Self‐Help Treatment for Insomnia Symptoms Associated with Chronic Conditions in Older Adults: A Randomized Controlled Trial
- 4 October 2012
- journal article
- research article
- Published by Wiley in Journal of the American Geriatrics Society
- Vol. 60 (10), 1803-1810
- https://doi.org/10.1111/j.1532-5415.2012.04175.x
Abstract
Objectives To evaluate the effectiveness of a self-help cognitive behavioral intervention in improving sleep quality in older adults reporting insomnia symptoms associated with chronic disease. Design A pragmatic two-arm randomized controlled trial comparing supported self-help with treatment as usual (TAU). Setting Primary care. Participants One hundred ninety-three self-referred individuals aged 55 to 87 with long-term conditions and chronic insomnia symptoms (as defined according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition). Intervention Self-help participants received six consecutive booklets, at weekly intervals, providing structured advice on important components of cognitive behavioral therapy for insomnia (CBT-I, including self-monitoring, sleep restriction, stimulus control procedures, and cognitive strategies), plus access to a telephone helpline. Control group participants received a single sheet of advice detailing standard sleep hygiene measures. Measurements The primary outcome was sleep quality, measured by the Pittsburgh Sleep Quality Index (PSQI). Secondary outcomes were the Insomnia Severity Index (ISI), the subjective sleep efficiency index, and the Fatigue Severity Scale. Results In the self-help group, sleep outcomes showed significant improvements after treatment (PSQI, P < .001; ISI, P < .001; sleep efficiency, P < .001) and at 3-month (PSQI, P = .002; ISI, P = .006; sleep efficiency, P = .001) and 6-month (PSQI, P = .003; ISI, P = .003; sleep efficiency, P = .001) follow-up. Effect sizes were moderate (range of adjusted Cohen d = 0.510.75). Treatment had no effect on levels of daytime fatigue. Most treated participants (73%) said they would recommend the self-help program to others. Conclusion Self-help CBT-I offers a practical first-line response to individual reporting insomnia symptoms associated with chronic disease in primary care settings. In these individuals, symptoms of daytime fatigue may be more closely associated with disease processes than with sleep quality.Keywords
This publication has 32 references indexed in Scilit:
- Efficacy of Brief Behavioral Treatment for Chronic Insomnia in Older AdultsArchives of Internal Medicine, 2011
- Relations between sleep, fatigue, and health-related quality of life in individuals with insomniaJournal of Psychosomatic Research, 2010
- One-Year Outcomes of a Behavioral Therapy Intervention Trial on Sleep Quality and Cancer-Related FatigueJournal of Clinical Oncology, 2009
- Effect of Exercise on Biomarkers, Fatigue, Sleep Disturbances, and Depressive Symptoms in Older Women With Breast Cancer Receiving Hormonal TherapyOncology Nursing Forum, 2008
- A Placebo-Controlled Test of Cognitive-Behavioral Therapy for Comorbid Insomnia in Older Adults.Journal of Consulting and Clinical Psychology, 2005
- Randomized Study on the Efficacy of Cognitive-Behavioral Therapy for Insomnia Secondary to Breast Cancer, Part I: Sleep and Psychological EffectsJournal of Clinical Oncology, 2005
- Restless legs syndrome: diagnostic criteria, special considerations, and epidemiology: A report from the restless legs syndrome diagnosis and epidemiology workshop at the National Institutes of HealthSleep Medicine, 2003
- Validation of the Insomnia Severity Index as an outcome measure for insomnia researchSleep Medicine, 2001
- Psychological treatment of secondary insomnia.Psychology and Aging, 2000
- Psychological treatment of secondary insomnia.Psychology and Aging, 2000