Research Evaluating Brief Behavioral Sleep Treatments for Rural Elderly (RESTORE): A Preliminary Examination of Effectiveness

McCrae, Christina S.; McGovern, Rene J.; Lukefahr, Robin; Stripling, Ashley M.

doi:10.1097/jgp.0b013e31813547e6

Cited by 54 publications

(48 citation statements)

References 8 publications

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“…31 Two other studies have found that brief behavioral treatment of insomnia (BBTi; 2 in person, 2 phone calls) resulted in clinically significant sleep improvements compared to information only and sleep hygiene education only controls. 32 When the sleep outcomes found for brief CBTi studies were matched with previous research done with a typical 6 sessions, the results were comparable. In addition to sleep outcomes, brief behavioral protocols have been shown to produce significant improvements in several secondary outcomes.…”

Section: S C I E N T I F I C I N V E S T I G a T I O N Ssupporting

confidence: 60%

“…This lends support that bCBTi may be an easily disseminated intervention with minimum training required. 32,48 There were several limitations associated with this research study. This sample was small and consisted of primarily middleaged and older Caucasian adults, many with several comorbid medical conditions such as hypertension, cardiovascular disease, and diabetes.…”

Section: Discussionmentioning

confidence: 99%

“…These findings are consistent with previous research on effectiveness of brief behavioral insomnia treatments. 30,32,47 Furthermore, a significant treatment response may not be necessary to impact HCU and costs-treatment completers saw a reduction-although a treatment response may augment the cost-savings. Furthermore, the intervention was delivered by clinical psychology doctoral students and predoctoral interns, only some of whom had a background and previous training in insomnia and behavioral sleep medicine interventions.…”

Section: Discussionmentioning

confidence: 99%

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Impact of Brief Cognitive Behavioral Treatment for Insomnia on Health Care Utilization and Costs

McCrae

Bramoweth

Williams

et al. 2014

Journal of Clinical Sleep Medicine

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Study Objectives: To examine health care utilization (HCU) and costs following brief cognitive behavioral treatment for insomnia (bCBTi). Methods: Reviewed medical records of 84 outpatients [mean age = 54.25 years (19.08); 58% women] treated in a behavioral sleep medicine clinic (2005)(2006)(2007)(2008)(2009)(2010) based in an accredited sleep disorders center. Six indicators of HCU and costs were obtained: estimated total and outpatient costs, estimated primary care visits, CPT costs, number of office visits, and number of medications. All patients completed ≥ 1 session of bCBTi. Those who attended ≥ 3 sessions were considered completers (n = 37), and completers with significant sleep improvements were considered responders (n = 32). Results: For completers and responders, all HCU and cost variables, except number of medications, signifi cantly decreased (ps < 0.05) or trended towards decrease at posttreatment. Completers had average decreases in CPT costs of $200 and estimated total costs of $75. Responders had average decreases in CPT costs of $210. No signifi cant decreases occurred for non-completers. Conclusions: bCBTi can reduce HCU and costs. Response to bCBTi resulted in greater reduction of HCU and costs. While limited by small sample size and non-normal data distribution, the fi ndings highlight the need for greater dissemination of bCBTi for several reasons: a high percentage of completers responded to treatment, as few as 3 sessions can result in signifi cant improvements in insomnia severity, bCBTi can be delivered by novice clinicians, and health care costs can reduce following treatment. Insomnia remains an undertreated disorder, and brief behavioral treatments can help to increase access to care and reduce the burden of insomnia. Keywords: Insomnia, health care utilization, costs, brief cognitive behavioral treatment, physician visits, medication Citation: McCrae CS; Bramoweth AD; Williams J; Roth A; Mosti C. Impact of brief cognitive behavioral treatment for insomnia on health care utilization and costs. J Clin Sleep Med 2014;10(2):127-135.http://dx.doi.org/10.5664/jcsm.3436 S C I E N T I F I C I N V E S T I G A T I O N SC hronic insomnia impacts approximately 8% to 10% of adults in the United States population 1 and carries substantial economic burden. Direct costs (i.e., costs directly related to treatment) have been estimated at $13.9 billion annually in the United States, with total treatment costs estimated at $77 to $92 billion. 2 When indirect costs (i.e., lost productivity, insomniarelated accidents, increased medical problems) are included, annual costs exceed $100 billion. 3 Evidence from outside the U.S. reveals a similar pattern. Specifi cally, a study in Quebec, Canada, found that the combined direct and indirect per-person costs of insomnia syndrome (insomnia complaint ≥ 3 nights/ week with > 1 month duration, dissatisfaction with sleep, and daytime impairment; prescription sleep medication ≥ 3 nights/ week) was approximately $5,010; with $293 attributed to direct costs and $4,717...

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Section: S C I E N T I F I C I N V E S T I G a T I O N Ssupporting

confidence: 60%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Impact of Brief Cognitive Behavioral Treatment for Insomnia on Health Care Utilization and Costs

McCrae

Bramoweth

Williams

et al. 2014

Journal of Clinical Sleep Medicine

Self Cite

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“…20,22,23 Some studies of brief interventions are also effective with older patients. 21,34 Consistent with traditional CBT-I interventions, all recommendations were tailored to the individual patient, addressing their specific circumstances, sleep patterns, and level of motivation to engage in the intervention.…”

Section: Interventionmentioning

confidence: 99%

A Four-Session Sleep Intervention Program Improves Sleep for Older Adult Day Health Care Participants: Results of a Randomized Controlled Trial

Martin

Song

Hughes

et al. 2017

Sleep

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Study Objective: To test the effectiveness of a 4-week behavioral Sleep Intervention Program (SIP: sleep compression, modified stimulus control, and sleep hygiene) compared to a 4-week information-only control (IC) among older adults attending a VA Adult Day Health Care (ADHC) program in a double-blind, randomized, clinical trial. Methods: Forty-two individuals (mean age: 77 years, 93% male) enrolled in a VA ADHC program were randomized to receive SIP or IC. All completed in-person sleep and health assessments at baseline, post-treatment and 4-months follow-up that included 3 days/nights of wrist actigraphy, the Pittsburgh Sleep Quality Index (PSQI), and the Insomnia Severity Index (ISI). Mixed repeated measures analysis was used to compare sleep outcomes at post-treatment and 4-months follow-up, with baseline values as covariates. Results: SIP participants (n = 21) showed significant improvement on actigraphy sleep efficiency (p = .007), number of nighttime awakenings (p = .016), and minutes awake at night (p = .001) at post-treatment, compared to IC participants (n = 21). Benefits were slightly attenuated but remained significant at 4-month follow-up (all p's < .05). There were no differences in total sleep time between groups. There was significant improvement on PSQI factor 3 (daily disturbances) at 4-month follow-up (p = .016), but no differences were observed between SIP and IC on other PSQI components or ISI scores at post-treatment or 4-month follow-up. Conclusions: A short behavioral sleep intervention may have important benefits in improving objectively measured sleep in older adults participating in ADHC. Future studies are needed to study implementation of this intervention into routine clinical care within ADHC.

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“…21 Although the number of sessions in this study were fewer than the 6 to 8 offered in traditional CBT-I, previous trials have indicated the efficacy of brief versions of CBT-I in patients with primary insomnia, older adults with chronic insomnia, and patients with alcoholism and insomnia. [22][23][24][25][26] The treatment regimen was highly structured and included modules on sleep hygiene education, an introduction to the behavioral model of insomnia, sleep restriction, stimulus control, sleep titration, and relapse prevention. 16 Five psychiatrists and a psychiatric nurse provided the psychotherapy, and they received a written manual describing the regimen.…”

Section: Study Design and Interventionsmentioning

confidence: 99%

Change in Quality of Life after Brief Behavioral Therapy for Insomnia in Concurrent Depression: Analysis of the Effects of a Randomized Controlled Trial

Shimodera

Watanabe

Furukawa

et al. 2014

Journal of Clinical Sleep Medicine

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Study Objectives:The effi cacy of cognitive behavioral therapy for insomnia (CBT-I) has been suggested for insomnia concomitant with depression, but its impact on quality of life (QoL) has not been adequately evaluated. The study aimed to determine which aspects of QoL could be affected by CBT-I and how any changes in QoL were mediated by changes in insomnia and depression. Methods: We conducted a 4-week randomized controlled trial with 4-week follow-up in outpatient clinics in Japan. Thirtyseven patients with DSM-IV diagnosis of major depressive disorder concomitant with chronic insomnia were randomly assigned to the treatment-as-usual (TAU) alone arm or the TAU with brief behavioral therapy for insomnia (TAU plus psychotherapy) arm using modifi ed CBT-I consisting of 4 weekly individual sessions. We evaluated QoL using normbased scoring of the Short Form-36 at baseline and at 8 weeks. We also examined associations between QoL subscales and remission in insomnia or depression while controlling for baseline scores of the entire sample. Results:We tested group effects while controlling for baseline scores. TAU plus psychotherapy resulted in signifi cantly better scores on physical functioning (p = 0.006), social functioning (p = 0.002), and mental health (p = 0.041) subscales than TAU alone at 8 weeks. Patients with either remitted insomnia or depression showed higher QoL scores than non-remitted patients; scores approximated those within the normal range. Conclusions: For patients with insomnia in depression, adding CBT-I to TAU can produce substantive benefi ts in some aspects of QoL. Trial Registration: ClinicalTrials.gov Identifi er: NCT00610259, http://www.clinicaltrials.gov/ Keywords: Depressive disorder, sleep initiation and maintenance disorders, behavior therapy, quality of life Citation: Shimodera S; Watanabe N; Furukawa TA; Katsuki F; Fujita H; Sasaki M; Perlis ML. Change in quality of life after brief behavioral therapy for insomnia in concurrent depression: analysis of the effects of a randomized controlled trial.

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Research Evaluating Brief Behavioral Sleep Treatments for Rural Elderly (RESTORE): A Preliminary Examination of Effectiveness

Cited by 54 publications

References 8 publications

Impact of Brief Cognitive Behavioral Treatment for Insomnia on Health Care Utilization and Costs

Impact of Brief Cognitive Behavioral Treatment for Insomnia on Health Care Utilization and Costs

A Four-Session Sleep Intervention Program Improves Sleep for Older Adult Day Health Care Participants: Results of a Randomized Controlled Trial

Change in Quality of Life after Brief Behavioral Therapy for Insomnia in Concurrent Depression: Analysis of the Effects of a Randomized Controlled Trial

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