A behavioral intervention to enhance the sleep-wake patterns of older adults with insomnia.

Abstract

The research study evaluated the effectiveness of a behavioral intervention for sleep maintenance insomnia in older adults. Twenty-two elders who spent 60 minutes or more awake during the night on a minimum of three nights per week for at least six months received treatment. The study utilized an experimental design with repeated measures. The subjects were randomly assigned to either an immediate or delayed (waiting list control) treatment group. Subjects completed daily sleep diaries and several other measures. The behavioral intervention was a treatment package consisting of sleep restriction therapy, stimulus control instructions, sleep education, and an optional daytime nap. A six-week treatment program consisting of four weekly classes and two weekly telephone interventions was implemented. Between and within group differences were identified using repeated measures analysis of variance (ANOVA). Post-hoc analyses were performed to identify significant differences. The between group analysis of sleep behaviors revealed an improvement in wake after sleep onset and sleep efficiency for the immediate treatment group. After intervention, the delayed treatment group improved on the same sleep behaviors as well as total sleep time. The therapeutic improvement was maintained at the three month follow-up. Sleep-wake impairment, dysfunctional cognitions, and presleep anxiety were reduced for both groups. The mood measures indicated that the subjects were not depressed prior to treatment and remained nondepressed following intervention. State and trait anxiety levels decreased. Favorable ratings for therapy evaluation were received. The majority of subjects felt they were compliant with treatment and had corresponding decreases in wake after sleep onset. In addition to statistical significance, the clinical significance of the study was established. Insomnia in older adults can be effectively treated using nonpharmacological intervention. Replication of the study is warranted as well as analysis to examine moderating factors affecting treatment outcomes. An effort should be made to increase the demographic diversity of subjects in future studies. Alternative treatment implementation modalities and settings other than the community should be considered for further research.