The DOI matches its Crossref record, with a small difference in title or year; 31 of the 31 references it cites were found in a registry or an index.
Behavioral and Pharmacological Therapies for Late-Life Insomnia: A Randomized Controlled Trial
Abstract
CONTEXT: Insomnia is a prevalent health complaint in older adults. Behavioral and pharmacological treatments have their benefits and limitations, but no placebo-controlled study has compared their separate and combined effects for late-life insomnia. OBJECTIVE: To evaluate the clinical efficacy of behavioral and pharmacological therapies, singly and combined, for late-life insomnia. DESIGN AND SETTING: Randomized, placebo-controlled clinical trial, at a single academic medical center. Outpatient treatment lasted 8 weeks with follow-ups conducted at 3, 12, and 24 months. SUBJECTS: Seventy-eight adults (50 women, 28 men; mean age, 65 years) with chronic and primary insomnia. INTERVENTIONS: Cognitive-behavior therapy (stimulus control, sleep restriction, sleep hygiene, and cognitive therapy) (n = 18), pharmacotherapy (temazepam) (n = 20), or both (n = 20) compared with placebo (n = 20). MAIN OUTCOME MEASURES: Time awake after sleep onset and sleep efficiency as measured by sleep diaries and polysomnography; clinical ratings from subjects, significant others, and clinicians. RESULTS: The 3 active treatments were more effective than placebo at posttreatment assessment; there was a trend for the combined approach to improve sleep more than either of its 2 single components (shorter time awake after sleep onset by sleep diary and polysomnography). For example, the percentage reductions of time awake after sleep onset was highest for the combined condition (63.5%), followed by cognitive-behavior therapy (55%), pharmacotherapy (46.5%), and placebo (16.9%). Subjects treated with behavior therapy sustained their clinical gains at follow-up, whereas those treated with drug therapy alone did not. Long-term outcome of the combined intervention was more variable. Behavioral treatment, singly or combined, was rated by subjects, significant others, and clinicians as more effective than drug therapy alone. Subjects were also more satisfied with the behavioral approach. CONCLUSIONS: Behavioral and pharmacological approaches are effective for the short-term management of insomnia in late life; sleep improvements are better sustained over time with behavioral treatment.
Overview
Integrity signals
Registry
Cites
Statistics
Verification
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
In the citing paper
“short-term pharmacological treatments alone are effective during the course of treatment for chronic insomnia”
From Clinical Guideline for the Evaluation and Management of Chronic Insomnia in Adults (2008) · cites this paper as [66]
In the citing paper
“Taken as a whole, these investigations do not demonstrate a clear advantage for combined treatment over cognitive behavioral treatment alone. 65,66,68-70”
From Clinical Guideline for the Evaluation and Management of Chronic Insomnia in Adults (2008) · cites this paper as [66]
In the citing paper
“but do not provide sustained improvement following discontinuation, 65,66”
From Clinical Guideline for the Evaluation and Management of Chronic Insomnia in Adults (2008) · cites this paper as [66]
In the citing paper
“The recommended first-line treatment, Cognitive Behavioral Therapy for Insomnia (CBTI) does not carry these risks and is therefore preferable for reasons beyond demonstrated efficacy(244-248), efficacy relative to medications(249-253), and effectiveness(254).”
From Sleep: important considerations for the prevention of cardiovascular disease (2016) · cites this paper as [252]
In the citing paper
“The trials compared CBT-I to zopiclone [29], zolpidem [30], temazepam [31,32], and triazolam [33].”
From Comparative effectiveness of cognitive behavioral therapy for insomnia: a systematic review (2012) · cites this paper as [31]
In the citing paper
“In Morin’s study [31] the Sleep Impairment Index declined 10 points after 24 months for patients treated with CBT-I, but only 4 points for patients given tamezepam (p = 0.01).”
From Comparative effectiveness of cognitive behavioral therapy for insomnia: a systematic review (2012) · cites this paper as [31]
In the citing paper
“Of note, three of the studies [29,31,32] included a treatment arm that was a combination of CBT-I and medication.”
From Comparative effectiveness of cognitive behavioral therapy for insomnia: a systematic review (2012) · cites this paper as [31]
In the citing paper
“CBTI has also been shown to be efficacious for the treatment of chronic insomnia in older adults [33,36].”
From Non-Pharmacological Treatment of Insomnia (2012) · cites this paper as [33]
Citations
Cites
Diagnostic and Statistical Manual of Mental Disorders
Williams, J. B. W., & First, M. B. (2013) · Oxford University Press eBooks · doi:10.1093/acrefore/9780199975839.013.104 · Cited by 109,845
Folstein, M. F., Folstein, S. E., & McHugh, P. R. (1975) · Journal of Psychiatric Research · doi:10.1016/0022-3956(75)90026-6 · Cited by 88,282
Rechtschaffen, A. (1968) · Medical Entomology and Zoology · Cited by 11,772
The brief symptom inventory: an introductory report.
Derogatis, L. R., & Melisaratos, N. (1983) · Psychological Medicine · doi:10.1017/s0033291700048017 · Cited by 6,650
The International Classification of Sleep Disorders
Daroff, R. B. (1991) · Neurology · doi:10.1212/wnl.41.1.160 · Cited by 5,023
Epidemiologic study of sleep disturbances and psychiatric disorders. An opportunity for prevention?
Ford, D. E. (1989) · JAMA · doi:10.1001/jama.262.11.1479 · Cited by 2,440
(1993) · Medical Entomology and Zoology · Cited by 2,324
Self-citationInsomnia and Its Treatment: Prevalence and Correlates
Mellinger, G. D. (1985) · Archives of General Psychiatry · doi:10.1001/archpsyc.1985.01790260019002 · Cited by 1,071
Treatment of Chronic Insomnia by Restriction of Time in Bed
(1987) · Sleep · doi:10.1093/sleep/10.1.45 · Cited by 948
Sleep in Normal Aging and Dementia
Bliwise, D. L. (1993) · SLEEP · doi:10.1093/sleep/16.1.40 · Cited by 854
Prevalence, burden, and treatment of insomnia in primary care
(1997) · American Journal of Psychiatry · doi:10.1176/ajp.154.10.1417 · Cited by 694 · cited 2×
“Although not all sleep changes are pathologic in late life,(7,8) severe sleep disturbances are associated with daytime fatigue and impaired functioning, reduced quality of life, and increased health care costs.(9,10)”
BackgroundIdentifying effective psychological treatments for insomnia: A meta-analysis.
Murtagh, D. R. R., & Greenwood, K. M. (1995) · Journal of Consulting and Clinical Psychology · doi:10.1037//0022-006x.63.1.79 · Cited by 664
Benzodiazepines and Zolpidem for Chronic Insomnia: A Meta-analysis of Treatment Efficacy
Nowell, P. D. (1997) · JAMA · doi:10.1001/jama.1997.03550240060035 · Cited by 451
Sleep problems in the community elderly as predictors of death and nursing home placement
Pollak, C. P., PERLICK, D. A., Linsner, J. P., Wenston, J., & Hsieh, F. (1990) · Journal of Community Health · doi:10.1007/bf01321316 · Cited by 350
Desforges, J. F., Prinz, P. N., Vitiello, M. V., Raskind, M. A., & Thorpy, M. J. (1990) · New England Journal of Medicine · doi:10.1056/nejm199008233230805 · Cited by 323
Stoller, M. K. (1995) · PubMed · Cited by 322
Bootzin, R. R., Epstein, D. R., & Wood, J. M. (1991) · Springer eBooks · doi:10.1007/978-1-4757-9586-8_2 · Cited by 307
Kupfer, D. J., & Reynolds, C. F. (1997) · New England Journal of Medicine · doi:10.1056/nejm199701303360506 · Cited by 293
Cognitive-behavior therapy for late-life insomnia.
Morin, C. M., Kowatch, R. A., Barry, T., & Walton, E. (1993) · Journal of Consulting and Clinical Psychology · doi:10.1037//0022-006x.61.1.137 · Cited by 274
Self-citationEfficacy of behavioral versus triazolam treatment in persistent sleep-onset insomnia
(1991) · American Journal of Psychiatry · doi:10.1176/ajp.148.1.121 · Cited by 152
Behavioral and cognitive treatments of geriatric insomnia.
Morin, C. M., & Azrin, N. H. (1988) · Journal of Consulting and Clinical Psychology · doi:10.1037//0022-006x.56.5.748 · Cited by 150
Self-citationFriedman, L., Bliwise, D. L., Yesavage, J. A., & Salom, S. R. (1991) · Journal of Gerontology · doi:10.1093/geronj/46.1.p1 · Cited by 150
Prevalence of insomnia in elderly general practice attenders and the current treatment modalities
Hohagen, F., Käppler, C. D. O., Schramm, E., Rink, K., Weyerer, S. B., Riemann, D. W., & Berger, T. (1994) · Acta Psychiatrica Scandinavica · doi:10.1111/j.1600-0447.1994.tb01563.x · Cited by 140
An evaluation of behavioral treatments for insomnia in the older adult
多賀, 谷., 嶋田, 洋., Hazlewood, L., & Tsao, C. (1992) · Journal of Clinical Psychology · doi:10.1002/1097-4679(199201)48:1 · Cited by 110
Can We Mix Behavioral Therapy With Hypnotics When Treating Insomniacs?
Hauri, P. J. (1997) · Sleep · doi:10.1093/sleep/20.12.1111 · Cited by 97
Risk factors for late-life insomnia in a representative general practice sample.
Morgan, K., & Clarke, D. M. (1997) · PubMed · Cited by 88
Effectiveness of combined triazolam-behavioral therapy for primary insomnia
Milby, J. B., Williams, V., Hall, J. N., Khuder, S., McGill, T., & Wooten, V. D. (1993) · American Journal of Psychiatry · doi:10.1176/ajp.150.8.1259 · Cited by 68
Marks, J., & Nicholson, A. N. (1984) · BMJ · doi:10.1136/bmj.288.6413.261 · Cited by 60
Allen, R. P., Mendels, J., Nevins, D. B., CHERNIK, D. A., & Hoddes, E. (1987) · The Journal of Clinical Pharmacology · doi:10.1002/j.1552-4604.1987.tb02994.x · Cited by 38
Double-blind evaluation of temazepam, flurazepam, and placebo in geriatric insomniacs.
Fillingim, J. M. (1982) · PubMed · Cited by 15
Insomnia and short-acting benzodiazepine hypnotics.
Mh, L. (1983) · PubMed · Cited by 10
Cited by
Sorted by citations
Validation of the Insomnia Severity Index as an outcome measure for insomnia research
Bastien, C. (2001) · Sleep Medicine · doi:10.1016/s1389-9457(00)00065-4 · Cited by 8,067
European guideline for the diagnosis and treatment of insomnia
Riemann, D., Baglioni, C., Bassetti, C., Bjorvatn, B., Dolenc Groselj, L., Ellis, J. G., Espie, C. A., Garcia‐Borreguero, D., Gjerstad, M., Gonçalves, M., et al. (2017) · Journal of Sleep Research · doi:10.1111/jsr.12594 · Cited by 2,049
Qaseem, A., Kansagara, D., Forciea, M. A., Cooke, M., Denberg, T. D., & for the Clinical Guidelines Committee of the American College of Physicians* (2016) · Annals of Internal Medicine · doi:10.7326/m15-2175 · Cited by 1,965
Clinical Guideline for the Evaluation and Management of Chronic Insomnia in Adults
Schutte-Rodin, S., Broch, L., Buysse, D., Dorsey, C., & Sateia, M. (2008) · Journal of Clinical Sleep Medicine · doi:10.5664/jcsm.27286 · Cited by 1,943
Sateia, M. J., Buysse, D. J., Krystal, A. D., Neubauer, D. N., & Heald, J. L. (2017) · Journal of Clinical Sleep Medicine · doi:10.5664/jcsm.6470 · Cited by 1,519
Metadata
- Authors
- Morin, C. M., Colecchi, C., Stone, J., Sood, R., & Brink, D.
- Affiliations
- Université Laval (CA)
- ORCID
- Morin, Charles M.
- Venue
- JAMA
- Publisher
- American Medical Association (AMA)
- Published
- 1999-03-17
- Volume
- 281
- Issue
- 11
- Pages
- 991
- ISSN
- 0002-9955 (ISSN-L)
- 0098-7484
- OpenAlex
- W2079808059
- Cited by
- 1,095
- References
- 31
- Citations by year
- 2026: 19 · 2025: 20 · 2024: 19 · 2023: 26 · 2022: 29 · 2021: 33 · 2020: 36 · 2019: 39 · 2018: 34 · 2017: 40 · 2016: 41 · 2015: 48 · 2014: 51 · 2013: 43 · 2012: 53
- FWCI
- 57.16
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- JAMA (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (5r29mh047020-05)
- National Institute of Mental Health (MH47020)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Health Sciences › Medicine › Physiology (medical) › Obstructive Sleep Apnea Research
- Life Sciences › Neuroscience › Endocrine and Autonomic Systems › Circadian rhythm and melatonin
- Keywords
- cognitive behavioral therapy for insomnia, temazepam, sleep restriction, stimulus control, sleep hygiene, cognitive therapy, sleep efficiency, older adults, long-term treatment outcomes, patient satisfaction
- MeSH terms
- Aged, Analysis of Variance, Behavior Therapy, Chronic Disease, Combined Modality Therapy, Female, Humans, Sleep Initiation and Maintenance Disorders, Male, Temazepam, Anti-Anxiety Agents, Cognitive Behavioral Therapy, Polysomnography
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review