Behavioral Treatment of Insomnia in Aging

NCT ID: NCT00280020

Last Updated: 2012-07-11

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

123 participants

Study Classification

INTERVENTIONAL

Study Start Date

2006-04-30

Study Completion Date

2011-08-31

Brief Summary

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The purpose of this study is to evaluate whether Tai Chi Chih vs. cognitive behavioral therapy vs. sleep education reduces insomnia in older adults. The secondary goal of the study is to determine whether the behavioral treatment of insomnia alters proinflammatory cytokine activity.

Detailed Description

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Insomnia is a prominent complaint in late-life. However, little scientific effort has been directed toward identifying the biological mechanisms that are related to abnormal sleep or to evaluating the efficacy of behavioral treatments for insomnia in older adults. Basic observations demonstrate that proinflammatory cytokines play a key role in the regulation of sleep. Previous research shows that cytokines are reciprocally linked with abnormal sleep. This trial builds upon these findings and extends a program of study that has examined the efficacy of behavioral interventions on health outcomes in the elderly.

Preliminary studies found that Tai Chi Chih (TCC), a slow moving meditation, contributes to improvements in subjective sleep quality, sleep amounts and sleep efficiency, alterations in sympathetic activity, decreases in proinflammatory cytokines, and improvements in health functioning in community-dwelling older adults. Additionally, cognitive behavior therapy (CBT) confers benefits on sleep outcomes.

In this randomized, controlled trial, 150 older adults will be randomly assigned to CBT, TCC, or sleep hygiene/education control (EC) over 16 weeks and followed for one year. The aims of this project are to: 1) evaluate the effects of CBT vs TCC vs. EC on objective and subjective measures of sleep and on fatigue, mood, and health functioning in older adults with insomnia; 2) determine the effects of CBT vs.TCC vs. EC on measures of proinflammatory cytokine activity and sympathovagal balance, and whether these two biological mechanisms are related to changes of disordered sleep over the course of the treatment trial; and 3) evaluate whether circulating levels of proinflammatory cytokines are associated with measures of sleep continuity in older adults with insomnia over the treatment trial. This study will advance psychobiological models of disordered sleep and the potential benefits of two readily exportable behavioral interventions for promoting improvements in sleep outcomes in the elderly.

Conditions

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Aging Insomnia

Keywords

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sleep disorders meditation cognitive behavior therapy

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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CBT

Group Type EXPERIMENTAL

Cognitive Behavior Therapy (CBT)

Intervention Type BEHAVIORAL

For each 2-hour session held once a week for 16 weeks, the CBT treatment manual will outline objectives, patient skills, and treatment activities. Therapists will direct role-playing and other skill-development exercises that will be designed to increase patients' self-efficacy in managing their insomnia. Homework assignments will be planned weekly to ensure practice and skill application.

TCC

Group Type EXPERIMENTAL

Tai Chi Chih (TCC)

Intervention Type BEHAVIORAL

Participants will learn and practice 20 movements in 1 hour sessions twice per week for 16 weeks

SS

Group Type ACTIVE_COMPARATOR

Sleep Seminar (SS)

Intervention Type BEHAVIORAL

Each 2-hour session, held once a week for 16 weeks, consists of a 60-minute video presentation followed by a 60-minute question-and-answer discussion.

Interventions

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Tai Chi Chih (TCC)

Participants will learn and practice 20 movements in 1 hour sessions twice per week for 16 weeks

Intervention Type BEHAVIORAL

Cognitive Behavior Therapy (CBT)

For each 2-hour session held once a week for 16 weeks, the CBT treatment manual will outline objectives, patient skills, and treatment activities. Therapists will direct role-playing and other skill-development exercises that will be designed to increase patients' self-efficacy in managing their insomnia. Homework assignments will be planned weekly to ensure practice and skill application.

Intervention Type BEHAVIORAL

Sleep Seminar (SS)

Each 2-hour session, held once a week for 16 weeks, consists of a 60-minute video presentation followed by a 60-minute question-and-answer discussion.

Intervention Type BEHAVIORAL

Eligibility Criteria

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Inclusion Criteria

* Older than 55 years of age at time of entry
* Sleep-onset delay, maintenance insomnia, or terminal insomnia
* Difficulties with sleep for a minimum of 3 nights per week
* Insomnia duration of at least 6 months
* Complaint of at least 1 negative effect during waking hours (e.g., fatigue, impaired functioning, mood disturbances) attributed to insomnia
* Habitual sleep-wake schedule reporting "lights-out" between 9:00 PM and midnight
* Accessible geographically

Exclusion Criteria

* Evidence that insomnia is directly related to a medical disorder (e.g., hyperthyroidism) or effects of a medication that affects sleep structure and/or immune functioning
* Presence of sleep apnea or periodic limb movements during sleep
* Presence of another sleep disorder (e.g., Advanced or Delay Sleep Phase Syndrome)
* Regular use of a hypnotic or psychotropic medication (sleeping pills) and/or current psychotherapy or other behavioral therapy that would confound CBT or TCC
* Current history of a major psychiatric disorder (e.g. current major depression, alcohol or substance dependence, anxiety disorder)
* Cognitive impairment as suggested by a score lower than 23 on the Mini-Mental State examination
* Abnormal screening laboratory tests (e.g., abnormal thyroid hormone, elevated TSH, positive screening for HIV or hepatitis C)
* Smokers will also be excluded because of potential confounding effects on markers of inflammation
* Body mass index that is greater than 30 kg/m2 as obesity is associated with excessive levels of inflammatory markers
* Women must be post-menopausal
* Unable to commit to intervention schedule
Minimum Eligible Age

55 Years

Maximum Eligible Age

90 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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National Institute on Aging (NIA)

NIH

Sponsor Role collaborator

University of California, Los Angeles

OTHER

Sponsor Role lead

Responsible Party

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Michael Irwin, M.D.

Professor in Residence

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Michael R. Irwin, MD

Role: PRINCIPAL_INVESTIGATOR

Cousins Center for Psychoneuroimmunology, UCLA Neuropsychiatric Institute

Locations

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Cousins Center for Psychoneuroimmunology, UCLA Neuropsychiatric Institute

Los Angeles, California, United States

Site Status

Countries

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United States

References

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Irwin M, Pike J, Oxman M. Shingles Immunity and Health Functioning in the Elderly: Tai Chi Chih as a Behavioral Treatment. Evid Based Complement Alternat Med. 2004 Dec;1(3):223-232. doi: 10.1093/ecam/neh048. Epub 2004 Dec 1.

Reference Type BACKGROUND
PMID: 15841255 (View on PubMed)

Irwin MR, Pike JL, Cole JC, Oxman MN. Effects of a behavioral intervention, Tai Chi Chih, on varicella-zoster virus specific immunity and health functioning in older adults. Psychosom Med. 2003 Sep-Oct;65(5):824-30. doi: 10.1097/01.psy.0000088591.86103.8f.

Reference Type BACKGROUND
PMID: 14508027 (View on PubMed)

Motivala SJ, Sarfatti A, Olmos L, Irwin MR. Inflammatory markers and sleep disturbance in major depression. Psychosom Med. 2005 Mar-Apr;67(2):187-94. doi: 10.1097/01.psy.0000149259.72488.09.

Reference Type BACKGROUND
PMID: 15784782 (View on PubMed)

Lee SM, Te S, Breen EC, Olmstead R, Irwin MR, Cho JH. Circulating versus lipopolysaccharide-induced inflammatory markers as correlates of subthreshold depressive symptoms in older adults. World J Biol Psychiatry. 2020 Oct;21(8):634-641. doi: 10.1080/15622975.2019.1671608. Epub 2019 Oct 9.

Reference Type DERIVED
PMID: 31552779 (View on PubMed)

Carroll JE, Seeman TE, Olmstead R, Melendez G, Sadakane R, Bootzin R, Nicassio P, Irwin MR. Improved sleep quality in older adults with insomnia reduces biomarkers of disease risk: pilot results from a randomized controlled comparative efficacy trial. Psychoneuroendocrinology. 2015 May;55:184-92. doi: 10.1016/j.psyneuen.2015.02.010. Epub 2015 Feb 25.

Reference Type DERIVED
PMID: 25770704 (View on PubMed)

Irwin MR, Olmstead R, Breen EC, Witarama T, Carrillo C, Sadeghi N, Arevalo JM, Ma J, Nicassio P, Bootzin R, Cole S. Cognitive behavioral therapy and tai chi reverse cellular and genomic markers of inflammation in late-life insomnia: a randomized controlled trial. Biol Psychiatry. 2015 Nov 15;78(10):721-9. doi: 10.1016/j.biopsych.2015.01.010. Epub 2015 Feb 4.

Reference Type DERIVED
PMID: 25748580 (View on PubMed)

Irwin MR, Olmstead R, Carrillo C, Sadeghi N, Breen EC, Witarama T, Yokomizo M, Lavretsky H, Carroll JE, Motivala SJ, Bootzin R, Nicassio P. Cognitive behavioral therapy vs. Tai Chi for late life insomnia and inflammatory risk: a randomized controlled comparative efficacy trial. Sleep. 2014 Sep 1;37(9):1543-52. doi: 10.5665/sleep.4008.

Reference Type DERIVED
PMID: 25142571 (View on PubMed)

Other Identifiers

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R01AG026364

Identifier Type: NIH

Identifier Source: secondary_id

View Link

AG0061

Identifier Type: -

Identifier Source: org_study_id