December 27, 2005

Behavioral Therapies Aid Elderly with Insomnia

By Amy Norton

NEW YORK -- Therapies focused on changing sleep habits may be a good alternative to sleeping pills for older adults with insomnia, a research review suggests.

The review of 23 clinical trials found that behavioral therapies aimed at changing people's habits and attitudes regarding sleep were generally effective in helping older adults get a better night's sleep.

The findings, published in the journal Health Psychology, add to evidence supporting behavioral sleep therapies.

In a study published last year, for example, researchers found that a few sessions of counseling were more effective than a common sleep medication at bringing lasting relief to people with chronic insomnia.

Those researchers concluded that behavioral therapies should constitute the first line of therapy for chronic insomnia. Sleep medications, though often effective in the short run, carry the risk of dependence and side effects such as daytime drowsiness. Their effectiveness in the long run is also questionable, as people can suffer even worse sleep problems once they go off the drugs.

Behavioral therapies, on the other hand, may take several weeks to show effects, but these benefits are maintained longer than those of medications -- though the evidence for that is based on a limited number of studies, Dr. Michael Irwin, the lead author on the new study, told Reuters Health.

Of the 23 clinical trials included in the study, only eight focused on adults older than 55.

It's not clear why so few studies have been conducted in this age group, according to Irwin, who is a professor of psychiatry at the University of California Los Angeles Cousins Center for Psychoneuroimmunology.

One reason, he noted, may be that the prevalence of insomnia among older adults -- with up to 30 percent affected -- has only recently been documented in large-scale studies. In addition, he said, there may be a "bias" that insomnia is a normal part of aging, and that older adults will not respond as well to therapy as middle-aged adults.

For their study, Irwin and his colleagues reviewed the results of clinical trials that tested three broad types of behavioral therapy.

One was cognitive-behavioral therapy, which aims to change insomniacs' thoughts and feelings regarding sleep and to teach them practical ways to surmount their sleep problems - like getting in bed only when they're drowsy, or getting up and reading a book when they fail to fall asleep in 20 minutes or so.

In addition, some of the studies investigated relaxation-based therapies, while others tested "behavioral-only" approaches, which limit their focus to altering sleep habits.

All three forms of therapy, the review found, were similarly effective at improving older adults' sleep quality and their ability to fall asleep and stay asleep all night.

The findings, Irwin said, offer evidence that older adults, like younger ones, can benefit from behavioral therapies for insomnia.

Behavioral therapies for insomnia are based, in part, on therapies used for depression. So most mental health professionals -- and some general practitioners -- should be able to offer such treatment, according to Irwin.

SOURCE: Health Psychology, January 2006.