BRIEF BEHAVIORAL TREATMENT OF INSOMNIA IN PRIMARY CARE

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Insomnia is a widely prevalent and typically chronic health problem among the elderly that is associated with significant psychological, physical, and economic consequences. Previous studies have demonstrated the efficacy and durability of behavioral treatments for primary insomnia, but there is less evidence regarding their utility in routine practice settings, in patients with comorbid medical and psychiatric disorders, and in a brief treatment format. The general aim of this study is to compare the efficacy of a brief behavioral treatment for insomnia (BBTI) to an information-only control condition in patients with the usual morbidities of agina seen in primary care settings. Specific aims for this study are 1. To test the short-term efficacy of BBTI versus an information-only control for improving sleep and health outcomes among individuals with insomnia in primary care settings; 2. To test the durability of BBTI among individuals with insomnia in primary care settings; and 3. To compare older adults with and without insomnia in terms of mental health, physical health, sleep and circadian function, and general functioning. We will also address the following Program-wide aim: To evaluate the effects of physical and mental health on sleep and the response to sleep interventions, and to evaluate the effects of sleep interventions on health and functioning. The study will include 50 subjects in each randomly-assigned treatment cell. Baseline measures will include each of the domains in the Program Project battery (Agebat). BBTI focuses on sleep education, healthy sleep practices, and behavioral interventions to improve insomnia. It is delivered in two sessions over a four-week interval by a nurse therapist, supplemented by brief weekly telephone calls. Treatment integrity will be monitored by audiotape ratings, and treatment adherence by sleep diaries. The information-only control condition is designed to approximate the type of information that may be available in a physician's office, and will consist of providing patients with three patient brochures that address sleep in aging, insomnia, and sleep hygiene. Short-term outcome will be assessed by administration of Agebatat the end of one month, and durability of BBTI will be evaluated by readministration of the clinical portions of Agebatat six months, and both clinical and polysomnographic components of Agebat at twelve months. This study represents a hybrid between a classic efficacy study, characterized by recruited and highly selected samples with "pure" forms of a disorder, and an effectiveness study, with a large sample of subjects treated in their usual care setting.