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Brief behavioral therapy diminishes insomnia in the elderly

Clinical Question:
Can a brief behavioral treatment improve sleep in older patients with chronic insomnia?

Bottom Line:
Older patients who received brief behavioral therapy regarding insomnia reported better results than patients assigned to read books with essentially the same information. The result may be due to better delivery of the information (when given in person rather than in writing), though it is possible that the increased contact with a health care provider induced a placebo effect. (LOE = 1b)

Reference:
Buysse DJ, Germain A, Moul DE, et al. Efficacy of brief behavioral treatment for chronic insomnia in older adults. Arch Intern Med 2011;171(10):887-895.  [PMID:21263078]

Study Design:
Randomized controlled trial (nonblinded)

Funding:
Government

Allocation:
Unconcealed

Setting:
Outpatient (primary care)

Synopsis:
The researchers identified 82 older patients (mean age = 72 years) with chronic insomnia who were willing to keep a sleep diary and have in-home polysomnography. The patients were assigned, with allocation unconcealed, to receive self-help books or to have brief behavioral therapy. The behavioral therapy was delivered by a nurse practitioner with no previous experience in behavioral interventions for insomnia. The therapy included instructions to get up at the same time each day, to go to bed only when sleepy, and to get out of bed if you are not sleeping. No cognitive behavioral therapy was provided. These instructions were provided in 2 face-to-face sessions, supplemented by 2 phone sessions. After 4 weeks, significantly more patients in the behavioral therapy group reported "no insomnia" (55% vs 13%; P < .001) and significantly more had a defined response to treatment (67% vs 25%; P < .001). No change was seen with polysomnography. The behavioral treatment group had much more contact with a health professional than the reading group, who received a single phone call to encourage participation, and this additional attention could have led them to overestimate changes in their sleep.

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