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ABSTRACT
Objectives: To examine relationships between cognitive expectancies about sleep and hypnotics and use of medications commonly used for insomnia (hypnotics).
Methods: We analyzed baseline data from older veterans who met diagnostic criteria for insomnia and were enrolled in a trial comparing CBTI delivered by a supervised, sleep educator to an attention control condition (N = 159; 97% male, mean age 72 years). We classified individuals as hypnotic users (N = 23) vs. non-users (N = 135) based upon medication diaries. Associations between hypnotic status and Dysfunctional Beliefs and Attitudes about Sleep-16 (DBAS) total score (0–10, higher = worse) and two DBAS medication item scores (Item 1: “…better off taking a sleeping pill rather than having a poor night’s sleep;” Item 2: “Medication… probably the only solution to sleeplessness”; 0–10, higher = worse) were examined in logistic regression models.
Results: Higher scores on the DBAS medication items (both odds ratios = 1.3; p-values < .001) were significantly associated with hypnotic use. DBAS-16 total score was not associated with hypnotic use.
Conclusion: Cognitive expectancy (dysfunctional beliefs) about hypnotics was associated with hypnotic use in older adults with chronic insomnia disorder.
Clinical Implications: Strategies that specifically target dysfunctional beliefs about hypnotics are needed and may impact hypnotic use in older adults.
KEYWORDS:
Clinical implications
Older adults who have a stronger belief that medication is the only solution for insomnia are more likely to use medication to treat their insomnia, a treatment strategy that is considered second-line (first-line therapy for chronic insomnia disorder is cognitive behavioral therapy for insomnia).
Dysfunctional beliefs and attitudes about sleep overall are not associated with a higher likelihood of using medication to treat insomnia.
Acknowledgments
VA Health Services Research and Development (Alessi IIR 08-295); VA Greater Los Angeles Geriatric Research, Education, and Clinical Center (GRECC); National Institute on Aging of the National Institutes of Health under Award Number (Fung K23AG045937; Dzierzewski 1K23AG049955). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or Department of Veterans Affairs.