Nonpharmacological treatment of late-life insomnia

doi:10.1016/S0022-3999(98)00077-4

Journal of Psychosomatic Research

Volume 46, Issue 2, February 1999, Pages 103-116

https://doi.org/10.1016/S0022-3999(98)00077-4 Get rights and content

Abstract

This article reviews the evidence regarding the efficacy of nonpharmacological interventions for the treatment of late-life insomnia. Outcome data from more than a dozen treatment studies conducted with community-dwelling older adults indicate that behavioral approaches produce reliable and durable therapeutic benefits, as evidenced by improved sleep efficiency and continuity and enhanced satisfaction with sleep patterns. Treatment is also helpful for reducing hypnotic usage among older adults who are dependent on sleep medications. Treatment methods such as stimulus control and sleep restriction, which target maladaptive sleep habits, are especially beneficial for older insomniacs, whereas relaxation-based interventions, aimed at decreasing arousal, produce more limited effects. Cognitive and educational interventions are instrumental in altering age-related dysfunctional beliefs and attitudes about sleep. Integrated behavioral and pharmacological therapies have received very little empirical attention thus far. Although a limited number of older adults resume “normal” sleep patterns after treatment, outcome is clinically meaningful as most patients report greater satisfaction with their sleep patterns, use less medications, and display less psychological distress and concerns about sleep.

Section snippets

Epidemiology of insomnia and hypnotic use

Insomnia is a widespread health complaint and it is the most common of all sleep disorders. Approximately 35% of the adult population is afflicted with insomnia during the course of a year, and for about one third of these (i.e., 9–12% of the population) sleep difficulties occur on a regular basis 1, 2, 3. Both the incidence and the complaint of insomnia increase across the life cycles. Epidemiological surveys indicate that up to 40% of people aged ⩾65 years are dissatisfied with their sleep or

When is insomnia pathological in late life?

Although it is clear that the complaint and incidence of insomnia are age-related, and that older adults use more hypnotic drugs, a more difficult issue is to determine the clinical significance of insomnia and the extent to which it deserves therapeutic attention. First, it is essential to distinguish changes in sleep patterns that are part of the normal aging process from insomnia as a clinical disorder. Several age-related changes in sleep patterns occur even in healthy normal aging 15, 16,

Nonpharmacological therapies

Nonpharmacological interventions for the management of late-life insomnia include relaxation-based treatments, stimulus control therapy, sleep restriction, and a variety of cognitive and educational strategies. The primary targets of such interventions are cognitive/physiologic arousal, maladaptive sleep habits, and faulty beliefs and attitudes about sleep 20, 23, 24. The clinical efficacy of these treatment modalities has been well established for insomnia among younger and middle-aged

Summary and conclusions

Insomnia is a prevalent health complaint in late life. Although it is generally undertreated, when treatment is initiated it is typically with hypnotic medications. It is only recently that the nonpharmacological treatment of insomnia in relation to age has received some research attention. More than a dozen treatment studies have focused on this segment of the population in the last decade. Although some early research suggested that older adults had a poorer prognosis [61], more recent

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ReviewNonpharmacological treatment of late-life insomnia

Abstract

Section snippets

Epidemiology of insomnia and hypnotic use

When is insomnia pathological in late life?

Nonpharmacological therapies

Summary and conclusions

Soc Sci Med

Clin Geriatr Med

Behav Ther

Behav Ther

Behav Res Ther

Behav Ther

Electroencephalogr Clin Neurophysiol

Clin Psychol Rev

Psychiatry Res

Behav Ther

Behav Ther

Epidemiologic study of sleep disturbances and psychiatric disordersan opportunity for prevention?

JAMA

Insomnia and its treatmentprevalence and correlates

Arch Gen Psychiatry

Insomnia in the elderlyprevalence, gender differences and relationships with morbidity and mortality

Int J Geriatr Psychiatry

Sleep complaints among elderly personsan epidemiologic study of three communities

Sleep

Prevalence of insomnia in elderly general practice attenders and the current treatment modalities

Acta Psychiatrica Scand

Sleep patterns and agingcomparison of older adults with and without insomnia complaints

Psychol Aging

Drug utilization in the U.S.—1985seventh annual review

Prevalence, frequency, and duration of hypnotic drug use among elderly living at home

BMJ

Sleep and aginga research-based guide to sleep in later life

Insomnia and use of hypnoticsstudy of a French population

Sleep

Good and poor sleepersan epidemiological survey of the San Marino population

Factors related to benzodiazepine use in Quebec—a secondary analysis of survey data

J Pharmacol Epidemiol

Sleep in normal aging and dementia

Sleep

“White paper” on sleep and aging

J Am Geriatr Soc

Sleep disturbances in the elderly

Insomnia

Insomniapsychological assessment and management

Disorders of initiating and maintaining de sleepthe distribution and clinical significance of sleep time misperceptions among insomniacs

Sleep

Self-report versus recorded sleep in healthy seniors

Psychophysiology

The psychological treatment of insomnia

Review
Nonpharmacological treatment of late-life insomnia