Insomnia (primary) in older people: non-drug treatments

Cathy Alessi, Michael V Vitiello, Cathy Alessi, Michael V Vitiello

Abstract

Introduction: Up to 40% of older adults have insomnia, with difficulty getting to sleep, early waking, or feeling unrefreshed on waking. The prevalence of insomnia increases with age. Other risk factors include psychological factors, stress, daytime napping, and hyperarousal.

Methods and outcomes: We conducted a systematic review and aimed to answer the following clinical question: What are the effects of non-drug treatments for primary insomnia in older people (aged 60 years and older)? We searched: Medline, Embase, The Cochrane Library, and other important databases up to May 2014 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).

Results: We found 14 studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.

Conclusions: In this systematic review, we present information relating to the effectiveness and safety of the following interventions: cognitive behavioural therapy for insomnia (CBT-I), exercise programmes, and timed exposure to bright light.

References

    1. American Academy of Sleep Medicine. International classification of sleep disorders, 3rd ed. Darien, IL: American Academy of Sleep Medicine, 2014:21–23.
    1. American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 5th ed. (DSM-5). Washington, DC: American Psychiatric Publishing, 2013:362–363.
    1. Liljenberg B, Almqvist M, Hetta J, et al. Age and the prevalence of insomnia in adulthood. Eur J Psychiatry 1989;3:5–12.
    1. Mellinger GD, Balter MB, Uhlenhuth EH. Insomnia and its treatment. Prevalence and correlates. Arch Gen Psychiatry 1985;42:225–232.
    1. Foley DJ, Monjan AA, Brown SL, et al. Sleep complaints among elderly persons: an epidemiologic study of three communities. Sleep 2005;18:425–432.
    1. Tjepkema M. Insomnia. Health Rep 2005;17:9–25.
    1. Bliwise DL. Sleep in normal aging and dementia. Sleep 1993;16:40–81.
    1. National Heart, Lung and Blood Institute Working Group on Insomnia. Insomnia: assessment and management in primary care. Am Fam Physician 1999;59:3029–3038.
    1. National Center on Sleep Disorders Research Working Group. Recognizing problem sleepiness in your patients. Am Fam Physician 1999;59:937–944.
    1. Reynolds CF, Buysse DJ, Kupfer DJ. Treating insomnia in older adults: taking a long term view. JAMA 1999;281:1034–1035.
    1. Cricco M, Simonsick EM, Foley DJ. The impact of insomnia on cognitive functioning in older adults. J Am Geriatr Soc 2001;49:1185–1189.
    1. McCurry SM, Logsdon RG, Teri L, et al. Evidence-based psychological treatments for insomnia in older adults. Psychol Aging 2007;22:18–27.
    1. Montgomery P, Dennis J. Cognitive behavioural interventions for sleep problems in adults aged 60+. In: The Cochrane Library, Issue 5, 2014. Chichester, UK: John Wiley & Sons, Ltd. Search date 2002.
    1. Montgomery P, Dennis J. A systematic review of non-pharmacological therapies for sleep problems in later life. Sleep Med Rev 2004;8:47–62.
    1. Morin CM, Bootzin RR, Buysse DJ, et al. Psychological and behavioral treatment of insomnia: update of the recent evidence (1998–2004). Sleep 2006;29:1398–1414.
    1. Irwin MR, Cole JC, Nicassio PM. Comparative meta-analysis of behavioral interventions for insomnia and their efficacy in middle-aged adults and in older adults 55+ years of age. Health Psychol 2006;25:3–14.
    1. Soeffing JP, Lichstein KL, Nau SD, et al. Psychological treatment of insomnia in hypnotic-dependant older adults. Sleep Med 2008;9:165–171.
    1. Germain A, Moul DE, Franzen PL, et al. Effects of a brief behavioral treatment for late-life insomnia: preliminary findings. J Clin Sleep Med 2006;2:403−406.
    1. Lichstein KL, Nau SD, Wilson NM, et al. Psychological treatment of hypnotic-dependent insomnia in a primarily older adult sample. Behav Res Ther 2013;51:787−796.
    1. Buysse DJ, Germain A, Moul DE, et al. Efficacy of brief behavioral treatment for chronic insomnia in older adults. Arch Intern Med 2011;171:887−895.
    1. Lovato N, Lack L, Wright H, et al. Evaluation of a brief treatment program of cognitive behavior therapy for insomnia in older adults. Sleep 2014;37:117−126.
    1. Epstein DR, Sidani S, Bootzin RR, et al. Dismantling multicomponent behavioral treatment for insomnia in older adults: a randomized controlled trial. Sleep 2012;35:797−805.
    1. Montgomery P, Dennis J. Physical exercise for sleep problems in adults aged 60+. In: The Cochrane Library, Issue 5, 2014. Chichester, UK: John Wiley & Sons, Ltd. Search date 2002.
    1. Irwin MR, Olmstead R, Motivala SJ, et al. Improving sleep quality in older adults with moderate sleep complaints: a randomized controlled trial of Tai Chi Chih. Sleep 2008;31:1001−1008.
    1. Montgomery P, Dennis J. Bright light therapy for sleep problems in adults aged 60+. In: The Cochrane Library, Issue 5, 2014. Chichester, UK: John Wiley & Sons, Ltd. Search date 2001.
    1. Friedman L, Zeitzer JM, Kushida C, et al. Scheduled bright light for treatment of insomnia in older adults. J Am Geriatr Soc 2009;57:441–452.
    1. Skjerve A, Bjorvatn B, Holsten F. Light therapy for behavioural and psychological symptoms. Int J Geriatr Psychiatry 2004;19:516−522.

Source: PubMed

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