Dec. 21, 2005 -- Behavioral approaches to treating insomnia work in older adults, a new analysis suggests.
The review of 23 previously reported studies challenges the notion that older adults may be less responsive than other age groups to behavioral treatments for chronic sleep problems, says researcher Michael Irwin, MD.
Irwin added that behavioral treatments offer advantages over drugs because they can be used for longer periods. Although the new generation of sleep drugs is increasingly being used in this way, he says their long-term safety and effectiveness have not been well studied in older patients.
Irwin is a professor of psychiatry at the UCLA Neuropsychiatric Institute.
"There has been a push, driven in part by the pharmaceutical industry, toward using drugs for the long-term management of insomnia," he tells WebMD. "But the data to support the efficacy of this approach is very limited."
Sleep Problems Common
Chronic insomnia is common among older adults. This is defined by the American Psychiatric Association as a person who has trouble falling or staying asleep at least three nights a week. In addition, the lack of sleep causes daytime problems such as tiredness and difficulty concentrating. The researchers write that as many as a quarter of this age group have chronic sleep problems, with trouble falling asleep and frequent waking during the night among the most common complaints.
Health problems related to lack of sleep are also a special concern for the elderly. They add that insomnia has been associated with a risk of death from heart disease and other causes. And the risk of potentially devastating falling injuries is greater for sleep-deprived older people.
Behavioral interventions for sleep problems include the following groups of therapy:
- Behavior changes, such as sleep scheduling and sleep restriction therapy that limits sleep quantity in an effort to improve sleep quality.
- Cognitive behavioral therapy, which examines lifestyle habits such as exercise and alcohol.
The studies Irwin reviewed involved more than 500 people (adults younger and older than age 55) with insomnia who got one or more of these treatments. All of the approaches were found to be useful for treating a variety of sleep complaints, including trouble falling asleep, frequent waking during the night, and poor sleep quality.
The findings are reported in the January 2006 issue of the journal Health Psychology.
Few studies have compared behavioral treatments to drug therapy. Yet the amount of improvement seen with behavioral therapy is similar to studies of newer sleep medications, says Irwin.
The new sleep medications like Ambien, Sonata, and Lunesta are acknowledged to be safer and have fewer side effects than older sleeping pills. While most are approved for short-term use, they are increasingly being used long term in people with chronic insomnia.
Irwin says there are many unanswered questions about the safety and usefulness of these medications when used long term. But sleep specialist David Neubauer, MD, says the risk of abuse and addiction with the newer sleeping pills appears small.
Neubauer tells WebMD that just as there are many different causes of insomnia in elderly people, there are many potential approaches to treatment.
"Sleep problems are not an inherent part of the aging process, but they are more common in the elderly," he says. "Older people have a greater risk for depression and chronic medical disorders that can undermine sleep. They are also more likely to be taking medications, which can also interfere with sleep."
Managing chronic pain or other medical conditions may be all that is needed to restore normal sleep, he says.
But like younger people, many elderly people with sleep problems will need long-term treatment, which may involve behavioral therapies or a combination of behavioral treatments and sleeping pills. He adds that undertreatment of insomnia is especially common among the elderly.
"It is important to identify and treat insomnia in the elderly because it is a big quality-of-life issue," he says.