Abstract

Poor sleep quality and complaints of insomnia are particularly prevalent in aging individuals. However, not all older people who experience what may be developmentally inevitable sleep disruption complain of insomnia. Psychological therapies for sleep disorder have been explored extensively with younger people but only recently have researchers turned their attention to applying these approaches to the treatment of insomnia in older adults. Recent research has demonstrated that older individuals can benefit from such treatment. However, despite abundant evidence for the importance of cognitive factors in insomnia, there has been a relative lack of attention to the development of cognitive interventions. The present study evaluated a new cognitive-behavioral technique, Countercontrol-Plus Audiobook, aimed directly at disrupting the intrusive thoughts that may interfere with sleep. Forty-one older adults (mean age = 67) with sleep onset and maintenance problems were assigned to one of three intervention conditions: Countercontrol-Plus Audiobook, Countercontrol-Plus Relaxation, and Self-Monitoring Only. All three groups showed significant improvement on various self-report, quantitative and qualitative measures of sleep, although no change was found on daytime sleepiness, fatigue and functioning. Cognitive and somatic presleep variables also showed improvement over the two week treatment period. Gains were generally maintained at a 2-week and 18-month follow-up. Evaluation of clinically significant change demonstrated that most participants still had some degree of sleep problem at post-intervention. Although most participants showed some improvement on quantitative sleep-wake parameters, insomnia distress and anxious presleep cognitions, only 4% to 29% of participants reached the defined clinically significant level of improvement from baseline to post-intervention, with more individuals improving on sleep onset latency and distress frequency than on duration of nocturnal awakenings. Consistent with previous studies, durations of nocturnal awakenings seem to be more resistant to change than latency to sleep onset. The findings are discussed in terms of the multidimensional nature of the insomnia experience and the multiple possible effects of the self-monitoring process.