What predicts patients' perceptions of improvement in insomnia?

Department of Clinical Health Psychology, University of Manitoba, Winnipeg, Manitoba, Canada.
Journal of Sleep Research (Impact Factor: 2.95). 10/2006; 15(3):301-8. DOI: 10.1111/j.1365-2869.2006.00529.x
Source: PubMed

ABSTRACT Although there has been considerable research into the effectiveness of individual cognitive behavioral treatment for chronic insomnia, less is known about patients' perceptions of what constitutes actual improvement. This study utilized 70 outpatients (mean age = 49.7 years, SD = 12.0) with insomnia who completed a 6-week cognitive behavioral group for sleep. Participants completed a number of primary (Pittsburgh Sleep Quality Index) and secondary measures (the Dysfunctional Beliefs about Sleep Scale, Insomnia Severity Index, Beck Depression Inventory, Penn State Worry Questionnaire) at pre- and post-treatment. Perceived improvement was measured using the Clinical Global Improvement Scale (CGI). Results were analyzed using a combination of Logistic Regression analysis and receiver operating curve characteristic analysis (ROC). Results demonstrated that sleep quality and sleep duration were the most sensitive primary measures, or best predicted perceived improvement, whereas sleep efficiency was the most specific primary measure, or best predicted perceived lack of improvement (defined as only mild improvement). Of the secondary measures, results showed that daytime impairment was the most sensitive predictor of perceived improvement and that mood was the most specific predictor of perceived lack of improvement. Implications of these findings are that sleep quality, sleep duration, and sleep efficiency may offer different types of information and the choice of measure for predicting global improvement in insomnia will depend on the needs of the researcher/clinician.

  • [Show abstract] [Hide abstract]
    ABSTRACT: Stepped care models for chronic insomnia are in their infancy. This study evaluated predictors of movement in a stepped care pathway using a sample of 50 adult outpatients with chronic insomnia. At assessment periods, participants completed daily sleep diaries, the Insomnia Severity Index, the Multi-Dimensional Fatigue Inventory (MFI), and the Dysfunctional Beliefs and Attitudes about Sleep Scale (DBAS-10). Following this, data were collected regarding whether the individual went on to receive more intensive services (i.e., individual consultation, group or individual therapy). Data were analyzed using multi-nomial logistic regression. Results showed that age, employment status, and sleep (quality, latency) predicted use of more intensive services. Results showed that psychiatric and sleep comorbidity, sleep attitudes, and insomnia severity did not. Implications of these findings are that stepped care resulted in a 69% improvement in efficiency, and that low-intensity treatment delivered in step 1 may have been particularly sufficient for the young and employed, and for those with better sleep. Vincent N; Walsh K. Stepped care for insomnia: an evaluation of implementation in routine practice. J Clin Sleep Med 2013;9(3):227-234.
    Journal of clinical sleep medicine: JCSM: official publication of the American Academy of Sleep Medicine 01/2013; 9(3):227-234. DOI:10.5664/jcsm.2484 · 2.93 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Insomnia is a common sleep disorder associated with substantial direct and indirect costs, yet there is a strong propensity among patients to self-medicate which often delays professional help. Understanding the process which underpins the initiation, engagement and adherence to insomnia treatment(s) is a vital step for understanding this phenomenon. The current paper explores how the patient perspective has been conceptualized in the research literature and its implications for insomnia treatment and health care delivery. A literature search was conducted using Embase, Medline and PsycINFO databases. Articles have been thematically organized into patient correlates of health behaviors, patient experiences and treatment attitudes. Deferral of professional help among insomnia patients is partially related to barriers embedded in the health care system and patient health beliefs.
    Behavioral Sleep Medicine 06/2012; DOI:10.1080/15402002.2012.694382 · 1.74 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The extant literature on predictors of treatment response to behavioral treatments for insomnia is equivocal and limited in scope. The current study examined demographic, clinical, and sleep characteristics as predictors of clinically significant treatment response to brief behavioral treatment of insomnia (BBTI) in older adults with insomnia. Thirty-nine older adults with insomnia (67% females, mean age: 72.54 years) were randomized to BBTI treatment. Treatment outcomes were defined according to 2 criteria: (1) "response," defined as change in Pittsburgh Sleep Quality Index (PSQI) score ≥ 3 points or increase in sleep diary sleep efficiency ≥ 10%); or (2) remission, defined as absence of a clinical diagnosis of insomnia according to standard diagnostic criteria. Logistic regression examined whether baseline demographic, clinical, or sleep characteristics predicted treatment outcomes at 1 month follow-up. Demographic variables did not predict treatment outcomes for either criterion. Higher anxiety, depression, poorer sleep quality, and longer polysomnography (PSG)-assessed sleep latency predicted greater likelihood of response at follow-up (p < 0.05). Longer sleep duration at baseline (measured by sleep diary and PSG) predicted greater likelihood of the remission at follow-up (p < 0.05). Patients with insomnia who have greater distress at baseline or prolonged sleep latency are more likely to show positive response to BBTI. In contrast, short sleepers at baseline are less likely to have resolution of insomnia diagnosis following BBTI, perhaps due to the sleep restriction component of the treatment. Identifying the characteristics that predict positive BBTI treatment outcomes can facilitate personalized behavioral treatments to improve outcomes. Troxel WM; Conrad TS; Germain A; Buysse DJ. Predictors of treatment response to brief behavioral treatment of insomnia (BBTI) in older adults. J Clin Sleep Med 2013;9(12):1281-1289.
    Journal of clinical sleep medicine: JCSM: official publication of the American Academy of Sleep Medicine 01/2013; 9(12):1281-9. DOI:10.5664/jcsm.3270 · 2.93 Impact Factor

Full-text (2 Sources)

Available from
Sep 29, 2014