL), wake after sleep onset (WASO), total sleep time (TST), time in bed (TIB), and sleep efficiency (SE). Secondary outcomes were clinical measures including response and remission rates. There were no differences between the single and multicomponent interventions on primary sleep outcomes measured by diary and actigraphy. All treatments produced significant improvement in diary-reported sleep in comparison with the control group. Effect sizes for sleep diary outcomes were medium to large. Treatment gains were maintained at follow-up for diary and actigraph measured SOL, WASO, and SE. The MCI group had the largest proportion of treatment remitters. CONCLUSIONS: For older adults with chronic primary insomnia, the findings provide initial evidence that SCT, SRT, and MCI are equally efficacious and produce sustainable treatment gains on diary, actigraphy, and clinical outcomes. From a clinical perspective, MCI may be a preferred treatment due to its higher remission rate. CLINICAL TRIAL INFORMATION: Behavioral Intervention for Insomnia in Older Adults. NCT01154023. URL: http://clinicaltrials.gov/ct2/show/NCT01154023?term=Behavioral+Intervention+for+Insomnia+in+Older+Adults&rank=1.

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References

1970Manual for the State-Trait Anxiety Inventory 2015Older Adults' Reasons for Using Technology while Aging in Place 1982Development and validation of a geriatric depression screening scale: A preliminary report 2001Validation of the Insomnia Severity Index as an outcome measure for insomnia research 1983The Brief Symptom Inventory: an introductory report 1993Insomnia: Psychological Assessment and Management 2000The Use of Psychological Testing for Treatment Planning and Outcome Assessment 2006Psychological And Behavioral Treatment Of Insomnia: Update Of The Recent Evidence (1998–2004)

Cited by

2014A Pilot Randomized Controlled Trial of the Effects of Cognitive-Behavioral Therapy for Insomnia on Sleep and Daytime Functioning in College Students 2019Changes in dysfunctional beliefs about sleep after cognitive behavioral therapy for insomnia: A systematic literature review and meta-analysis 2018Cognitive and Behavioral Interventions to Improve Sleep in School-Age Children and Adolescents: A Systematic Review and Meta-Analysis 2018Treating chronic insomnia in postmenopausal women: a randomized clinical trial comparing cognitive-behavioral therapy for insomnia, sleep restriction therapy, and sleep hygiene education

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