TREATMENTS FOR INSOMNIA

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This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. There are a number of gaps in the literature about bright light treatment for insomnia: 1) It has not been studied in enough subjects to fully understand its efficacy on improving basic sleep measures including those obtained by actigraphy and polysomnography (PSG); 2) The issue of the best time of day for treatment delivery has not yet been resolved; 3) We do not know how long treatment effects last; 4) We don't know whether treatment efficacy is greater in some subjects than others; 5) We don't know the mechanisms of action; and 6) Finally, even if this therapy affects sleep measures, it is unknown whether it also affects measures of quality of life. We plan to address these gaps by testing the following hypotheses: Efficacy We plan to evaluate the short-term and long-term efficacy of three nonpharmacologic treatments for insomnia in older adults: 1) a behavioral treatment that employs the basic principles of sleep hygiene to improve sleep and timed exposure to bright light in addition to sleep hygiene principles with; 2) light delivered in the morning, or; 3) light delivered in the evening. We hypothesize that bright light therapy will have a significant additive effect when combined with Hygiene compared to Hygiene alone. Primary outcome measures will be total sleep time, wake after sleep onset, and sleep efficiency as recorded by actigraphy. We expect that these results will be present not only at the end of the 3-month treatment period, but also over a 3-month follow-up. Individual Differences in Response (Moderators) We expect that there will be individual differences in the efficacy of the two Hygiene and Light treatments depending upon the phase, amplitude, or the degree of synchronization of subjects circadian rhythm measures demonstrated prior to treatment. This proposal provides us the opportunity to examine, in a preliminary manner, the ability of circadian markers and CLOCK gene allele status to predict treatment response in a group of patients with insomnia. Mechanisms of Action (Mediators) We expect that changes in the phase, amplitude, or the degree of synchronization of circadian rhythm measures over treatment may account for some of the observed effects of treatment. To test this hypothesis, changes during treatment of markers of four circadian body rhythms will be assessed: sleep/wakefulness, rest/activity, melatonin secretion, and core body temperature. Quality of Life We will determine if the two light therapies are effective for insomnia relative to Hygiene in terms of their impact on health-related quality of life. These hypotheses will be tested in a parallel groups design with three conditions: Hygiene, Hygiene and Morning Light, and Hygiene and Evening Light. Daily treatments will last three months and after the end of treatment patients will be followed on a once-a-month basis for a period of three months. This will ultimately include 90 treatment subjects aged >60 yrs (three groups of 30 each) with PSG recordings, actigraphy, self-reports, circadian rhythm measures, and genotyping on all subjects in each condition. This five-year proposal will ultimately include 90 treatment subjects aged >60 years (three groups of 30 each) with PSG recordings, actigraphy, self-reports, circadian rhythm measures, and genotyping on all subjects in each condition.