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Cognitive Expectancies for Hypnotic Use among Older Adult Veterans with Chronic Insomnia.

Fung CH, Martin JL, Josephson K, Fiorentino L, Dzierzewski JM, Jouldjian S, Song Y, Rodriguez Tapia JC, Mitchell MN, Alessi CA. Cognitive Expectancies for Hypnotic Use among Older Adult Veterans with Chronic Insomnia. Clinical Gerontologist. 2018 Mar 1; 41(2):130-135.

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OBJECTIVES: To examine relationships between cognitive expectancies about sleep and hypnotics and use of medications commonly used for insomnia (hypnotics). METHODS: We analyzed baseline data from older veterans who met diagnostic criteria for insomnia and were enrolled in a trial comparing CBTI delivered by a supervised, sleep educator to an attention control condition (N  =  159; 97% male, mean age 72 years). We classified individuals as hypnotic users (N  =  23) vs. non-users (N  =  135) based upon medication diaries. Associations between hypnotic status and Dysfunctional Beliefs and Attitudes about Sleep-16 (DBAS) total score (0-10, higher  =  worse) and two DBAS medication item scores (Item 1: "…better off taking a sleeping pill rather than having a poor night's sleep;" Item 2: "Medication… probably the only solution to sleeplessness"; 0-10, higher  =  worse) were examined in logistic regression models. RESULTS: Higher scores on the DBAS medication items (both odds ratios  =  1.3; p-values < .001) were significantly associated with hypnotic use. DBAS-16 total score was not associated with hypnotic use. CONCLUSION: Cognitive expectancy (dysfunctional beliefs) about hypnotics was associated with hypnotic use in older adults with chronic insomnia disorder. CLINICAL IMPLICATIONS: Strategies that specifically target dysfunctional beliefs about hypnotics are needed and may impact hypnotic use in older adults.

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