BRIEF BEHAVIORAL TREATMENT OF INSOMNIA IN PRIMARY CARE

失眠是老年人普遍存在的一种典型的慢性健康问题，它与严重的心理、身体和经济后果有关。先前的研究已经证明了行为疗法对原发性失眠的有效性和持久性，但在常规实践环境中，在患有合并症和精神疾病的患者中，以及在简短的治疗形式中，关于其效用的证据较少。本研究的总体目的是比较短期行为治疗失眠（BBTI）的疗效与在初级保健机构中看到的阴道常见发病率的患者的仅信息对照条件。本研究的具体目的是：1。测试BBTI与信息对照在改善初级保健机构失眠症患者睡眠和健康结果方面的短期疗效；2. 测试初级保健机构失眠患者BBTI的持久性；和3。比较有失眠症和没有失眠症的老年人在心理健康、身体健康、睡眠和昼夜节律功能以及一般功能方面的差异。我们还将讨论以下整个项目的目标：评估身心健康对睡眠的影响以及对睡眠干预的反应，并评估睡眠干预对健康和功能的影响。该研究将在每个随机分配的治疗细胞中包括50名受试者。基线度量将包括Program Project电池（Agebat）中的每个域。BBTI专注于睡眠教育、健康睡眠习惯和行为干预来改善失眠。它由一名护士治疗师在四周的时间间隔内分两次提供，辅以每周简短的电话。治疗的完整性将通过录音带评分来监测，并通过睡眠日记来监测治疗的依从性。这个

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.