Treating Sleep Problems in VA Adult Day Health Care

The Veterans Millennium Health Care and Benefits Act (Millennium Act) of 1999 mandated the
Department of Veterans Affairs (VA) to provide non-institutional long-term care to veterans.
Adult Day Health Care (ADHC) is a key component of that spectrum of long-term care services.
ADHC provides health maintenance, rehabilitation services and socialization in a group
setting during daytime hours. Veterans in ADHC commonly suffer from limited physical
functioning, depression, cognitive difficulties and low quality of life. These factors
increase the likelihood of continued deterioration in functioning, loss of independence,
hospitalizations, nursing home placement and death. Previous studies, including our own
work, have demonstrated that sleep disruption is associated with depression, low quality of
life, functional decline, nursing home placement, and death among older people. The
investigators have found that sleep disturbance is common among ADHC patients, it is not
addressed within routine clinical care, and treatment is commonly limited to medications
(e.g., hypnotics, sedating antidepressants). Numerous studies show that both untreated
insomnia and pharmacological treatment of insomnia can be associated with increased risk of
falls and other adverse health events among older persons. On the other hand,
nonpharmacological interventions on sleep do not show these adverse effects, have been shown
to be effective and are associated with improvements in mood, quality of life and health.

The goal of the proposed study is to test the effectiveness of cognitive-behavioral
interventions to improve self-reported and objectively-measured sleep quality among older
veterans with insomnia in a VA ADHC program. The intervention programs will involve
4-session manualized treatments, plus daily time outdoors to increase exposure to bright
light. This Sleep Intervention Program (SIP) will be will be compared with a second program
including 4 individual sessions plus daily relaxation practice using a randomized trial with
70 veterans. To our knowledge, this study would be the first to address the unmet need for
non-pharmacological treatment of sleep problems among ADHC patients. The intervention design
(e.g., use of a manualized treatment that can be provided by non-psychologists) will
facilitate translation into routine care and application in other similar VA programs.

Inclusion Criteria:

All of the following:

- ADHC program participant

- Age >= 60 years

- Ability to communicate verbally

Exclusion Criteria:

One or more of the following:

- Significant cognitive impairment (Mini Mental State Examination score<20)