Nancy M. Wilson

Psychological Treatment of Secondary Insomnia

Psychological treatment of insomnia has focused on primary insomnia (i.e., having a psychological origin). Secondary insomnia, sleep disturbance caused by a psychiatric or medical disorder, although it is more common than primary insomnia, has received very little attention as a result of the belief that it would be refractory to treatment. The present study randomly assigned older adults with secondary insomnia to a treatment group, 4 sessions composed of relaxation and stimulus control, or a no-treatment control group. Self-report assessments conducted at pretreatment, posttreatment, and a 3-month follow-up revealed that treated participants showed significantly greater improvement on wake time during the night, sleep efficiency percentage, and sleep quality rating. The authors hypothesize that treatment success was probably due in part to difficulty in diagnostic discrimination between primary and secondary insomnia.

Relaxation and sleep compression for late-life insomnia: a placebo-controlled trial.

Older adults with insomnia were recruited from the community and randomized to treatments: relaxation, sleep compression, and placebo desensitization. Questionnaire data collected at baseline, posttreatment, and 1-year follow-up and polysomnography data collected at baseline and follow-up yielded the following conclusions: All treatments improved self-reported sleep, but objective sleep was unchanged. Clinical significance analyses yielded the strongest findings supporting the active treatments and suggested that sleep compression was most effective. Results partially supported the conclusion that individuals with high daytime impairment (i.e., fatigue) respond best to treatments that extend sleep, as in relaxation, and individuals with low daytime impairment respond best to treatments that consolidate sleep, as in sleep compression. Strong methodological features including a placebo condition and a treatment implementation scheme elevate the confidence due these findings.

‘Young old’ and ‘old old’ poor sleepers with and without insomnia complaints

OBJECTIVE Sleep, psychological adjustment, health and insomnia complaints were examined in 277 community-dwelling seniors in order to identify characteristics that distinguish poor sleepers with complaints (likely to seek treatment) and those without complaints (unlikely to seek treatment). METHODS Two weeks of sleep diaries and other sleep-related measures were collected. Young old (65-74 years) and old old (75+) participants were categorized as: good sleepers, poor sleepers with complaints (complainers), and poor sleepers without complaints (noncomplainers). RESULTS In both age groups, complainers had poorer sleep than noncomplainers. Complainers also reported more depressive symptoms and had poorer health than noncomplainers. The old old slept longer each night, but took longer to fall asleep, napped more, and were more likely to complain of insomnia than the young old; otherwise, the young old/old old distinction did not explain sleep differences among the three types of sleepers. CONCLUSIONS Implications for treating late-life insomnia include greater inclusion of the old old in treatment outcome research and more focus on the development of integrated intervention and prevention strategies that target health, depressive symptoms, and sleep.

Psychological Treatment of Hypnotic-Dependent Insomnia in a Primarily Older Adult Sample

OBJECTIVE This study tested cognitive behavior therapy (CBT) in hypnotic-dependent, late middle-age and older adults with insomnia. METHOD Seventy volunteers age 50 and older were randomized to CBT plus drug withdrawal, placebo biofeedback (PL) plus drug withdrawal, or drug withdrawal (MED) only. The CBT and PL groups received eight, 45 min weekly treatment sessions. The drug withdrawal protocol comprised slow tapering monitored with about six biweekly, 30 min sessions. Assessment including polysomnography (PSG), sleep diaries, hypnotic consumption, daytime functioning questionnaires, and drug screens collected at baseline, posttreatment, and 1-year follow-up. RESULTS Only the CBT group showed significant sleep diary improvement, sleep onset latency significantly decreased at posttreatment. For all sleep diary measures for all groups, including MED, sleep trended to improvement from baseline to follow-up. Most PSG sleep variables did not significantly change. There were no significant between group differences in medication reduction. Compared to baseline, the three groups decreased hypnotic use at posttreatment, down 84%, and follow-up, down 66%. There was no evidence of withdrawal side-effects. Daytime functioning, including anxiety and depression, improved by posttreatment. Rigorous methodological features, including documentation of strong treatment implementation and the presence of a credible placebo, elevated the confidence due these findings. CONCLUSIONS Gradual drug withdrawal was associated with substantial hypnotic reduction at posttreatment and follow-up, and withdrawal side-effects were absent. When supplemented with CBT, participants accrued incremental self-reported, but not PSG, sleep benefits.

Self-Reported Sleep, Demographics, Health, and Daytime Functioning in Young Old and Old Old Community-Dwelling Seniors

Sleep, demographics, health, and daytime functioning were examined in young old (60–74 years; n = 175) and old old (75–98 years; n = 147) community-dwelling seniors. Sleep diaries (2 weeks), 6 daytime functioning measures, and a demographics–health questionnaire were collected. The old old reported worse sleep than the young old. Women reported worse sleep than men. Hierarchical regressions revealed demographic information alone was not sufficient for understanding sleep. Specifically, demographic information predicted sleep onset latency and sleep efficiency for both groups, but not number of awakenings or total nap time. Health and daytime functioning accounted for significant increases in the variance in sleep “over and above” that accounted for by demographics alone or demographics and health combined, respectively. All variables combined accounted for 15% to 30% of the variance in sleep. Because the importance of specific measures varied by group and sleep variable, research exploring the differential utility of specific measures for young old versus old old appears warranted.

Community-based physical activity as adjunctive smoking cessation treatment: Rationale, design, and baseline data for the Lifestyle Enhancement Program (LEAP) randomized controlled trial

Despite advances in behavioral and pharmacological treatment for tobacco use and dependence, quit rates remain suboptimal. Increasing physical activity has shown some promise as a strategy for improving cessation outcomes. However, initial efficacy studies focused on intensive, highly structured exercise programs that may not be applicable to the general population of smokers. We describe the rationale and study design and report baseline participant characteristics from the Lifestyle Enhancement Program (LEAP), a two-group, randomized controlled trial. Adult smokers who engaged in low levels of leisure time physical activity were randomly assigned to treatment conditions consisting of an individualized physical activity intervention delivered by health fitness instructors in community-based exercise facilities or an equal contact wellness control. All participants received standard cognitive behavioral smoking cessation counseling combined with nicotine replacement therapy. The primary outcomes are seven-day point prevalence abstinence at seven weeks, six- and 12 months. Secondary outcomes include self-reported physical activity, dietary intake, body mass index, waist circumference, percent body fat, and nicotine withdrawal symptoms. Participants consist of 392 sedentary smokers (mean [standard deviation] age = 44.6 [10.2] = years; 62% female; 31% African American). Results reported here provide information regarding experiences recruiting smokers willing to change multiple health behaviors including smoking and physical activity.