Dismantling multicomponent behavioral treatment for insomnia in older adults: a randomized controlled trial.
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.


METHODS
A randomized, controlled study.


METHODS
Veterans Affairs medical center.


METHODS
179 older adults (mean age, 68.9 yr ± 8.0; 115 women [64.2%]) with chronic primary insomnia.


METHODS
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.


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.


BACKGROUND
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.
Phoenix Veterans Affairs Health Care System, Phoenix, AZ, USA. dana.epstein@va.gov
Dana R
DR
Epstein
Souraya
S
Sidani
Richard R
RR
Bootzin
Michael J
MJ
Belyea
D056044:Actigraphy; D000368:Aged; D001521:Behavior Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D010349:Patient Compliance; D012890:Sleep; D007319:Sleep Initiation and Maintenance Disorders / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome