Effects of Brief Cognitive Behavioral Therapy for insomnia on sleep and usage of hypnotics among community-dwelling older adults: Randomized controlled trial

Objectives Chronic insomnia is common in late adulthood. A non-pharmacological approach should take priority in the treatment of insomnia for the elderly. Many studies have shown the efficacy of Cognitive Behavioral Therapy for Insomnia (CBT-I) for elderly diagnosed with insomnia. However the effect of CBT-I on mild insomnia among older adults in community settings has not been ascertained. We conducted a randomized controlled trial to evaluate the effectiveness of a brief CBT-I delivered by nurses, which is feasible in community settings, to improve sleep quality and decrease the dose of hypnotics use for older adults.Methods Participants aged 60 years and over were enrolled in this study. The participants in the intervention group were administrated the brief CBT-I consisting of a group session (60 min) and an individual session (30 min). The primary outcomes were the score differences in the Pittsburgh Sleep Quality Index (PSQI) and Insomnia Severity Index (ISI). The secondary outcomes were the change in the proportion of people diagnosed with insomnia and the dose of hypnotics used. The follow-up period was 3 months.Results The score on PSQI in the intervention group (n=41) significantly decreased compared to the control group (n=38). The effect size (Cohen's d) was 0.56 (95% Confidence interval [CI], 0.07 to 1.05). The score on ISI also decreased significantly and Cohen's d was 0.77 (95%CI, 0.27 to 1.26). According to subgroup analysis, Number Needed to Treat (NNT) for improvement of insomnia was 2.8 (95%CI, 1.5-17.2) and NNT for decreasing of dose of hypnotics use was 2.8 (95%CI, 1.5-45.1).Conclusion The present results have demonstrated that the brief CBT-I significantly improved subjective evaluation of sleep quality and insomnia symptoms among the elderly. In addition, the brief CBT-I decreased the usage of hypnotics. Further studies are needed in terms of the procedure and the effects of brief CBT-I for older adults living in a community.