• Michael R Irwin, Richard Olmstead, Carmen Carrillo, Nina Sadeghi, Elizabeth C Breen, Tuff Witarama, Megumi Yokomizo, Helen Lavretsky, Judith E Carroll, Sarosh J Motivala, Richard Bootzin, and Perry Nicassio.
• Sleep. 2014 Sep 1; 37 (9): 1543-52.

Study ObjectivesTo investigate the comparative efficacy of cognitive behavioral therapy (CBT), Tai Chi Chih (TCC), and sleep seminar education control (SS) on the primary outcome of insomnia diagnosis, and secondary outcomes of sleep quality, fatigue, depressive symptoms, and inflammation in older adults with insomnia.DesignRandomized controlled, comparative efficacy trial.SettingLos Angeles community.Patients123 older adults with chronic and primary insomnia.InterventionsRandom assignment to CBT, TCC, or SS for 2-hour group sessions weekly over 4 months with follow-up at 7 and 16 months.MeasurementsInsomnia diagnosis, patient-reported outcomes, polysomnography (PSG), and high-sensitivity C-reactive protein (CRP) levels.ResultsCBT performed better than TCC and SS in remission of clinical insomnia as ascertained by a clinician (P < 0.01), and also showed greater and more sustained improvement in sleep quality, sleep parameters, fatigue, and depressive symptoms than TCC and SS (all P values < 0.01). As compared to SS, CBT was associated with a reduced risk of high CRP levels (> 3.0 mg/L) at 16 months (odds ratio [OR], 0.26 [95% CI, 0.07-0.97] P < 0.05). Remission of insomnia was associated with lower levels of CRP (P < 0.05) at 16 months. TCC was associated with improvements in sleep quality, fatigue, and depressive symptoms as compared to SS (all P's < 0.05), but not insomnia remission. PSG measures did not change.ConclusionsTreatment of late-life insomnia is better achieved and sustained by cognitive behavioral therapies. Insomnia treatment and remission reduces a marker of inflammatory risk, which has implications for cardiovascular morbidity and diabetes observed with sleep disturbance in epidemiologic surveys.© 2014 Associated Professional Sleep Societies, LLC.

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