title: Self-help treatment for insomnia symptoms associated with chronic conditions in older adults: a randomized controlled trial.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  A pragmatic two-arm randomized controlled trial comparing supported self-help with treatment as usual (TAU).
  
  
  METHODS
  Primary care.
  
  
  METHODS
  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).
  
  
  METHODS
  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.
  
  
  METHODS
  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 = 0.51-0.75). Treatment had no effect on levels of daytime fatigue. Most treated participants (73%) said they would recommend the self-help program to others.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Clinical Sleep Research Unit, School of Sport, Exercise and Health Sciences, Loughborough University, Leicestershire, UK. k.morgan@lboro.ac.uk
authors.forename: Kevin
authors.initials: K
authors.lastname: Morgan
authors.forename: Pamela
authors.initials: P
authors.lastname: Gregory
authors.forename: Maureen
authors.initials: M
authors.lastname: Tomeny
authors.forename: Beverley M
authors.initials: BM
authors.lastname: David
authors.forename: Claire
authors.initials: C
authors.lastname: Gascoigne
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D015928:Cognitive Behavioral Therapy / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012648:Self Care; D007319:Sleep Initiation and Maintenance Disorders / Q000209:etiology / Q000628:therapy*