Insomnia remission and improvement of bodily pain in older adults: a randomized clinical trial

Older adults with insomnia frequently report bothersome pain. Whether insomnia treatment reduces bodily pain in older adults without chronic pain conditions is not known.

This randomized controlled trial aimed to determine whether treatment of insomnia disorder with cognitive behavioral therapy for insomnia (CBT-I), as compared with sleep education therapy (SET), yields durable remission of insomnia and reduces moderate pain symptoms over 36 months in older adults with insomnia disorder.

A community-based sample of 291 adults ages 60 years and older (mean age, 70.1 years; 57.7% female) with insomnia disorder, but no chronic pain condition, were randomized to 2 months of intervention with either CBT-I (n = 156) or SET (n = 135). The primary outcome was change in bodily pain as measured by the short form 36 (SF-36) health survey. Secondary outcome was remission of insomnia continuously sustained over 36 months of follow-up.

Improvements in bodily pain, as indexed by increases in SF-36 scores, were found in CBT-I with insomnia remission (adjusted β = 0.18; 95% CI, 0.004-0.360; P = 0.045) and in SET with insomnia remission (adjusted β = 0.25; 95% CI, 0.035-0.457; P = 0.023) but not in treatment groups without insomnia remission. As compared with those without insomnia remission, insomnia remission was associated with improvements in pain (adjusted β = 0.19; 95% CI, 0.047-0.325; P = 0.009) and with increases in the proportion of participants who achieved a minimal clinically important difference (likelihood ratio χ² _1,16 = 264.04; P < 0.001).

Sustained remission of insomnia disorder leads to improvements in bodily pain, with the potential to prevent chronic pain disorders in older adults with insomnia.

ClinicalTrials.gov NCT01641263.