0445 Non-pharmacological Insomnia Therapy is Robust to Co-occurring Pain in Older Adults

Abstract Introduction Pain worsens insomnia symptoms and increases hyperarousal during sleep. The effectiveness of treatments for improving insomnia symptoms may therefore be affected by co-occurring pain, though this currently remains unknown. Methods We tested the hypotheses that (1) higher levels of pain will lead to smaller improvements in subjective and objective markers of insomnia following a non-pharmacological insomnia treatment and (2) insomnia treatment will moderate the relationship between pain and markers of insomnia. 114 adults >60 years (age=69.7, SD=6.3, 66% female) with insomnia (Insomnia Severity Index [ISI] score >10, Mean=16.1, SD=4.5) underwent polysomnographic (PSG) recordings before and after completing a 6-session non-pharmacological insomnia treatment regimen. Pain severity (Brief Pain Inventory), insomnia symptoms (ISI), and hyperarousal derived from the PSG (relative α-band power [7.5-12.0Hz] across all sleep stages) were acquired at each time-point. Two-tailed paired t-tests were used to determine the main effects of treatment on insomnia and alpha power. Ranked-correlation tests were used to assess the impact of baseline pain on treatment outcomes, and mixed-effects models were employed to assess whether the relationship between pain and markers of insomnia differed pre- and post-treatment. Results Non-pharmacological insomnia treatment reduced insomnia symptom severity (t=19.4, p<0.001) but not α-power (t=0.97, p=0.33). Baseline pain severity was not associated with insomnia symptom improvement (ρ=-0.09, p=0.49) nor with changes in α-power (ρ=-0.19, p=0.23). There was no significant pain-by-time interaction in determining insomnia symptom improvement (β=-0.05, t=-0.18, p=0.86), and a trending pain-by-time interaction in determining changes in α-power (β=-0.007, t=-1.8, p = 0.07). Conclusion These findings suggest that pain is not likely to alter the effectiveness of non-pharmacological treatment for subjective insomnia symptoms, but pain may reduce change in the markers of hyperarousal in older adults with co-occurring pain and insomnia. Support (If Any) National Institute of Mental Health grant 1R01MH101468-01