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Behavioral and pharmacological therapies for late-life insomnia: a randomized controlled trial.

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.

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  • Publisher Full Text
  • Authors+Show Affiliations

    ,

    Université Laval, Ecole de Psychologie, Sainte-Foy, Quebec, Canada. cmorin@psy.ulaval.ca

    , , ,

    Source

    JAMA 281:11 1999 Mar 17 pg 991-9

    MeSH

    Aged
    Analysis of Variance
    Anti-Anxiety Agents
    Behavior Therapy
    Chronic Disease
    Cognitive Behavioral Therapy
    Combined Modality Therapy
    Female
    Humans
    Male
    Polysomnography
    Sleep Initiation and Maintenance Disorders
    Temazepam

    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 -