Change in Dysfunctional Sleep-Related Beliefs is Associated with Changes in Sleep and Other Health Outcomes Among Older Veterans With Insomnia: Findings From a Randomized Controlled Trial

Abstract

Background Cognitive behavioral therapy for insomnia (CBTI) targets changing dysfunctional sleep-related beliefs. The impact of these changes on daytime functioning in older adults is unknown. Purpose We examined whether changes in sleep-related beliefs from pre- to post-CBTI predicted changes in sleep and other outcomes in older adults. Method Data included 144 older veterans with insomnia from a randomized controlled trial testing CBTI. Sleep-related beliefs were assessed with the Dysfunctional Beliefs and Attitudes about Sleep-16 (DBAS-16, subscales: Consequences, Worry/Helplessness, Sleep Expectations, Medication). Outcomes included sleep diary variables, actigraphy-measured sleep efficiency, Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), Epworth Sleepiness Scale (ESS), Flinders Fatigue Scale (FFS), Patient Health Questionnaire-9, and health-related quality of life. Analyses compared slope of change in DBAS subscales from baseline to posttreatment between CBTI and control, and assessed the relationship between DBAS change and the slope of change in outcomes from baseline to 6 months. Results Compared to controls, the CBTI group demonstrated stronger associations between improvement in DBAS-Consequences and subsequent improvement in PSQI, ISI, ESS, and FFS. The CBTI group also demonstrated stronger associations between improvement in DBAS-Worry/Helplessness and subsequent improvements in PSQI, ISI, and FFS; improvements in DBAS-Medication and PSQI; and improvements in DBAS-Sleep Expectations and wake after sleep onset (sleep diary) and FFS (all p < .05). Conclusions Significant reduction in dysfunctional sleep-related beliefs following CBTI in older adults predicted improvement in several outcomes of sleep and daytime functioning. This suggests the importance of addressing sleep-related beliefs for sustained improvement with CBTI in older veterans. Trial Registration ClinicalTrials.gov Identifier: NCT00781963.

Relationship Between Attitudes and Beliefs About Sleep, Sleep Disturbance, and Pain Interference in Patients With Spinal Pain

“…A recent study has suggested that pain-affected older adults' belief that they need to sleep more the next day or night to make up for lost sleep attributed to their pain. 69 We found similar findings with 61.3% of participants reporting that pain disturbed their sleep and half of the participants had a strong belief that without proper sleep on a given night, they would need to catch up the next day by napping or the next night by sleeping longer. Furthermore, our findings suggest that patients with spine pain have dysfunctional beliefs related to expectations for sleep and consequences of insomnia that may be related to sleeprelated impairment associated with their pain.…”

“…Understanding the unique and specific contributions of both health literacy and maladaptive behavior is important to recognize to effectively target treatment interventions (ie, more focus on education or behavior change). Changing sleep-related beliefs has been associated with improvements in sleep and other health outcomes in older adults and veterans 69. Understanding how changes in dysfunctional attitudes and beliefs are correlated with changes in pain-related outcomes longitudinally would also help improve our understanding of meaningful targets for intervention.…”

“…Changing sleep-related beliefs has been associated with improvements in sleep and other health outcomes in older adults and veterans. 69 Understanding how changes in dysfunctional attitudes and beliefs are correlated with changes in pain-related outcomes longitudinally would also help improve our understanding of meaningful targets for intervention. Future work should also focus on determining the impact of improving sleep-related beliefs and behaviors to determine whether they positively influence pain interference and sleep-related impairment.…”

Group-delivered cognitive behavioural therapy versus waiting list in the treatment of insomnia in primary care: Study protocol for a pragmatic, multicentre randomized controlled trial

“…However, we chose the medium Cohen's d effect size of 0.50 for the sample size calculation, mostly due to the differences in the number of given CBT-I sessions across studies. Treatment in this RCT includes 4 sessions, while other reviewed studies include 5 (37,38,41) and 8(39, 40) sessions, respectively. It is reasonable to assume that treatment effectiveness may decrease with fewer number of sessions.…”

Cognitive Behavioral Therapy for Insomnia in Patients with Mental Disorders and Comorbid Insomnia: A Systematic Review and Meta-Analysis

“…Since chronic stress can lead to depression, stress induced by constant worry about sleep may play a role in the development of depression [70e73]. CBT-I also improves dysfunctional thoughts and attitudes about sleep [73]. Therefore, improved mental health after CBT-I may be attributable to reduced worry about sleep rather than improved sleep itself.…”