Insomnia is a prevalent health problem in late life and its treatment is predominantly pharmacological in nature. Between 10 percent to 15 percent of those prescribed a hypnotic medication continue using it for more than a year, despite evidence that chronic usage is ineffective and detrimental to health and quality of life. Prolonged uses of hypnotic medications are primary older adults. Although psychological (cognitive-behavioral) interventions have been used successfully with unmedicated insomniacs, there is little empirical data on the efficacy of such nonpharmacological interventions for hypnotic-dependent insomnia. The proposed study is designed to evaluate the efficacy of cognitive-behavior therapy (CBT) and supervised medication taper, alone and in combination, for benzodiazepine discontinuation among hypnotic-dependent insomniacs. A total of 75 older adults (age > 60 years) meeting criteria for hypnotic-dependent insomnia will be randomly assigned to one of three treatment conditions: (a) cognitive-behavior therapy combined with a supervised medication taper (n = 25); (b) medication taper only (n = 25); or, (c) cognitive-behavior therapy only (n = 25). All three interventions (CBT + Taper; Taper alone; CBT alone) will last 10 weeks after the initial 2-week baseline period. Follow-ups will be conducted at 3, 12, and 24 months. Treatment outcome will be assessed across measures of sleep, mood, daytime performance, and quality of life. The main research questions are: (1) which of three treatment modalities (i.e., CBT+Taper, Taper, or CBT) is most effective for benzodiazepine- discontinuation and improving sleep patterns among hypnotic-dependent insomniacs; (2) what are the short- and long-term effects of hypnotic discontinuation on sleep, daytime performance, mood, and quality of life of older insomniacs; and (3) are there predictors (e.g., insomnia chronicity, duration of hypnotic use, coping styles) of successful outcome (i.e., drug-free and/or improved sleep). The long-term objectives of this study are to further the understanding of insomnia and chronic use of benzodiazepines in late life, and to design an effective treatment program that could be implemented routinely in the clinical management of hypnotic-dependent insomnia.

Agency
National Institute of Health (NIH)
Institute
National Institute of Mental Health (NIMH)
Type
Research Project (R01)
Project #
5R01MH055469-03
Application #
2519799
Study Section
Mental Disorders of Aging Review Committee (MDA)
Project Start
1995-09-30
Project End
2000-08-31
Budget Start
1997-09-01
Budget End
1998-08-31
Support Year
3
Fiscal Year
1997
Total Cost
Indirect Cost
Name
Laval University
Department
Type
DUNS #
208704593
City
Quebec
State
PQ
Country
Canada
Zip Code
G1 0-A6
Morin, Charles M; Belanger, Lynda; Bastien, Celyne et al. (2005) Long-term outcome after discontinuation of benzodiazepines for insomnia: a survival analysis of relapse. Behav Res Ther 43:1-14
Morin, Charles M; Bastien, Celyne; Guay, Bernard et al. (2004) Randomized clinical trial of supervised tapering and cognitive behavior therapy to facilitate benzodiazepine discontinuation in older adults with chronic insomnia. Am J Psychiatry 161:332-42
Bastien, Celyne H; Morin, Charles M; Ouellet, Marie-Christine et al. (2004) Cognitive-behavioral therapy for insomnia: comparison of individual therapy, group therapy, and telephone consultations. J Consult Clin Psychol 72:653-9
Bastien, Celyne H; Vallieres, Annie; Morin, Charles M (2004) Precipitating factors of insomnia. Behav Sleep Med 2:50-62
Bouchard, Sebastien; Bastien, Celyne; Morin, Charles M (2003) Self-efficacy and adherence to cognitive-behavioral treatment of insomnia. Behav Sleep Med 1:187-99
Savard, Josee; Laroche, Liny; Simard, Sebastien et al. (2003) Chronic insomnia and immune functioning. Psychosom Med 65:211-21
Bastien, Celyne H; Fortier-Brochu, Emilie; Rioux, Isabelle et al. (2003) Cognitive performance and sleep quality in the elderly suffering from chronic insomnia. Relationship between objective and subjective measures. J Psychosom Res 54:39-49
Morin, C M; Blais, F; Savard, J (2002) Are changes in beliefs and attitudes about sleep related to sleep improvements in the treatment of insomnia? Behav Res Ther 40:741-52
Morin, C M (2001) [Psychological vulnerability to insomnia] Rev Neurol (Paris) 157:S67-70
Bastien, C H; Morin, C M (2000) Familial incidence of insomnia. J Sleep Res 9:49-54

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