Feasibility and Preliminary Efficacy of an Internet-Delivered Intervention for Insomnia in Individuals with Mild Cognitive Impairment

2021 ◽  
pp. 1-12
Author(s):  
Meghan K. Mattos ◽  
Carol A. Manning ◽  
Mark Quigg ◽  
Eric M. Davis ◽  
Laura Barnes ◽  
...  
Keyword(s):  
Older Adults ◽  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Behavioral Therapy ◽  
Qualitative Interviews ◽  
Sleep Onset ◽  
Severity Index ◽  
The Internet ◽  
Sleep Onset Latency ◽  
Sleep Quantity

Background: Approximately 50%of older adults with cognitive impairment suffer from insomnia. When untreated, pre-existing cognitive problems may be exacerbated and potentially contribute to further cognitive decline. One promising approach to maintain cognitive health is to improve sleep quantity and quality. Objective: To determine feasibility, acceptability, and preliminary efficacy of Sleep Health Using the Internet for Older Adult Sufferers of Insomnia and Sleeplessness (SHUTi OASIS), an Internet-delivered cognitive behavioral therapy for insomnia (CBT-I) program in older adults with mild cognitive impairment (MCI). Methods: Older adults with MCI and insomnia were recruited from hospital-based memory and sleep disorders clinics and enrolled in a single-arm pilot study. Participants completed the six cores of SHUTi OASIS, over nine weeks with two-week baseline and post-assessments using self-reported sleep diaries. Feasibility and acceptability were informed by usage statistics and qualitative interviews; preliminary efficacy was informed by patient-generated sleep data. Results: Twelve participants enrolled and, on average, were 75.8 years of age. Ten participants completed the study and logged in most days. Most participants reported a positive overall experience, and interviews revealed successful and independent program management and completion. There were significant changes on all baseline to post-assessment sleep measures, including clinically meaningful improvements on the Insomnia Severity Index (13.5 to 8.3, p <  0.01), sleep efficiency, wake after sleep onset, and sleep onset latency (ps <  0.02). There was no statistically significant change in cognitive measures (p >  0.05). Conclusion: This study supports that older adults with cognitive impairment can independently complete CBT-I via the Internet and achieve clinical sleep improvements.

scholarly journals Mindfulness-based therapy for insomnia for older adults with sleep difficulties: a randomized clinical trial

2021 ◽  
pp. 1-11
Author(s):  
Francesca Perini ◽  
Kian Foong Wong ◽  
Jia Lin ◽  
Zuriel Hassirim ◽  
Ju Lynn Ong ◽  
...  
Keyword(s):  
Older Adults ◽  
Sleep Quality ◽  
Behavioral Therapy ◽  
Sleep Onset ◽  
Exercise Program ◽  
Severity Index ◽  
Poor Sleep ◽  
Sleep Onset Latency ◽  
Post Intervention ◽  
Insomnia Severity

Abstract Objective Poor sleep is a modifiable risk factor for multiple disorders. Frontline treatments (e.g. cognitive-behavioral therapy for insomnia) have limitations, prompting a search for alternative approaches. Here, we compare manualized Mindfulness-Based Therapy for Insomnia (MBTI) with a Sleep Hygiene, Education, and Exercise Program (SHEEP) in improving subjective and objective sleep outcomes in older adults. Methods We conducted a single-site, parallel-arm trial, with blinded assessments collected at baseline, post-intervention and 6-months follow-up. We randomized 127 participants aged 50–80, with a Pittsburgh Sleep Quality Index (PSQI) score ⩾5, to either MBTI (n = 65) or SHEEP (n = 62), both 2 hr weekly group sessions lasting 8 weeks. Primary outcomes included PSQI and Insomnia Severity Index, and actigraphy- and polysomnography-measured sleep onset latency (SOL) and wake after sleep onset (WASO). Results Intention-to-treat analysis showed reductions in insomnia severity in both groups [MBTI: Cohen's effect size d = −1.27, 95% confidence interval (CI) −1.61 to −0.89; SHEEP: d = −0.69, 95% CI −0.96 to −0.43], with significantly greater improvement in MBTI. Sleep quality improved equivalently in both groups (MBTI: d = −1.19; SHEEP: d = −1.02). No significant interaction effects were observed in objective sleep measures. However, only MBTI had reduced WASOactigraphy (MBTI: d = −0.30; SHEEP: d = 0.02), SOLactigraphy (MBTI: d = −0.25; SHEEP: d = −0.09), and WASOPSG (MBTI: d = −0.26; SHEEP (d = −0.18). There was no change in SOLPSG. No participants withdrew because of adverse effects. Conclusions MBTI is effective at improving subjective and objective sleep quality in older adults, and could be a valid alternative for persons who have failed or do not have access to standard frontline therapies.

361 Relative Effectiveness of Cognitive Behavioral Therapy and its Components in Improving Insomnia Symptoms in Older Adults

SLEEP ◽  
2021 ◽  
Vol 44 (Supplement_2) ◽  
pp. A144-A144
Author(s):  
Kathleen O’Hora ◽  
Beatriz Hernandez ◽  
Laura Lazzeroni ◽  
Jamie Zeitzer ◽  
Leah Friedman ◽  
...  
Keyword(s):  
Older Adults ◽  
Cognitive Behavioral Therapy ◽  
Behavioral Therapy ◽  
Sleep Onset ◽  
Post Treatment ◽  
Cognitive Behavioral ◽  
Sleep Onset Latency ◽  
Significant Group ◽  
Time Interaction ◽  
Insomnia Symptoms

Abstract Introduction The prevalence of insomnia complaints in older adults is 30–48%, compared to 10–15% in the general population. Cognitive Behavioral Therapy for Insomnia (CBT-I) is a first-line, non-pharmacological sleep treatment for Insomnia. However, the relative impact of Behavioral (BT) and Cognitive (CT) components compared to that of CBT-I in older adults is unknown. Methods 128 older adults with insomnia were randomized to receive CBT-I, BT, or CT. Sleep diaries and the Insomnia Severity Index (ISI) were collected pre- and post-treatment and at a 6-month follow-up. We conducted split-plot linear mixed models with age and sex as covariates to assess within and between subject changes to test effects of group, time, and their interaction on ISI, sleep onset latency (SOL), wake after sleep onset (WASO), total sleep time (TST), time in bed (TIB), sleep efficiency (SE), and percent of treatment responders (ISI decrease&gt;7) and remitters (ISI&lt;8). Effect size (d) was calculated by dividing the difference between means by the root-mean-squared error of the mixed effects model. Results All treatments lead to a significant improvement across outcome measures at post-treatment (p’s&lt;0.001) and 6-months (p’s&lt;0.01), with the exception of TIB, response, and remission. For TIB, there was a significant Group x Time interaction (p&lt;0.001): while all treatments significantly reduced TIB post-treatment relative to baseline, CBT-I (p&lt;0.001,d=-2.26) and BT (p&lt;0.001,d=-1.59) performed significantly better than CT (p=0.003, d=-0.68). In contrast, at 6-months CBT-I (p&lt;0.001,d=-1.16) performed significantly better at reducing TIB than CT (p=0.195,d=-0.24) or BT (p=0.023,d=-0.61) relative to baseline. There was also a non-significant trend for a Group x Time interaction for remission status (p=0.062). Whereas, the percentage of remitters within all groups post-treatment did not differ from chance (p&gt;0.234), at 6 months, the percentage of remitters was significantly higher than chance in CBT-I (73.63%,p=0.026) and BT (78.08%,p=0.012), but not CT (47.85%,p=0.826). There were no other significant time or interaction effects (all p&gt;0.05). Conclusion CBT-I and its components are effective in improving subjective insomnia symptoms in older adults. Evidence suggests CBT-I may be superior to either CT or BT alone in improving TIB in older adults. Support (if any) NIMHR01MH101468; MIRECC at VAPAHCS

scholarly journals Poor Sleep Increases Next Day Pain, Particularly for Older Adults With Mild Cognitive Impairment

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 527-527
Author(s):  
Xiaopeng Ji ◽  
Mary Bowen ◽  
Mari Griffieon
Keyword(s):  
Older Adults ◽  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Sleep Onset ◽  
Brief Pain Inventory ◽  
Community Dwelling ◽  
Pain Interference ◽  
Poor Sleep ◽  
Increased Risk ◽  
Movement Index

Abstract Sleep studies examine how pain is associated with poor sleep. However, emergent research suggests poor sleep increases pain and may interfere with activities of daily living (ADL) among older adults. This study will examine how poor sleep may affect next-day pain interference and how this relationship may vary by cognitive function. Ten community-dwelling older adults with lower extremity chronic pain wore an Actigraph GT9X Link for 7 days to measure poor sleep and next-day pain interference (Brief Pain Inventory; BPI). Multi-level mixed models accounted for intra-individual changes in sleep and pain interference and controlled for age, mild cognitive impairment (MCI) and depressive symptoms. Poor sleep among older adults with MCI (14 total observations) was also explored. Across 79 observations, increased number of awakenings (β=0.03; p≤ 0.05) and movement index scores (β=0.08; p≤ 0.05) were associated with increased next-day pain interference. In exploratory analyses, MCI intensified relationships between sleep efficiency (β=-0.10; p≤ 0.05), increased awakenings after sleep onset (β=0.01; p≤ 0.05) and increased length of sleep awakenings (β=0.39; p≤ 0.01) on next-day pain interference. This study’s findings suggest poor sleep is associated with next-day pain interference and the ability to perform ADL. Older adults with MCI may be at an increased risk for poor sleep and pain-related interference in ADL. Interventions designed to moderate the association between poor sleep and pain in general and for adults with MCI in particular may be warranted.

Sleep disturbance in mild cognitive impairment: differential effects of current and remitted depression

2011 ◽  
Vol 23 (4) ◽  
pp. 167-172 ◽  
Author(s):  
Sharon L. Naismith ◽  
Naomi L. Rogers ◽  
Simon J. G. Lewis ◽  
Keri Diamond ◽  
Zoë Terpening ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Major Depression ◽  
Sleep Quality ◽  
Sleep Disturbance ◽  
Rating Scale ◽  
Sleep Onset ◽  
Sleep Onset Latency ◽  
Differential Effects ◽  
Remitted Depression

Naismith SL, Rogers NL, Lewis SJG, Diamond K, Terpening Z, Norrie L, Hickie IB. Sleep disturbance in mild cognitive impairment: differential effects of current and remitted depression.Objective:Although patients with mild cognitive impairment (MCI) commonly report sleep disturbance, the extent to which depressive symptoms contribute to this relationship is unclear. This study sought to delineate the contribution of current and remitted major depression (MD) to sleep disturbance in MCI.Methods:Seventy-seven patients meeting criteria for MCI (mean age = 66.6 ± 8.8 years) were grouped according to those withnohistory of depression (MCI,n= 33), those meeting criteria forcurrentMD [mild cognitive impairment and meeting criteria for current major depression (DEP-C),n= 14] and those withremittedMD [mild cognitive impairment and remitted major depression (DEP-R),n= 30]. Additionally, 17 healthy controls (CON) participated. Sleep was patient-rated using the Pittsburgh Sleep Quality Index and included assessment of sleep quality, duration, efficiency, disturbances, medications, sleep onset latency and daytime dysfunction. Depression severity was clinician-rated using the Hamilton Depression Rating Scale.Results:Overall sleep disturbance was significantly greater in the DEP-C and DEP-R groups in comparison to the CON and MCI groups (p< 0.001). Only 12% of CON reported sleep disturbance, compared to 30% of MCI, 63% of DEP-R and 86% of DEP-C. Sub-scale analysis showed that the sleep disturbance in depressive groups was most evident across the domains of sleep quality, sleep efficiency, sleep latency and daytime dysfunction.Conclusion:Sleep disturbance in MCI is strongly associated with a current or past diagnosis of MD. The finding that sleep complaints are still prominent in those with remitted depression, suggests that ‘trait' markers exist that may reflect underlying neurobiological changes within the sleep–wake system.

scholarly journals Efficacy of Face-to-Face Delivered Cognitive Behavioral Therapy in Improving Health Status of Patients With Insomnia: A Meta-Analysis

2021 ◽  
Vol 12 ◽  
Author(s):  
Dawei Xu ◽  
Elizabeth Cardell ◽  
Simon A. Broadley ◽  
Jing Sun
Keyword(s):  
Sleep Quality ◽  
Behavioral Therapy ◽  
Meta Analysis ◽  
Sleep Onset ◽  
Intervention Group ◽  
Severity Index ◽  
Sleep Time ◽  
Control Group ◽  
Sleep Onset Latency ◽  
Face To Face

Background: Face-to-face cognitive behavioral therapy (CBT) is one of the most widely used non-pharmacological treatment approaches for insomnia. The aim of this study is to assess the efficacy of face-to-face delivered CBT on health outcomes and to evaluate the effect of CBT components as subgroup variables to explain the efficacy of face-to-face delivered CBT on health outcomes in adults over 18 years old with insomnia.Methods: Relevant randomized controlled trial studies published in the past 22 years were searched through the electronic databases. The Physiotherapy Evidence Database (PEDro) scale was used to assess the quality of the 31 included studies. The mean difference and standard deviation of outcome variables and subgroup variables were analyzed using random effect model, and the heterogeneity among the articles was assessed with the Q-test and I2. Egger regression analysis was used to assess publication bias.Results: The meta-analysis showed a significant reduction in Insomnia Severity Index [standardized mean difference (SMD) = −2.56, 95% CI −3.81 to −1.30, p &lt; 0.001], Pittsburgh Sleep Quality Index (SMD = −0.96, 95% CI −1.25 to −0.68, p &lt; 0.001), sleep onset latency (SMD = −1.31, 95% CI −2.00 to −0.63, p &lt; 0.001), wakening after sleep onset (SMD = −1.44, 95% CI −2.14 to −0.74, p &lt; 0.001), number of awakenings (SMD = −1.18, 95% CI −2.10 to −0.26, p &lt; 0.05), depression (SMD = −1.14, 95% CI −1.85 to −0.42, p &lt; 0.01), and fatigue (SMD = −2.23, 95% CI −3.87 to −0.58, p &lt; 0.01), and a significant increase in total sleep time (SMD = 0.63, 95% CI 0.28 to 0.98, p &lt; 0.001), sleep efficiency (SMD = 1.61, 95% CI 0.92 to 2.29, p &lt; 0.001), and physical health (SMD = 0.42, 95% CI 0.08 to 0.76, p &lt; 0.05), in the CBT intervention group compared with the control group. There was no significant change in anxiety (SMD = −0.62, 95% CI −1.55 to 0.32, p &gt; 0.05) and mental health (SMD = 1.09, 95% CI −0.59 to 2.77, p &gt; 0.05) in CBT intervention group compared with control group. Group-delivered studies with larger number of intervention sessions and longer duration of single session provided a larger improvement in sleep quality.Conclusion: Face-to-face delivered CBT is effective in increasing total sleep time, sleep efficiency, and physical health, and reducing Insomnia Severity Index scores, Pittsburgh Sleep Quality Index scores, sleep onset latency, wakening after sleep onset, number of awakenings, depression, anxiety, and fatigue in patients with insomnia. Face-to-face delivered CBT is more effective when delivered through a larger number of sessions with longer duration of each session, and when delivered in groups. Face-to-face CBT is recommended to provide treatment to patients with insomnia in clinical settings.Systematic Review Registration:www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020200091, identifier: CRD4202020009.

scholarly journals 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

2021 ◽  
Author(s):  
Yeonsu Song ◽  
Monica R Kelly ◽  
Constance H Fung ◽  
Joseph M Dzierzewski ◽  
Austin M Grinberg ◽  
...  
Keyword(s):  
Older Adults ◽  
Randomized Controlled Trial ◽  
Behavioral Therapy ◽  
Controlled Trial ◽  
Sleep Onset ◽  
Severity Index ◽  
Sleep Diary ◽  
Daytime Functioning ◽  
Randomized Controlled ◽  
The Impact

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 &lt; .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.

scholarly journals A ChineseChan-Based Mind-Body Intervention Improves Sleep on Patients with Depression: A Randomized Controlled Trial

2012 ◽  
Vol 2012 ◽  
pp. 1-10 ◽  
Author(s):  
Agnes S. Chan ◽  
Queenie Y. Wong ◽  
Sophia L. Sze ◽  
Patrick P. K. Kwong ◽  
Yvonne M. Y. Han ◽  
...  
Keyword(s):  
Effect Size ◽  
Sleep Problems ◽  
Behavioral Therapy ◽  
Controlled Trial ◽  
Sleep Onset ◽  
Sleep Time ◽  
Sleep Onset Latency ◽  
Sleep Quantity ◽  
Wake Time ◽  
Positive Effects

Sleep disturbance is a common problem associated with depression, and cognitive-behavioral therapy (CBT) is a more common behavioral intervention for sleep problems. The present study compares the effect of a newly developed ChineseChan-based intervention, namelyDejianmind-body intervention (DMBI), with the CBT on improving sleep problems of patients with depression. Seventy-five participants diagnosed with major depressive disorder were randomly assigned to receive 10 weekly sessions of CBT or DMBI, or placed on a waitlist. Measurements included ratings by psychiatrists who were blinded to the experimental design, and a standardized questionnaire on sleep quantity and quality was obtained before and after the 10-week intervention. Results indicated that both the CBT and DMBI groups demonstrated significantly reduced sleep onset latency and wake time after sleep onset (effect size range=0.46–1.0,P≤0.05) as compared to nonsignificant changes in the waitlist group (P>0.1). Furthermore, the DMBI group, but not the CBT or waitlist groups, demonstrated significantly reduced psychiatrist ratings on overall sleep problems (effect size=1.0,P=0.00) and improved total sleep time (effect size=0.8,P=0.05) after treatment. The present findings suggest that a ChineseChan-based mind-body intervention has positive effects on improving sleep in individuals with depression.

scholarly journals Lessons Learned From Clinical Recruitment of Older Adults With MCI for an Internet-Delivered Intervention Study

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 33-33
Author(s):  
Meghan Mattos ◽  
Mark Quigg ◽  
Carol Manning ◽  
Eric Davis ◽  
Ann Sollinger ◽  
...  
Keyword(s):  
Older Adults ◽  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Behavioral Intervention ◽  
Behavioral Interventions ◽  
Intervention Study ◽  
Lessons Learned ◽  
The Internet ◽  
Eligibility Criteria ◽  
Study Recruitment

Abstract Clinical research involving participants with mild cognitive impairment (MCI) presents challenges to recruitment that may be further compounded by concerns when delivering a behavioral intervention via the Internet. The purpose of this talk is to describe recruitment adaptations for an Internet-delivered behavioral intervention study with older adults living with MCI and insomnia. Over the course of study recruitment, unforeseen barriers to recruitment were discovered, including fewer older adults with MCI endorsing sleep concerns than expected. The most substantive changes made to improve clinical recruitment were related to eligibility criteria, yielding 50% of the overall sample. Anticipated concerns of older adults with MCI using technology or accessing the Internet were not significant barriers to recruitment. Study findings support Internet-delivered intervention use in this population, which in the context of the COVID-19 pandemic, presents a potentially efficient and effective method for recruiting and delivering behavioral interventions in this difficult-to-enroll population.

Toward Identifying Mild Cognitive Impairment in Hispanic and African American Adults

2017 ◽  
Vol 2 (2) ◽  
pp. 110-116
Author(s):  
Valarie B. Fleming ◽  
Joyce L. Harris
Keyword(s):  
Older Adults ◽  
African American ◽  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Healthcare Access ◽  
Communication Disorders ◽  
Healthcare Systems ◽  
Prevention Education ◽  
Education Management ◽  
African American Adults

Across the breadth of acquired neurogenic communication disorders, mild cognitive impairment (MCI) may go undetected, underreported, and untreated. In addition to stigma and distrust of healthcare systems, other barriers contribute to decreased identification, healthcare access, and service utilization for Hispanic and African American adults with MCI. Speech-language pathologists (SLPs) have significant roles in prevention, education, management, and support of older adults, the population must susceptible to MCI.

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