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Browsing by Author "Wilson, Nancy M."

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    Psychological treatment of hypnotic-dependent insomnia in a primarily older adult sample
    (Pergamon, 2013) Lichstein, Kenneth L.; Nau, Sidney D.; Wilson, Nancy M.; Aguillard, R. Neal; Lester, Kristin W.; Bush, Andrew J.; McCrae, Christina S.; University of Alabama Tuscaloosa; University of Memphis; University of Tennessee Knoxville; University of Florida
    Objective: This study tested cognitive behavior therapy (CBT) in hypnotic-dependent, late middle-age and older adults with insomnia. Method: Seventy volunteers age 50 and older were randomized to CBT plus drug withdrawal, placebo biofeedback (PL) plus drug withdrawal, or drug withdrawal (MED) only. The CBT and PL groups received eight, 45 min weekly treatment sessions. The drug withdrawal protocol comprised slow tapering monitored with about six biweekly, 30 min sessions. Assessment including polysomnography (PSG), sleep diaries, hypnotic consumption, daytime functioning questionnaires, and drug screens collected at baseline, posttreatment, and 1-year follow-up. Results: Only the CBT group showed significant sleep diary improvement, sleep onset latency significantly decreased at posttreatment. For all sleep diary measures for all groups, including MED, sleep trended to improvement from baseline to follow-up. Most PSG sleep variables did not significantly change. There were no significant between group differences in medication reduction. Compared to baseline, the three groups decreased hypnotic use at posttreatment, down 84%, and follow-up, down 66%. There was no evidence of withdrawal side-effects. Daytime functioning, including anxiety and depression, improved by posttreatment. Rigorous methodological features, including documentation of strong treatment implementation and the presence of a credible placebo, elevated the confidence due these findings. Conclusions: Gradual drug withdrawal was associated with substantial hypnotic reduction at posttreatment and follow-up, and withdrawal side-effects were absent. When supplemented with CBT, participants accrued incremental self-reported, but not PSG, sleep benefits. (C) 2013 Elsevier Ltd. All rights reserved.
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    Psychological treatment of insomnia in hypnotic-dependant older adults
    (Elsevier, 2008-01) Soeffing, James P.; Lichstein, Kenneth L.; Nau, Sidney D.; McCrae, Christina S.; Wilson, Nancy M.; Aguillard, R. Neal; Lester, Kristin W.; Bush, Andrew J.; University of Alabama Tuscaloosa; State University System of Florida; University of Florida; University of Memphis; University of Tennessee System; University of Tennessee Health Science Center
    Background: The existing literature does not address the question of whether cognitive-behavioral therapy would have an impact on insomnia in older adults who are chronic users of sleep medication and have current insomnia, but are also stable in their quantity of medication usage during treatment. The present report seeks to answer this question. Methods: Hypnotic-dependant older adults, who were stable in their amount of medication usage and still met the criteria for chronic insomnia put forth by American Academy of Sleep Medicine, were treated using a cognitive-behavioral intervention for insomnia. The three-component treatment included relaxation training, stimulus control, and sleep hygiene instructions. Participants were randomly assigned to either the active treatment group or a comparably credible placebo control group, and were instructed not to alter their pattern of hypnotic consumption during treatment. Results: The active treatment group had significantly better self-report measures of sleep at post-treatment. Statistically significant improvement was paralleled by clinically meaningful improvement for key sleep variables. As planned, there was no significant change in sleep medication usage from pre- to post-treatment. Conclusions: The findings support the use of cognitive-behavioral therapy for insomnia in hypnotic-dependant older adults. (c) 2007 Elsevier B.V. All rights reserved.