Behavioral Therapy Effective in Treating Insomnia

Summary
This study targeted elderly people suffering from insomnia, a common problem for seniors, and attempted to research how successful brief behavioral therapy can be.  Results showed that more elderly insomniacs responded to brief behavioral therapy with higher self-reported improvements in sleep. Authors concluded that short-term behavioral therapy “is a simple, efficacious, and durable intervention for chronic insomnia in older adults that has potential for dissemination across medical settings.”

Introduction
Between 5% and 20% of adults suffer from insomnia (lack of sleep), and its related functional and health consequences. However, in the elderly with other chronic diseases, the prevalence of sleep disturbances can be as high as 74%. While drugs that are effective are prescribed for these individuals, there tend to be problems like side effects and loss of effectiveness with pharmacotherapy. Behavioral therapy is also approved for management of insomnia. This study attempted to see if short sessions of simple behavioral therapy that can be delivered by a health care worker, like a nurse, could be effective in restoring sleep for the elderly.

Methodology

  • The study included 79 elderly insomniacs with a mean age of nearly 72 years.
  • Some of them were randomly given behavioral therapy and the rest were given information brochures regarding sleep to read. Both were facilitated by a nurse.
  • All patients maintained diaries to record their sleep time. At the end of four weeks, the patients’ sleep times were assessed, going by diaries, self reports of improvements in sleep and tests like polysomnography and actigraphy.

Results

  • At the end of the study, 55% of those doing behavioral therapy did not have insomnia clinically. In the other group, only 13% of the participants did not have insomnia at end of therapy.
  • The behavioral therapy group also reported “improved sleep quality” and earlier onset of sleep compared to the other group.
  • Those on behavioral therapy showed better self-reported sleep improvements and also fared better on the wrist meter (actigraphy). However, both groups performed similarly on polysomnography. Sleep improvements lasted for half a year with continued behavioral therapy.

Shortcomings
Some of the identified limitations of the study included less follow up time and an inadequate control group for behavioral therapy. Also, authors note that many participants (68%) had other problems like snoring or obstructive sleep apnea, which could have affected the results. Future longer term studies with better control measures could be useful.

Conclusions
This study shows that brief behavioral therapy made significant improvements in elderly, chronic insomniacs, as measured over a period of six months. Development of this module of behavioral therapy could mean that a nurse or other health care giver can successfully administer this therapy. While sleep problems are largely neglected, this study helps to show that brief interventions can be effective in the management of insomnia. In the elderly, this modality of therapy may be particularly effective since it helps reduce the need for prescription drugs that often are misused, loss of efficacy over time, or side effects.

For More Information:
Efficacy of Brief Behavioral Treatment for Chronic Insomnia in Older Adults
Archives of Internal Medicine, January 2011
By Daniel J. Buysse, MD; Anne Germain, PhD
From the University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania

*FYI Living Lab Reports Are Summaries of the Original Research.
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