Strategies for evaluating adherence to sleep restriction treatment for insomnia

The methodology of assessing adherence to sleep restriction therapy for insomnia has received little attention in the empirical literature. The present study proposes and evaluates several approaches to assessing adherence to sleep restriction. We investigated multiple methods of measuring adherence and tested their utility by determining the strength of their association with treatment outcome in a sample of 22 older adults with insomnia (16 women, six men). As a group, the measures indicated reasonably good adherence to treatment recommendations. Time spent in bed was significantly reduced at post-treatment, and the night to night consistency of time spent in bed and arising time was significantly greater at post-treatment. However, time spent in bed per night at post-treatment still exceeded therapist recommendations by a mean of 27.89 min (SD=31.72). Greater consistency of time spent in bed per night and a more consistent arising time predicted a better treatment outcome. Measures of degree of bedtime reduction did not predict treatment outcome.