Changes in sleep effort mediate insomnia severity in older adults following online cognitive behavioural therapy

Abstract

AbstractBackgroundTo examine treatment mechanisms of digitally delivered cognitive behavioural therapy for insomnia (CBT‐I), this study assessed the mediating effects of dysfunctional beliefs, hyperarousal, locus of control, self‐efficacy, sleep effort, and safety behaviours on self‐reported insomnia severity in older adults before and following the completion of a self‐guided, online CBT‐I program.MethodsThe baseline and follow‐up measurements were completed by 62 older adults (55 female, 89%). This was a two‐condition within‐participant design. Mediation analysis using a parallel mediation model was conducted using the MEMORE macro for repeated measure designs.ResultsOut of all the included mediator variables, only a reduction in sleep effort scores (0.88; SE 0.51; 95% CI 0.001–2.00) significantly mediated changes in insomnia severity scores following the intervention. Insomnia severity scores significantly reduced following the intervention (Mpre = 9.84, SD = 5.89, Mpost = 6.87, SD = 4.90); t(61) = 5.19, P = <0.001; d = 0.55 95% CI 0.38–0.93.ConclusionsSleep in older adults improved following digitally delivered CBT‐I, and these changes were influenced by a reduction in sleep control efforts exerted by participants. These findings highlight possible treatment pathways of CBT‐I. Further investigation of CBT‐I as a strategy to prevent sleep problems is warranted.Trial RegistrationAustralian New Zealand Clinical Trials Registry (ANZCTR), ACTRN 12619001509156; http://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=378451.