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Self‐Help Treatment for Insomnia Symptoms Associated with Chronic Conditions in Older Adults: A Randomized Controlled Trial
Author(s) -
Morgan Kevin,
Gregory Pamela,
Tomeny Maureen,
David Beverley M.,
Gascoigne Claire
Publication year - 2012
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/j.1532-5415.2012.04175.x
Subject(s) - medicine , sleep hygiene , insomnia , randomized controlled trial , pittsburgh sleep quality index , physical therapy , sleep onset latency , cognitive behavioral therapy for insomnia , cognitive behavioral therapy , sleep disorder , psychiatry , sleep quality
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 P ittsburgh S leep Q uality I ndex ( PSQI ). Secondary outcomes were the I nsomnia S everity I ndex ( ISI ), the subjective sleep efficiency index, and the F atigue S everity S cale. 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 C ohen d = 0.51–0.75). 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.