Sleep Outcomes With Cognitive Behavioral Therapy for Insomnia Are Similar Between Older Adults With Low vs. High Self-Reported Physical Activity

Timothy Yeung, Jennifer L Martin, Constance H Fung, Lavinia Fiorentino, Joseph M Dzierzewski, Juan C Rodriguez Tapia, Yeonsu Song, Karen Josephson, Stella Jouldjian, Michael N Mitchell, Cathy Alessi, Timothy Yeung, Jennifer L Martin, Constance H Fung, Lavinia Fiorentino, Joseph M Dzierzewski, Juan C Rodriguez Tapia, Yeonsu Song, Karen Josephson, Stella Jouldjian, Michael N Mitchell, Cathy Alessi

Abstract

We examined whether baseline self-reported physical activity is associated with the efficacy of cognitive behavioral therapy for insomnia (CBT-I) in older veterans. Community-dwelling veterans aged 60 years and older with insomnia received CBT-I in a randomized controlled trial. Participants who received active treatment were divided into low and high physical activity based on self-report. Sleep outcomes were measured by sleep diary, questionnaire and wrist actigraphy; collected at baseline, post-treatment, 6-month and 12-month follow-up. Mixed-effects models compared differences between physical activity groups in change in sleep outcome from baseline to each follow-up, and equivalence tests examined if physical activity groups were clinically equal. There were no significant differences in sleep outcomes between physical activity groups. Equivalence tests suggested possible equality in physical activity groups for five of seven sleep outcomes. Efficacy of CBT-I in older veterans was not associated with self-reported physical activity at baseline. Older adults with insomnia who report low levels of physical activity can benefit from CBT-I.

Keywords: chronic illness; cognitive behavioral therapy for insomnia; insomnia; older adults; physical activity; veterans.

Figures

Figure 1
Figure 1
Mixed effects-models mean and 95% confidence interval for each sleep outcome at each time point. No differences were found for any of the sleep outcomes at each time point. Panel (A) shows the data for diary sleep onset latency (SOL-D) in minutes. Panel (B) shows the data for diary total wake time (TWT-D) in minutes. Panel (C) shows the data for diary wake after sleep onset (WASO-D) in minutes. Panel (D) shows the data for diary sleep efficiency (SE-D) in percent. Panel (E) shows the data for actigraphy sleep efficiency (SE-A) in percent. Panel (F) shows the data for the Pittsburgh Sleep Quality Index (PSQI), total score. Panel (G) shows the data for the Insomnia Severity Index (ISI) total score.
Figure 2
Figure 2
Equivalence tests using both thresholds of clinical significance (bold line for large threshold, thin line for small threshold) at post-treatment, 6- and 12-month follow-ups. Groups are equivalent if confidence interval brackets are completely within clinical thresholds (depicted as horizontal lines). Panel (A) shows that SOL-D in minutes was not significantly equal for the two groups by either threshold. Panel (B) shows that WASO-D in minutes was equal for the two groups using the large threshold but not the small threshold. Panel (C) shows that TWT-D in minutes was not equal by either threshold. Panel (D) shows SE-D in percent was equal using the large threshold but not the small threshold. Panel (E) shows SE-A in percent was equal for the PA groups by both thresholds. Panel (F) shows PSQI total score was equal using the large threshold but not the small threshold. Panel (G) shows ISI total score was equal using the large threshold but not the small threshold.

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