Cognitive-behavioral therapy - helping Older People with Insomnia 24 Nov 2016

CBT Can Help Older People with Insomnia Sleep difficulties are common — 30 percent to 50 percent of adults report having trouble sleeping.

For older adults, insomnia can often be chronic and is linked to other serious health conditions. Elders who have difficulty sleeping are also at higher risk for depression, falls, stroke, and trouble with memory and thinking. They also may experience a poorer quality of life.

For these individuals, sedatives or hypnotic-type sleeping pills are a common choice as a sleep aid, however, the medications bring a risk of falls, fractures, and even death.

Cognitive-behavioral therapy for insomnia (CBT-I) is a type of talk therapy that is considered highly effective for treating older adults with insomnia. During CBT-I sessions, therapists work with patients to help them change their thinking, behavior, and emotional responses related to sleep issues, which can improve their insomnia.

Although treatment guidelines recommend CBT-I as a primary therapy for older adults with insomnia, many people do not receive it because only a limited number of therapists have CBT-I training. Primary care providers also may believe that it is challenging to motivate older adults to see a therapist for insomnia.

To address these problems, a team of researchers developed a new CBT-I treatment program. The program uses trained “sleep coaches” who are not therapists. They learn how to give CBT-I using a manual and have weekly, supervised telephone calls with a CBT-I psychologist.

The program requires brief training for the sleep coaches, who are social workers or other health educators.

In their study published in the Journal of the American Geriatrics Society, the researchers assigned 159 people to one of three treatment groups. The participants were mostly white male veterans who ranged in age from 60- to 90-years-old.

The first two groups of people received CBT-I from sleep coaches (who had a master’s degree in social work, public health, or communications) who had attended the special CBT-I training. One group of people received one-on-one CBT-I sessions with the sleep coach.

The second group also received CBT-I , but in a group format. People in the third group (the control group) received a general sleep education program, which also consisted of five one-hour sessions over six weeks. These people did not receive CBT-I from sleep coaches.

During the five one-hour sessions over a six-week period, in both the one-on-one and group sessions, the coaches counseled participants about improving sleep habits and how to avoid practices that can make it harder to sleep well.

Participants were taught techniques to enhance good sleeping. Recommendations such as using the bed only for sleeping, not for watching TV or reading, limiting the amount of time in bed so sleep becomes more consolidated, and other techniques were provided.

In both groups, the sleep coaches also had one weekly telephone call with a CBTI-trained psychologist to review how the participants were doing with the program.

Researchers collected information about the participants’ sleep habits at the beginning of the study and one week after treatments ended. They also followed up with participants six months and one year later.

Following their treatment, people with insomnia who received CBT-I from a sleep coach (either one-on-one or in a group) had lessened their sleep problems significantly, compared to people in the control group.

Improvements included:

-Participants took about 23 minutes less to fall asleep; -Participants’ awake time was about 18 minutes less once they fell asleep; -Participants’ total awake time was about 68 minutes less throughout the night; -Participants also reported that the quality of their sleep had improved. -Six and 12 months after treatment, the participants in both CBT-I treatment groups maintained most of their sleep improvements.

The researchers said that improvements in sleep were about the same whether people worked with the sleep coach in one-on-one or group sessions.

The primary limitations of the research accompany study composition as investigators report the study was mostly limited to male veterans. As such, the results might not be the same for women or for non-veterans.

Overall, the researchers concluded that this CBT-I treatment program, delivered by sleep coaches, improved sleep quality for older adults.

Source: American Geriatrics Society

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