Insomnia is a widespread health problems among the elderly. Its treatment in relation to age, however, has received very little empirical attention. Controlled evaluations of psychological and pharmacological treatments have focused on young adults and on sleep onset problems while the most prevalent complaint in late life is sleep-maintenance insomnia. There has been no direct comparison of these two treatment modalities for insomnia and it is equivocal whether drug treatments in older people produce more sleep benefits than residual daytime impairments. The proposed study is intended to evaluate the clinical and comparative efficacy of cognitive- behavior therapy and pharmacotherapy for late-life insomnia in 100 older adults. A 5 (Group) X 5 (Assessment) split-plot factorial design with repeated measures on the second factor will be used. Prospective subjects will be matched on gender and insomnia severity and randomly assigned to one of the following conditions: (a) cognitive-behavior therapy; (b) pharmacotherapy (temazepam); (c) cognitive-behavior therapy plus pharmacotherapy; (d) drug-placebo; and (e) waiting-list. All treatment will last eight weeks after the initial 2-week baseline period. Treatment outcome will be evaluated across measures of sleep, mood, and neuropsychological functioning. Placebo and wait-list subjects will receive treatment after the initial 8-week experimental phase. Follow-ups will be conducted at 3, 12, and 24 months. The main research questions addressed by this study are: (a) which treatment modality or combination produces the best outcome on subjective and objective sleep parameters? (b) what is the impact of improved sleep on mood and daytime performance measures? (c) are there predictors of successful outcome within and across treatment modalities? and, (e) how does exposure to drug and nondrug interventions for insomnia impact on long-term utilization of health-related services. Despite its widespread prevalence in the aging population, insomnia remains for the most part untreated. The long-term objective of this proposal is to design a comprehensive and cost-effective treatment program which would routinely be administered for the management of late-life insomnia.
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