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 stated.
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.
