***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE To test the effectiveness of brief behavioral intervention for  insomnia in rural elderly . METHODS Twenty older insomniacs ( > or = 65 years of age ) were r and omly assigned to sleep hygiene education ( SHE ; N = 9 ) or multicomponent behavioral treatment ( MBT ; N = 11 ) . Rural care providers individually administered treatment ( two in-person sessions/two telephone follow-ups ) . Training involved a two-day workshop . RESULTS At posttreatment , 10 MBT participants no longer met criteria for insomnia compared to 3 SHE participants . CONCLUSION Brief behavioral intervention for late-life insomnia can be quickly taught and effectively delivered by " real-world " care providers in rural primary care setting UNLABELLED The aim of this study was to compare guided Internet-delivered to group-delivered cognitive behavioral therapy ( CBT ) for  insomnia .  We conducted an 8-week r and omized controlled non-inferiority trial with 6-months follow-up . Participants were forty-eight adults with insomnia , recruited via media . Interventions were guided Internet-delivered CBT ( ICBT ) and group-delivered CBT ( GCBT ) for insomnia . Primary outcome measure was the Insomnia Severity Index ( ISI ) , secondary outcome measures were sleep diary data , depressive symptoms , response- and remission rates . Both treatment groups showed significant improvements and large effect sizes for ISI ( Within Cohen 's d : ICBT post = 1.8 , 6-months follow-up = 2.1 ; GCBT post = 2.1 , 6-months follow-up = 2.2 ) . Confidence interval of the difference between groups post-treatment and at FU6 indicated non-inferiority of ICBT compared to GCBT . At post-treatment , two thirds of patients in both groups were considered responders ( ISI-reduction > 7p ) . Using diagnostic criteria , 63 % ( ICBT ) and 75 % ( GCBT ) were in remission . Sleep diary data showed moderate to large effect sizes . We conclude that both guided Internet-CBT and group-CBT in this study were efficacious with regard to insomnia severity , sleep parameters and depressive symptoms . The results are in line with previous research , and strengthen the evidence for guided Internet-CBT for insomnia . TRIAL REGISTRATION The study protocol was approved by , and registered with , the regional ethics review board in Linköping , Sweden , registration number 2010/385 - 31 Background Cognitive behavioral therapy is treatment of choice for insomnia , but availability is scarce . Self-help can increase availability at low cost , but evidence for its efficacy is limited , especially for the typical insomnia patient with co-morbid problems . We hypothesized that a cognitive behaviorally based self-help book is effective to treat  insomnia in individuals , also with co-morbid problems , and that the effect is enhanced by adding brief therapist telephone support . Methods Volunteer sample ; 133 media-recruited adults with insomnia . History of sleep difficulties ( mean [ SD ] ) 11.8 [ 12.0 ] years . 92.5 % had co-morbid problems ( e.g. allergy , pain , and depression ) . Parallel r and omized ( block-r and omization , n ≥ 21 ) controlled " open label " trial ; three groups-bibliotherapy with ( n = 44 ) and without ( n = 45 ) therapist support , and waiting list control ( n = 44 ) . Assessment s before and after treatment , and at three-month follow-up . Intervention was six weeks of bibliotherapeutic self-help , with established cognitive behavioral methods including sleep restriction , stimulus control , and cognitive restructuring . Therapist support was a 15-minute structured telephone call scheduled weekly . Main outcome measures were sleep diary data , and the Insomnia Severity Index . Results Intention-to-treat analyses of 133 participants showed significant improvements in both self-help groups from pre to post treatment compared to waiting list . For example , treatment with and without support gave shorter sleep onset latency ( improvement minutes [ 95 % Confidence Interval ] , 35.4 [ 24.2 to 46.6 ] , and 20.6 [ 10.6 to 30.6 ] respectively ) , and support gave a higher remission rate ( defined as ISI score below 8 ; 61.4 % ) , than bibliotherapy alone ( 24.4 % , p 's < .001 ) . Improvements were not seen in the control group ( sleep onset latency 4.6 minutes shorter [ -1.5 to 10.7 ] , and remission rate 2.3 % ) . Self-help groups maintained gains at three-month follow-up . Conclusions Participants receiving self-help for insomnia benefited markedly . Self-help , especially if therapist-supported , has considerable potential to be as effective as individual treatment at lower cost , also for individuals with co-morbid problems . Trial Registration Clinical Trials.gov : Forty-five adults with primary insomnia received cognitive-behavioral therapy ( CBT ) implemented in a group therapy format , in individual face-to-face therapy or through brief individual telephone consultations . The results indicate that CBT was effective in improving sleep parameters with all 3 methods of treatment implementation , and there was no significant difference across methods of implementation . All 3 treatment modalities produced improvements in sleep that were maintained for 6 months after treatment completion . These results suggest that group therapy and telephone consultations represent cost-effective alternatives to individual therapy for the management of insomnia Insomnia is an epidemic in the US . Neurofeedback ( NFB ) is a little used , psychophysiological treatment with demonstrated usefulness for treating insomnia . Our objective was to assess whether two distinct Z-Score NFB protocol s , a modified sensorimotor ( SMR ) protocol and a sequential , quantitative EEG (sQEEG)-guided , individually design ed ( IND ) protocol , would alleviate sleep and associated daytime dysfunctions of participants with insomnia . Both protocol s used instantaneous Z scores to determine reward condition administered when awake . Twelve adults with insomnia , free of other mental and uncontrolled physical illnesses , were r and omly assigned to the SMR or IND group . Eight completed this r and omized , parallel group , single-blind study . Both groups received fifteen 20-min sessions of Z-Score NFB . Pre-post assessment s included sQEEG , mental health , quality of life , and insomnia status . ANOVA yielded significant post-treatment improvement for the combined group on all primary insomnia scores : Insomnia Severity Index ( ISI p < .005 ) , Pittsburgh Sleep Quality Inventory ( PSQI p < .0001 ) , PSQI Sleep Efficiency ( p < .007 ) , and Quality of Life Inventory ( p < .02 ) . Binomial tests of baseline EEGs indicated a significant proportion of excessively high levels of Delta and Beta power ( p < .001 ) which were lowered post-treatment ( paired z-tests p < .001 ) . Baseline EEGs showed excessive sleepiness and hyperarousal , which improved post-treatment . Both Z-Score NFB groups improved in sleep and daytime functioning . Post-treatment , all participants were normal sleepers . Because there were no significant differences in the findings between the two groups , our future large scale studies will utilize the less burdensome to administer Z-Score SMR protocol OBJECTIVE To assess the effectiveness of mindfulness-based stress reduction ( MBSR ) for chronic insomnia and combined depressive or anxiety symptoms of older adults aged 75 years and over . DESIGN A r and omized , controlled , single-blind clinical trial . PATIENTS AND METHODS Participants included 60 adults aged 75 years and over with chronic insomnia . Participants were r and omly assigned to the eight-week MBSR group or the wait-list control group . Assessment s using the Pittsburgh Sleep Quality Index ( PSQI ) , Self-rating Anxiety Sale ( SAS ) , and Geriatric Depression Scale ( GDS ) were taken at baseline and post-treatment . For each outcome measure , a repeated measures analysis of variance was used to detect changes across assessment s. RESULTS There was a significant time × group interaction for the PSQI global score ( P = .006 ) ; the MBSR group had a decrease in the PSQI global score ( Cohen׳s d = 1.12 ) , while the control group did not ( Cohen׳s d = -0.06 ) . Among the PSQI components , there was a significant time × group interaction for daytime dysfunction ( P = .048 ) ; Cohen׳s d of the MBSR group was 0.76 , while Cohen׳s d of control group was -0.04 . There was no significant time × group interaction for the SAS score ( P = .116 ) , while for the GDS there was a significant time × group interaction ( P = .039 ) ; the Cohen׳s d value for the MBSR group was 1.20 , and it was 0.12 for the control group . CONCLUSION This study demonstrated that the MBSR program could be a beneficial treatment for chronic insomnia in adults aged 75 years and older BACKGROUND Chronic sleep-onset insomnia is a prevalent health complaint in adults . Although behavioral and pharmacological therapies have been shown to be effective for insomnia , no placebo-controlled trials have evaluated their separate and combined effects for sleep-onset insomnia . The objective of this study was to evaluate the clinical efficacy of behavioral and pharmacological therapy , singly and in combination , for chronic sleep-onset insomnia . METHODS This was a r and omized , placebo-controlled clinical trial that involved 63 young and middle-aged adults with chronic sleep-onset insomnia . Interventions included cognitive behavior therapy ( CBT ) , pharmacotherapy , or combination therapy compared with placebo . The main outcome measures were sleep-onset latency as measured by sleep diaries ; secondary measures included sleep diary measures of sleep efficiency and total sleep time , objective measures of sleep variables ( Nightcap sleep monitor recorder ) , and measures of daytime functioning . RESULTS In most measures , CBT was the most sleep effective intervention ; it produced the greatest changes in sleep-onset latency and sleep efficiency , yielded the largest number of normal sleepers after treatment , and maintained therapeutic gains at long-term follow-up . The combined treatment provided no advantage over CBT alone , whereas pharmacotherapy produced only moderate improvements during drug administration and returned measures toward baseline after drug use discontinuation . CONCLUSIONS These findings suggest that young and middle-age patients with sleep-onset insomnia can derive significantly greater benefit from CBT than pharmacotherapy and that CBT should be considered a first-line intervention for chronic insomnia . Increased recognition of the efficacy of CBT and more widespread recommendations for its use could improve the quality of life of a large numbers of patients with insomnia STUDY OBJECTIVES Osteoarthritis pain affects more than half of all older adults , many of whom experience co-morbid sleep disturbance . Pain initiates and exacerbates sleep disturbance , whereas disturbed sleep maintains and exacerbates pain , which implies that improving the sleep of patients with osteoarthritis may also reduce their pain . We examined this possibility in a secondary analysis of a previously published r and omized controlled trial of cognitive behavioral therapy for insomnia ( CBT-I ) in patients with osteoarthritis and co-morbid insomnia . METHODS Twenty-three patients ( mean age 69.2 years ) were r and omly assigned to  CBT-I  and 28 patients ( mean age 66.5 years ) to an attention control . Neither directly addressed pain management . Twelve subjects crossed over to CBT-I after control treatment .  Sleep and pain were assessed by self-report at baseline , after treatment , and ( for CBT-I only ) at 1-year follow-up . RESULTS CBT-I subjects reported significantly improved sleep and significantly reduced pain after treatment . Control subjects reported no significant improvements . One-year follow-up found maintenance of improved sleep and reduced pain for both the CBT-I group alone and among subjects who crossed over from control to CBT-I. CONCLUSIONS CBT-I but not an attention control , without directly addressing pain control , improved both immediate and long-term self-reported sleep and pain  in older patients with osteoarthritis and comorbid insomnia . These results are unique in suggesting the long-term durability of CBT-I effects for co-morbid insomnia . They also indicate that improving sleep , per se , in patients with osteoarthritis may result in decreased pain . Techniques to improve sleep may be useful additions to pain management programs in osteoarthritis , and possibly other chronic pain conditions as well BACKGROUND Insomnia is a prevalent problem with a high burden of disease ( e.g. reduced quality of life , reduced work capacity ) and a high co-morbidity with other mental and somatic disorders . Cognitive behavioural therapy ( CBT ) is effective in the treatment of insomnia but is seldom offered . CBT delivered through the Internet might be a more accessible alternative . In this study we examined the effectiveness of a guided Internet-delivered CBT for adults with insomnia using a r and omized controlled trial ( RCT ) . METHOD A total of 118 patients , recruited from the general population , were r and omized to the 6-week guided Internet intervention ( n = 59 ) or to a wait-list control group ( n = 59 ) . Patients filled out an online question naire and a 7-day sleep diary before ( T0 ) and after ( T1 ) the 6-week period . The intervention group received a follow 
    Output:
    
Older adults typically report difficulty maintaining sleep as opposed to initiating sleep , which is common in younger adults ( 8) .
Adverse effects were rarely reported .
Withdrawals were not always reported by group .