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.
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