Objective Telehealth has proven effective with a wide range of disorders, but there is a paucity of data on the use of telehealth using cognitive-behavior therapy (CBT) with late-life insomnia and depression. This pilot study was designed to examine the feasibility and effectiveness of using telehealth to treat older adults with comorbid insomnia and depression living in rural Alabama. Method Five patients received 10 sessions of CBT for insomnia and depression. Patients were engaged in treatment via Skype from their primary care physician’s office. Assessments were conducted at baseline, posttreatment, and 2-month follow-up. Results Patients exhibited clinically significant improvement in both insomnia (sleep diaries and Insomnia Severity Index) and depression (Hamilton Rating Scale for Depression) at posttreatment, and these gains were well maintained at 2-month follow-up. Conclusions These preliminary data suggest that telehealth may be an effective means of providing treatment to older adults, including underserved populations.

To truly assess and understand individual differences in the sleep of older adults, future research needs to take into account night-to-night variability (including what makes sleep vary from one night to the next), in addition to average sleep.

This study explored cognitive pre-sleep arousal in chronic pain patients with varying degrees of insomnia symptoms. Forty-eight adult outpatients with chronic pain completed the Pre-Sleep Arousal Scale (PSAS) and selfreport questionnaires on sleep, pain, and other health and mood issues. Participants were divided into two subgroups based on scores on the Insomnia Severity Index and compared on PSAS scores. Results demonstrated that pain patients with moderate to severe sleep complaints (n = 32) reported higher levels of cognitive and somatic pre-sleep arousal than pain patients with mild sleep complaints (n = 16). Further comparisons with individual items on the cognitive PSAS revealed no differences between the groups on seven of the eight items. Worry about sleep was the only item to differentiate the pain patients with moderate to severe sleep complaints from those with mild sleep complaints. These results provide further support for extending a cognitive-behavioral model of insomnia to comorbid insomnia and chronic pain.

insomnia is the most common sleep problem in the general population, with chronic insomnia being most prevalent in older adults (foley et al., 1995;lichstein, durrence, riedel, Taylor, & Bush, 2004;morphy, dunn, lewis, Boardman, & croft, 2007; ohayon, 2002). Insomnia is defined as a complaint of difficulty falling asleep, difficulty staying asleep, early morning awakenings, and/or nonrestorative sleep, which results in daytime consequences (Diagnostic and Statistical Manual of Mental Disorders, 4th ed., text revision; DSM-IV-TR; american Psychiatric association, 2000). Particularly in older adults, consequences of insomnia can include increased risk for the onset of depression and anxiety, substance abuse, cognitive decline, falls, and reduced quality of life (

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