Sleep outcomes in older adults following online cognitive behavioural therapy for insomnia

Author Identifier

Yvonne Kutzer

https://orcid.org/0000-0003-3568-5030

Date of Award

2023

Document Type

Thesis

Publisher

Edith Cowan University

Degree Name

Doctor of Philosophy

School

School of Medical and Health Sciences

First Supervisor

Mandy Stanley

Second Supervisor

Lisa Whitehead

Third Supervisor

Eimear Quigley

Abstract

It is widely known that sleep problems such as insomnia are highly prevalent in adults aged over 60 years. Cognitive Behavioural Therapy, the gold standard of insomnia therapy, is an effective treatment but is characterised by a shortage of trained clinicians and a lack of available services. This thesis explores changes in subjective and objective sleep outcomes in community – dwelling older adults following the completion of a programme of digital, unassisted Cognitive Behavioural Therapy for insomnia. The thesis also examines cognitive, behavioural, and arousal-related factors which mediate the relationship between Cognitive Behavioural Therapy for insomnia and treatment outcomes and potential treatment mediators. A specific focus of this thesis is uncoupled sleep, which is an asynchrony between sleep pattern and sleep appraisal. When characterising individuals using the presence or absence of a sleep complaint combined with the presence or absence of a poor sleep pattern, four possible sleeper groups emerge, two with coupled sleep (non-complaining good sleepers and complaining poor sleepers), and two with uncoupled sleep (complaining good sleepers and non-complaining poor sleepers). Complaining good sleepers lament their poor sleep despite there not being any indication of poor sleep using objective measures of sleep assessment, whereas non-complaining poor sleepers have poor sleep but do not complain about it.

Following an initial feasibility study, the second study to form part of this thesis investigated subjective and objective sleep parameters and rate of uncoupled sleep in a sample of older adults in Western Australia. In a sample of 80 adults aged 60-80 years (71 females), 45% were uncoupled sleepers. Complaining good sleepers reported a sleep duration that was significantly shorter than that of non-complaining poor sleepers, even though sleep duration as measured by actigraphy did not support this finding. Complaining good sleepers also had significantly higher levels of dysfunctional beliefs.

The third study examined the same subjective and objective sleep outcomes following digital Cognitive Behavioural Therapy for insomnia. Out of a total of 62 participants (55 females); 16 were complaining good sleepers, 26 complaining poor sleepers, 11 non-complaining good sleepers, and nine non-complaining poor sleepers. Complaining good sleepers described fewer self-reported awakenings following treatment. Participants showed significantly improved self-reported sleep quality following insomnia treatment, and both complaining good sleepers and non-complaining poor sleepers reported significantly lower levels of dysfunctional beliefs following the intervention.

The fourth study reported significant treatment effects of digital Cognitive Behavioural Therapy for insomnia, as evidenced by a reduction in insomnia severity scores, in a sample of 62 older adults (55 females). However, of the hypothesised mediators only sleep effort mediated the relationship between Cognitive Behavioural Therapy for insomnia and treatment outcomes.

In summary, digital Cognitive Behavioural Therapy for insomnia is effective in improving sleep outcomes, such as dysfunctional sleep beliefs and sleep quality, in older adults. The wider provision of online, self-guided Cognitive Behavioural Therapy for insomnia could decrease the burden on healthcare providers, who often struggle to find the clinical and financial resources to adequately assess and treat sleep problems in older individuals.

DOI

10.25958/68a1-ek34

Access Note

Access to this thesis is embargoed until 22nd December 2024

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