The effectiveness of cognitive behavioral therapy for insomnia on sleep outcomes in the context of pain among older adult veterans

Simple item page
dc.contributor.authorErickson, Alexander J.
dc.contributor.authorRodriguez, Juan Carlos
dc.contributor.authorRavyts, Scott G.
dc.contributor.authorDzierzewski, Joseph M.
dc.contributor.authorFung, Constance H.
dc.contributor.authorKelly, Monica R.
dc.contributor.authorRyden, Armand M.
dc.contributor.authorCarlson, Gwendolyn C.
dc.contributor.authorJosephson, Karen
dc.contributor.authorMitchell, Michael N.
dc.contributor.authorMartin, Jennifer L.
dc.contributor.authorAlessi, Cathy A.
dc.date.accessioned2025-01-20T16:15:31Z
dc.date.available2025-01-20T16:15:31Z
dc.date.issued2024
dc.description.abstractBackground: Cognitive behavioral therapy for insomnia (CBT-I) is the gold-standard treatment for insomnia disorder in adults. Compared to young adults, older adults have increased risk for the development of conditions associated with chronic pain, which may impact the efficacy of CBT-I in improving insomnia symptoms in older adults. This study evaluated the effect of participant-rated pain on sleep-related outcomes of a supervised, non-clinician administered CBT-I program in older adult patients with chronic insomnia disorder. Methods: Secondary analysis was conducted using data from a randomized controlled trial among 106 community-dwelling older adult veterans (N = 106; mean age 72.1 years, 96% male, 78.3% White, 6.6% Hispanic, 5.7% African American) with chronic (>= 3 months) insomnia disorder. Participants engaged in five sessions of manual-based CBT-I in individual or group format within one Department of Veterans Affairs healthcare system, provided by non-clinician "sleep coaches" who had weekly telephone supervision by behavioral sleep medicine specialists. Insomnia symptoms (Insomnia Severity Index), perceived sleep quality (Pittsburgh Sleep Quality Index), fatigue (Flinder's Fatigue Scale), daytime sleepiness (Epworth Sleepiness Scale), and perceived pain severity (items from the Geriatric Pain Measure) were assessed at 4 time points: baseline, one-week posttreatment, 6-month follow-up, and 12-month follow-up. Mixed effects models with time invariant and time varying predictors were employed for analyses. Results: CBT-I improved insomnia symptoms, perceived sleep quality, fatigue, and daytime sleepiness among older veterans with chronic insomnia. Participant-reported pain was associated with greater improvements in insomnia symptoms following CBT-I. Pain did not affect improvements in other sleep-related outcomes (-0.38 <= b <= 0.07, p > 0.05). Between-subjects differences in pain, but not within-subject changes in pain over time, appeared to play a central role in insomnia symptom improvement at posttreatment, with individuals with higher-than-average pain showing greater insomnia symptom improvement (ISI score reduction; -0.32 <= b <= -0.28, p <= 0.005). Conclusions: Pain did not meaningfully hinder the effects of CBT-I on sleep outcomes. Among older veterans with chronic insomnia disorder, individuals with higher pain exhibited slightly greater improvement in insomnia than those with lower levels of pain. These findings suggest that experiencing pain does not impair treatment response and should not preclude older adults with insomnia from being offered CBT-I.
dc.description.funderU.S. Department of Veterans Affairs Health Services Research Development
dc.fuente.origenWOS
dc.identifier.doi10.1111/jgs.18910
dc.identifier.eissn1532-5415
dc.identifier.issn0002-8614
dc.identifier.urihttps://doi.org/10.1111/jgs.18910
dc.identifier.urihttps://repositorio.uc.cl/handle/11534/90499
dc.identifier.wosidWOS:001249745400001
dc.issue.numero8
dc.language.isoen
dc.pagina.final2328
dc.pagina.inicio2319
dc.revistaJournal of the american geriatrics society
dc.rightsacceso restringido
dc.subjectcognitive behavioral therapy for insomnia
dc.subjectinsomnia
dc.subjectolder adults
dc.subjectpain
dc.subjectveterans
dc.subject.ods03 Good Health and Well-being
dc.subject.odspa03 Salud y bienestar
dc.titleThe effectiveness of cognitive behavioral therapy for insomnia on sleep outcomes in the context of pain among older adult veterans
dc.typeartículo
dc.volumen72
sipa.indexWOS
sipa.trazabilidadWOS;2025-01-12
Files
Collections
Artículos de revistas