A large proportion of the geriatric population suffers from insomnia.
Hypnotic medication, though offering short-term relief, loses its efficacy
in a matter of weeks. In addition, particularly for the aged, hypnotic
medication may lead to carry-over effects. anterograde amnesia and
exacerbation of sleep apnea. Effective non-pharmacological treatments for
insomnia are sorely needed for this age group.
Most existing research on psychological treatments for insomnia has focused
on younger individuals. Use of such techniques in older subjects may
require novel approaches and modifications of existing techniques. Changes
should reflect the primacy of sleep maintenance (opposed to sleep latency)
problems in elders and increased frequency of daytime sleepiness in this
group.
We propose to study a treatment recently reported to be successful in
younger insomniacs, Sleep Restriction Therapy (SRT). SRT improves sleep
quality by restricting excessive time in bed and allowing a modest accrual
of sleep debt, resulting in consolidated sleep. On the basis of our initial
success and experience with SRT in the aged, we will also employ a Modified
SRT (MSRT) as a second treatment. In the MSRT condition subjects will be
encouraged to take a single nap, carefully scheduled to occur in a fixed
time relationship to their bedtimes. Both SRT and MSRT conditions will be
compared to a third condition (Hygiene). Our goal is to evaluate treatments
for geriatric insomnia not only in terms of improvement of sleep but also
in terms of daytime function and performance.
We plan to test two hypotheses:
1. Efficacy Hypothesis: SRT and MSRT will improve the sleep of community
residing elderly by increasing sleep efficiency (SE) and total sleep time
(TST). and by reducing latency to sleep onset (SO), the number of
awakenings, and wakefulness after sleep onset (WASO), when compared with
subjects in the Hygiene condition.
2. Side-Effects Hypothesis: Subjective daytime sleepiness will increase for
subjects in the SRT condition but not for subjects in the MSRT condition;
performance on attentional measures will improve in the MSRT condition but
will remain the same or decline in the SRT condition.
Hypothesis 1 (Efficacy) will be tested in a comparative group study with
three conditions: SRT, MSRT, and Hygiene. All groups will report
information about their sleep twice daily to a telephone answering machine.
This will continue for a six-week period: two weeks of baseline data
collection plus four weeks of treatment. The Hygiene group will control for
transient changes in sleep patterns over time, and nonspecific effects of
self-observation, telephone call-in, exposure to principles of sleep
hygiene, problem-solving techniques, and therapist contact. Outcome
assessments will include measures of 24TST, TST. WASO, SO, SE, and measures
of subjective sleep quality. Hypothesis 2 (SideEffects) will be tested by
measures taken before and after treatment on daytime sleepiness and
attentional function. Additional Research Questions will address the issue
of whether or not measures of depression and anxiety taken before and after
treatment vary by treatment.
Public Health Relevance Statement
Data not available.
NIH Spending Category
No NIH Spending Category available.
Project Terms
anxietybehavior modificationdepressionhuman old age (65+)human subjecthuman therapy evaluationhuman very old age (85+)sleep deprivationsleep disorderswakefulness
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