|dc.identifier.isbn||82-308-0251-3 (print version)||eng
Insomnia is one of the most common conditions in older adults, affecting almost one third of
adults aged 55 years or older. Insomnia has been linked to a number of individual adverse
medical and psychological consequences, in addition to having large socioeconomic
consequences in terms of lost productivity and risk of accidents. Still, only ten percent of
chronic insomniacs receive treatment for their condition, of which the vast majority is
treated pharmacologically. Psychological treatment options have previously been
successfully applied in younger adults, but only a few studies have focused on nonpharmacological
treatment in the elderly.
In the first paper of this thesis, we investigated empirically the contribution of insomnia to
the award of disability pensions. The aim of the study was to estimate the independent effect
of insomnia on permanent work disability by statistically controlling for a range of possible
In the second paper we examined both the short- and long-term treatment effect of cognitivebehavior
therapy (CBT) and pharmacological treatment in older adults suffering from
In the third paper, we compared both the psychometric properties and clinical utility of two
objective measures of sleep (polysomnography and actigraphy) in the same study sample as
in paper II. Methods:
In the first paper we used a historical cohort design to estimate the effect of DSM-IV defined
insomnia on permanent work disability. Baseline data comprised 37 308 working age people
from a large population based Norwegian health study. The outcome was subsequent award
of a disability pension 18 to 48 months after baseline assessment, as registered in the
National Insurance Administration. In order to estimate the independent contribution of
insomnia, we statistically controlled for a range of possible confounders. These included
both physical and mental symptoms and diagnoses, as well as lifestyle behaviors, shift work
and other potential socio-demographic factors.
The two papers from the treatment study are based on a double-blinded randomized
controlled trial of 46 patients with chronic primary insomnia who received either cognitivebehavior
therapy (CBT, n=18), sleep medication (7.5 mg zopiclone daily, n=16), or placebo
(n=12). All active treatments lasted 6 weeks with follow-ups conducted at 6 months.
Ambulant clinical polysomnography (PSG), actigraphy and sleep diaries were used on all
three assessment points. In paper II we primarily focused on the treatment effect of the two
active interventions, while we in paper III explored the ability of actigraphy to correctly
classify sleep/wake patterns.
From the first paper it is concluded that insomnia is a robust and independent predictor of
subsequent permanent work disability. Socio-demographic and shift work characteristics
barely affected the association, which also remained significant after adjusting for both
psychiatric and physical morbidity and health-related behaviors.
In the treatment study (paper II) we found that CBT produced significantly better short- andlong-term treatment effect than zopiclone. We found no significant outcome differences
between zopiclone and placebo. Patients receiving CBT spent significantly less time awake
and had higher sleep efficiency than patients treated pharmacologically. Patients in the CBT
condition spent significantly more time in slow wave sleep (stages 3/4) than either of the two
In paper III we found that actigraphy performed poorly in detecting wakefulness, and
consequently overestimated the patients’ total sleep time and sleep efficiency. Compared
with PSG, actigraphy captured only part of the treatment effects on total wake time and sleep
onset latency, and failed to detect significant changes in sleep efficiency.
Even though a diagnosis of insomnia is legally insufficient for the award of a disability
pension, we found that insomnia is an independent predictor of subsequent work disability.
Considering the direct costs of disability expenditures, in addition to the indirect costs from
lost productivity, sleep medications and sleep-related accidents, we believe that early
detection and interventions for insomnia should receive increased focus.
Based on the findings from the treatment study we conclude that interventions based on CBT
are superior to zopiclone treatment, both in terms of short- and long-term management of
insomnia in older adults. We also conclude that the clinical utility of actigraphy is still
suboptimal in older insomniacs, and should hence not be used in a clinical setting without
parallel use of additional assessment tools.||en
|dc.publisher||The University of Bergen||eng
|dc.relation.haspart||Paper I: American Journal of Epidemiology 163(11), Sivertsen, B.; Overland, S.; Neckelmann, D.; Glozier, N.; Krokstad, S.; Pallesen, S.; Bjorvatn, B. & Mykletun, A, The long-term effect of insomnia on work disability. The HUNT-2 historical cohort study, pp. 1018-1024. Copyright 2006 Oxford University Press. <a href"=http://dx.doi.org/10.1093/aje/kwj145"target=_blank>http://dx.doi.org/10.1093/aje/kwj145</a>||eng
|dc.relation.haspart||Paper II: Published in JAMA, 295(24), Sivertsen, B.; Omvik, S.; Pallesen, S.; Bjorvatn, B.; Havik, O. E.; Kvale, G.; Nielsen, G. H.; Nordhus, I. H, Cognitive behavioral therapy vs zopiclone for treatment of chronic primary insomnia in older adults. A randomized controlled trial, pp. 2851-2858. Copyright 2006 American Medical Association, reproduced with permission.||eng
|dc.relation.haspart||Paper III: Sleep 29(10), Sivertsen, B.; Omvik, S.; Havik, O. E.; Pallesen, S.; Bjorvatn, B.; Nielsen, G. H.; Straume, S. & Nordhus, I. H., A comparison of actigraphy and polysomnography in older adults treated for chronic primary insomnia, 2006, pp. 1353-1358. Copyright permission for single-use of the information contained in this material was obtained from the Associated Professional Sleep Societies, LLC, November 2006.||eng
|dc.title||Insomnia in older adults Consequences, assessment and treatment||eng
|dc.subject.nsi||VDP::Samfunnsvitenskap: 200::Psykologi: 260::Klinisk psykologi: 262||nob