Sleep Discrepancy in a Randomized Controlled Trial of Brief Behavioral Therapy for Chronic Insomnia in Older Adults

ABSTRACT

Background/Objective: Some older adults with insomnia experience sleep discrepancy, often characterized by greater subjective sleep difficulties and shorter subjective sleep duration than the estimates derived from objective measures. The present study examined whether a brief behavioral therapy for insomnia (BBTi) is efficacious for reducing sleep discrepancy in older adults.

Methods: This study is a secondary analysis of a randomized controlled trial of BBTi for community dwelling older adults with chronic insomnia (N = 62). Thirty-two participants received BBTi, delivered in four individual face-to-face sessions. Thirty received the self-monitoring control (SMC). They all completed daily sleep diaries and wore an actigraph from baseline to posttreatment, and for 2 weeks at 3-month follow-up. Sleep discrepancy was calculated by subtracting diary from actigraphy estimates of sleep onset latency (SOL), wake after sleep onset (WASO), and total sleep time (TST). Mixed modeling was used to analyze data. SOL discrepancy decreased significantly in BBTi participants compared to SMC participants. The decreases in SOL discrepancy were explained by changes in diary-assessed SOL and subjective sleep quality but not changes in actigraphy-assessed SOL. Although WASO discrepancy and TST discrepancy decreased from baseline to posttreatment and follow-up, the Time by Group interaction effects were not significant indicating that BBTi participants did not experience greater reductions in WASO discrepancy and TST discrepancy than SMC participants. In conclusion, BBTi is efficacious for reducing SOL discrepancy in older adults with chronic insomnia.

Acknowledgments

The authors thank Jacob Williams, Dr. Richard B. Berry, and Dr. Michael Marsiske for their consultations on the study design and statistical analysis.

Author contribution

WSC conducted data analysis and wrote the manuscript. NDD, JPHM, AS, JMD, and KM contributed to data collection and manuscript preparation. CSM conceived and designed the study and contributed to manuscript preparation.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

The project described was supported by Award Number AG024459 (Christina S. McCrae, PhD, PI) and K23AG049955 (Joseph M. Dzierzewski, PhD, PI) from the National Institute on Aging (NIA). Additional support was provided by an Institutional Training Grant Award Number AG020499 (Michael Marsiske, PhD, Director) from the NIA. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIA.