Adapting an Evidenced Based Insomnia Intervention for Older Adults in Residential Care

Morin and Espie's cognitive behavioral therapy (CBT), 8-session, evidence based manual for sleep disturbance, entitled, “Insomnia: A Clinical Guide to Assessment and Treatment” was piloted with a small group of older adults (N=5) living in a residential care facility for the elderly (RCFE) who suffered from mild cognitive impairment. Sleep disturbance is one of the most frequent symptoms observed in older patients with mild cognitive impairment (MCI), occurring 14-59% of the time. Sleep is an ideal target due to evidence that treatments are very successful for a broad range of individuals; improvements have the potential to broadly impact public health; and further, sleep represents a modifiable risk factor for a range of other disorders, such as declining cognition, depression and functional impairment. Pre-post, paired sample t-tests showed significant improvements in the participants ratings of their sleep quality via the Insomnia Severity Index [t(4)=10.61, p<.00], as well as a decrease in the number of awakenings after sleep onset via actigraphy [t(4)=5.74, p<.00]. It is not yet understood how MCI may moderate the effects of treatment and what therapeutic adaptations are needed to maximize treatment effects. Adaptations found to aid implementation and outcome will be detailed. Specifically the content (e.g., amount covered, need for simplified language), delivery (e.g., pace, use of repetition) and measurement (e.g., reliability, validity, burden) adaptations used with RCFE residents with both sleep disturbances and MCI will be presented. If effective on a larger scale, future studies would focus on transferability and scalability across residential care settings.