Testing two types of self-help CBT-I for insomnia in older adults with arthritis or coronary artery disease

The present study tested two methods of self-help cognitive-behavioral therapy for insomnia (CBT-I) for 106 older adults (mean age = 68) with osteoarthritis (n = 33) or coronary artery disease (n = 33) or no significant medical condition (n = 40). The latter was employed as a comparison group to test the differential efficacy between primary and comorbid insomnia.

Self-help CBT-I has demonstrated efficacy in previous studies, so two treatments were compared rather than employing a no treatment control group. Participants were randomly assigned to a book version or an enhanced multimedia version of CBT-I.

Both versions of CBT-I demonstrated efficacy in improving all measures of sleep at posttreatment, using intent-to-treat analyses. These sleep improvements were maintained among 86 treatment completers who participated in 1-year follow-up assessment. There were no significant differences in treatment response between primary (no medical condition) and comorbid insomnia participants and no significant differences between the two types of self-help according to sleep log measure. However, multimedia participants compared to book participants showed more improvement on three global sleep measures administered at posttreatment only.

Although outcomes were attenuated relative to those obtained in therapist led intervention studies, the results suggest that self-help CBT-I has good potential to serve as a first-line, cost-effective treatment for both primary and comorbid insomnia in older adults.