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Behavioral and pharmacological therapies for late-life insomnia: a randomized controlled trial.
JAMA 1999; 281(11):991-9JAMA

Abstract

CONTEXT

Insomnia is a prevalent health complaint in older adults. Behavioral and pharmacological treatments have their benefits and limitations, but no placebo-controlled study has compared their separate and combined effects for late-life insomnia.

OBJECTIVE

To evaluate the clinical efficacy of behavioral and pharmacological therapies, singly and combined, for late-life insomnia.

DESIGN AND SETTING

Randomized, placebo-controlled clinical trial, at a single academic medical center. Outpatient treatment lasted 8 weeks with follow-ups conducted at 3, 12, and 24 months.

SUBJECTS

Seventy-eight adults (50 women, 28 men; mean age, 65 years) with chronic and primary insomnia.

INTERVENTIONS

Cognitive-behavior therapy (stimulus control, sleep restriction, sleep hygiene, and cognitive therapy) (n = 18), pharmacotherapy (temazepam) (n = 20), or both (n = 20) compared with placebo (n = 20).

MAIN OUTCOME MEASURES

Time awake after sleep onset and sleep efficiency as measured by sleep diaries and polysomnography; clinical ratings from subjects, significant others, and clinicians.

RESULTS

The 3 active treatments were more effective than placebo at posttreatment assessment; there was a trend for the combined approach to improve sleep more than either of its 2 single components (shorter time awake after sleep onset by sleep diary and polysomnography). For example, the percentage reductions of time awake after sleep onset was highest for the combined condition (63.5%), followed by cognitive-behavior therapy (55%), pharmacotherapy (46.5%), and placebo (16.9%). Subjects treated with behavior therapy sustained their clinical gains at follow-up, whereas those treated with drug therapy alone did not. Long-term outcome of the combined intervention was more variable. Behavioral treatment, singly or combined, was rated by subjects, significant others, and clinicians as more effective than drug therapy alone. Subjects were also more satisfied with the behavioral approach.

CONCLUSIONS

Behavioral and pharmacological approaches are effective for the short-term management of insomnia in late life; sleep improvements are better sustained over time with behavioral treatment.

Authors+Show Affiliations

Université Laval, Ecole de Psychologie, Sainte-Foy, Quebec, Canada. cmorin@psy.ulaval.caNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Journal Article
Randomized Controlled Trial
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

10086433

Citation

Morin, C M., et al. "Behavioral and Pharmacological Therapies for Late-life Insomnia: a Randomized Controlled Trial." JAMA, vol. 281, no. 11, 1999, pp. 991-9.
Morin CM, Colecchi C, Stone J, et al. Behavioral and pharmacological therapies for late-life insomnia: a randomized controlled trial. JAMA. 1999;281(11):991-9.
Morin, C. M., Colecchi, C., Stone, J., Sood, R., & Brink, D. (1999). Behavioral and pharmacological therapies for late-life insomnia: a randomized controlled trial. JAMA, 281(11), pp. 991-9.
Morin CM, et al. Behavioral and Pharmacological Therapies for Late-life Insomnia: a Randomized Controlled Trial. JAMA. 1999 Mar 17;281(11):991-9. PubMed PMID: 10086433.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Behavioral and pharmacological therapies for late-life insomnia: a randomized controlled trial. AU - Morin,C M, AU - Colecchi,C, AU - Stone,J, AU - Sood,R, AU - Brink,D, PY - 1999/3/23/pubmed PY - 2001/8/14/medline PY - 1999/3/23/entrez SP - 991 EP - 9 JF - JAMA JO - JAMA VL - 281 IS - 11 N2 - CONTEXT: Insomnia is a prevalent health complaint in older adults. Behavioral and pharmacological treatments have their benefits and limitations, but no placebo-controlled study has compared their separate and combined effects for late-life insomnia. OBJECTIVE: To evaluate the clinical efficacy of behavioral and pharmacological therapies, singly and combined, for late-life insomnia. DESIGN AND SETTING: Randomized, placebo-controlled clinical trial, at a single academic medical center. Outpatient treatment lasted 8 weeks with follow-ups conducted at 3, 12, and 24 months. SUBJECTS: Seventy-eight adults (50 women, 28 men; mean age, 65 years) with chronic and primary insomnia. INTERVENTIONS: Cognitive-behavior therapy (stimulus control, sleep restriction, sleep hygiene, and cognitive therapy) (n = 18), pharmacotherapy (temazepam) (n = 20), or both (n = 20) compared with placebo (n = 20). MAIN OUTCOME MEASURES: Time awake after sleep onset and sleep efficiency as measured by sleep diaries and polysomnography; clinical ratings from subjects, significant others, and clinicians. RESULTS: The 3 active treatments were more effective than placebo at posttreatment assessment; there was a trend for the combined approach to improve sleep more than either of its 2 single components (shorter time awake after sleep onset by sleep diary and polysomnography). For example, the percentage reductions of time awake after sleep onset was highest for the combined condition (63.5%), followed by cognitive-behavior therapy (55%), pharmacotherapy (46.5%), and placebo (16.9%). Subjects treated with behavior therapy sustained their clinical gains at follow-up, whereas those treated with drug therapy alone did not. Long-term outcome of the combined intervention was more variable. Behavioral treatment, singly or combined, was rated by subjects, significant others, and clinicians as more effective than drug therapy alone. Subjects were also more satisfied with the behavioral approach. CONCLUSIONS: Behavioral and pharmacological approaches are effective for the short-term management of insomnia in late life; sleep improvements are better sustained over time with behavioral treatment. SN - 0098-7484 UR - https://www.unboundmedicine.com/medline/citation/10086433/full_citation L2 - https://jamanetwork.com/journals/jama/fullarticle/vol/281/pg/991 DB - PRIME DP - Unbound Medicine ER -