A brief behavioral treatment consisting of two in-person sessions and two phone calls appears to alleviate insomnia in older adults for at least 6 months, according to a report posted online that will be published in the May 23 print issue of Archives of Internal Medicine, one of the JAMA/Archives journals.
Daniel J. Buysse, MD, of the University of Pittsburgh School of Medicine, and colleagues conducted a randomized clinical trial of a brief behavioral treatment involving 79 older adults (average age 71.7) with insomnia; 39 received the treatment, consisting of individualized behavioral instruction delivered by a nurse clinician over four sessions, two in person and two by phone. The other 40 were assigned to an information control group and received only general printed educational material about insomnia and sleep habits.
All participants provided demographic information, completed self-report and interviewer-administered questionnaires about sleep habits, kept 2-week sleep diaries, and underwent sleep assessment by actigraphy (using a wrist or ankle monitor) and polysomnography (a more in-depth monitoring procedure) before treatment and 4 weeks after beginning therapy. Participants who showed a response to the brief treatment were contacted again after 6 months and asked to complete questionnaires and sleep diaries.
After 4 weeks, a larger percentage of those receiving the brief behavioral treatment showed a favorable response to the treatment (67% vs 25%) or were classified as no longer having insomnia (55% vs 13%). Based on the results, the authors estimate that for every 2.4 patients treated, one would respond favorably and one would no longer meet criteria for insomnia.
The brief intervention produced significantly better outcomes at 4 weeks as measured by patients’ reports of sleep and health, sleep diaries and actigraphy, but not polysomnography. Improvements were maintained at the 6-month follow-up.
"Future studies should examine the feasibility of educating nurses and other health professionals in brief behavioral treatment for insomnia and the effectiveness of brief behavioral treatment for insomnia delivered in actual practice settings on symptom-based, functional, and health care economic outcomes," the authors write.