Efficacy of Brief Behavioral Treatment for Chronic Insomnia in Older Adults

Abstract

Background Chronic insomnia is a common health problem with substantial consequences in older adults. Cognitive behavioral treatments are efficacious but not widely available. The aim of this study was to test the efficacy of brief behavioral treatment for insomnia (BBTI) vs an information control (IC) condition. Methods A total of 79 older adults (mean age, 71.7 years; 54 women [70%]) with chronic insomnia and common comorbidities were recruited from the community and 1 primary care clinic. Participants were randomly assigned to either BBTI, consisting of individualized behavioral instructions delivered in 2 intervention sessions and 2 telephone calls, or IC, consisting of printed educational material. Both interventions were delivered by a nurse clinician. The primary outcome was categorically defined treatment response at 4 weeks, based on sleep questionnaires and diaries. Secondary outcomes included self-report symptom and health measures, sleep diaries, actigraphy, and polysomnography. Results Categorically defined response (67% [n=26] vs 25% [n=10]; χ2=13.8) (P<.001) and the proportion of participants without insomnia (55% [n=21] vs 13% [n=5]; χ2=15.5) (P<.001) were significantly higher for BBTI than for IC. The number needed to treat was 2.4 for each outcome. No differential effects were found for subgroups according to hypnotic or antidepressant use, sleep apnea, or recruitment source. The BBTI produced significantly better outcomes in self-reported sleep and health (group × time interaction, F5,73=5.99, P<.001), sleep diary (F8,70= 4.32, P<.001), and actigraphy (F4,74=17.72, P<.001), but not polysomnography. Improvements were maintained at 6months. Conclusion We found that BBTI is a simple, efficacious, and durable intervention for chronic insomnia in older adults that has potential for dissemination across medical settings.

Impact of Brief Cognitive Behavioral Treatment for Insomnia on Health Care Utilization and Costs

“…These findings are consistent with previous research on effectiveness of brief behavioral insomnia treatments. 30,32,47 Furthermore, a significant treatment response may not be necessary to impact HCU and costs-treatment completers saw a reduction-although a treatment response may augment the cost-savings. Furthermore, the intervention was delivered by clinical psychology doctoral students and predoctoral interns, only some of whom had a background and previous training in insomnia and behavioral sleep medicine interventions.…”

“…[25][26][27] However, Manber and colleagues have described the successful training of mental health clinicians without sleep specialization to deliver CBTi in the VA healthcare system. 28 In response to this, shortened protocols (i.e., ≤ 4 sessions) have been developed, and research has shown them to be efficacious and effective in treating insomnia in adults of all ages (see McCrae, 29 Buysse,30 or Edinger and Sampson, 31 for review). For example, Edinger and Sampson demonstrated that four sessions of CBTi resulted in clinically significant improvements in wake after sleep onset, total wake time, and sleep efficiency compared to sleep hygiene recommendations alone.…”

“…For example, Buysse and colleagues also found moderate effect sizes for other outcomes following brief BBTi, including improved anxiety, depression, and quality of life. 30 HCU and other health related cost reductions represent other potentially important secondary outcomes that, unfortunately, have yet to be examined. Given evidence of brief behavioral protocols' impact on sleep, mood, and quality of life outcomes, demonstration of its ability to also reduce HCU and health care costs is particularly important.…”

A Four-Session Sleep Intervention Program Improves Sleep for Older Adult Day Health Care Participants: Results of a Randomized Controlled Trial

“…20,22,23 Some studies of brief interventions are also effective with older patients. 21,34 Consistent with traditional CBT-I interventions, all recommendations were tailored to the individual patient, addressing their specific circumstances, sleep patterns, and level of motivation to engage in the intervention.…”

“…CBT-I has been shown to be as effective for older as for younger adults; 17 however, studies of older adults have typically been conducted in outpatient settings with participants who do not have significant functional impairments. [20][21][22][23] It also is not clear whether adapting CBT-I for patients with limited physical abilities will reduce potency. ADHC participants may not be able to adhere to all of the traditional recommendations of CBT-I, such as getting out of bed at night (because of high fall risk) or completing complex sleep diaries (due to visual or cognitive difficulties).…”