Predictors of Cognitive Behavioral Therapy for Insomnia in Older Adults

Cognitive Behavioral Therapy for Insomnia (CBT-I) is the recommended non-pharmacological treatment for insomnia in adults; however, it remains unclear which older adults are most likely to benefit from CBT-I.

Data from a Randomized Controlled Trial (RCT) examining the effect of CBT-I on cognitive performance in older adults were used for this study. Ninety-six older adults with insomnia received six weeks of CBT-I and were assessed at baseline, immediately following treatment, and at the 12-month follow-up. Ten baseline variables, including demographic, psychological, and sleep-related characteristics, were included in linear regression to examine their association with CBT-I success, defined as the Insomnia Severity Index (ISI) scores after six weeks of CBT-I and at the one-year follow-up.

ISI significantly decreased following six weeks of CBT-I (Z = 8.3, p < .001) and remained significantly improved at the 12-month follow-up (Z = 8, p < .001). Higherbaseline sleep self-efficacy (β = -0.03, p < .02) and lower depression severity (β = 0.06, p = .04) were significantly associated with lower ISI scores immediately after CBT-I. Higherbaselinesleep self-efficacy was significantly associated (β = -0.03, p < .01) with lower ISI scores at the 12-month follow-up.

Six weeks of CBT-I resulted in significant and sustained reductions in insomnia severity in older adults. Baseline sleep self-efficacy and depression severity significantly predicted lower insomnia severity following CBT-I, whereas only sleep self-efficacy predicted the long-term maintenance of treatment gains. These findings underscore the importance of baseline sleep self-efficacy as key predictor for optimizing treatment planning and long-term outcomes.