A large proportion of the geriatric population suffers from insomnia. Hypnotic medication, though offering short-term relief, loses its efficacy in a matter of weeks. In addition, particularly for the aged, hypnotic medication may lead to carry-over effects. anterograde amnesia and exacerbation of sleep apnea. Effective non-pharmacological treatments for insomnia are sorely needed for this age group. Most existing research on psychological treatments for insomnia has focused on younger individuals. Use of such techniques in older subjects may require novel approaches and modifications of existing techniques. Changes should reflect the primacy of sleep maintenance (opposed to sleep latency) problems in elders and increased frequency of daytime sleepiness in this group. We propose to study a treatment recently reported to be successful in younger insomniacs, Sleep Restriction Therapy (SRT). SRT improves sleep quality by restricting excessive time in bed and allowing a modest accrual of sleep debt, resulting in consolidated sleep. On the basis of our initial success and experience with SRT in the aged, we will also employ a Modified SRT (MSRT) as a second treatment. In the MSRT condition subjects will be encouraged to take a single nap, carefully scheduled to occur in a fixed time relationship to their bedtimes. Both SRT and MSRT conditions will be compared to a third condition (Hygiene). Our goal is to evaluate treatments for geriatric insomnia not only in terms of improvement of sleep but also in terms of daytime function and performance. We plan to test two hypotheses: 1. Efficacy Hypothesis: SRT and MSRT will improve the sleep of community residing elderly by increasing sleep efficiency (SE) and total sleep time (TST). and by reducing latency to sleep onset (SO), the number of awakenings, and wakefulness after sleep onset (WASO), when compared with subjects in the Hygiene condition. 2. Side-Effects Hypothesis: Subjective daytime sleepiness will increase for subjects in the SRT condition but not for subjects in the MSRT condition; performance on attentional measures will improve in the MSRT condition but will remain the same or decline in the SRT condition. Hypothesis 1 (Efficacy) will be tested in a comparative group study with three conditions: SRT, MSRT, and Hygiene. All groups will report information about their sleep twice daily to a telephone answering machine. This will continue for a six-week period: two weeks of baseline data collection plus four weeks of treatment. The Hygiene group will control for transient changes in sleep patterns over time, and nonspecific effects of self-observation, telephone call-in, exposure to principles of sleep hygiene, problem-solving techniques, and therapist contact. Outcome assessments will include measures of 24TST, TST. WASO, SO, SE, and measures of subjective sleep quality. Hypothesis 2 (SideEffects) will be tested by measures taken before and after treatment on daytime sleepiness and attentional function. Additional Research Questions will address the issue of whether or not measures of depression and anxiety taken before and after treatment vary by treatment.
| Friedman, L; Benson, K; Noda, A et al. (2000) An actigraphic comparison of sleep restriction and sleep hygiene treatments for insomnia in older adults. J Geriatr Psychiatry Neurol 13:17-27 |
| Bliwise, D L; Friedman, L; Nekich, J C et al. (1995) Prediction of outcome in behaviorally based insomnia treatments. J Behav Ther Exp Psychiatry 26:17-23 |
| Friedman, L; Brooks 3rd, J O; Bliwise, D L et al. (1995) Perceptions of life stress and chronic insomnia in older adults. Psychol Aging 10:352-7 |
| Brooks 3rd, J O; Friedman, L; Bliwise, D L et al. (1993) Use of the wrist actigraph to study insomnia in older adults. Sleep 16:151-5 |
| Bliwise, D L; Friedman, L; Yesavage, J A (1993) Depression as a confounding variable in the estimation of habitual sleep time. J Clin Psychol 49:471-7 |
