Saturday, February 26, 2011

Behavioral Treatment of Insomnia in Older Adults

A study was published in the online version of the January issue of the Archives of Internal Medicine about behavioral treatment of insomnia in older adults. Researchers studied 79 adults (mean age 72, 70% women) with chronic insomnia and common other illnesses. They randomly selected half to receive brief behavioral treatment for insomnia (BBTI) or information control (IC). BBTI consisted of two intervention sessions and two telephone calls. The interventions were reducing time in bed, getting up at the same time each day, not going to bed unless sleepy, and not staying in bed unless asleep. IC consisted of printed educational materials and two telephone calls. Both treatments were administered by a nurse clinician.

BBTI produced a response in 67%, whereas IC had a 25% response. The percentage without insomnia after the intervention was 55% with BBTI and 13% with IC. The BBTI group reported better sleep and health after the intervention, had more improved sleep diaries, and had less insomnia when their sleep was studied at home with wrist-watch actigraphy. There was no difference between BBTI and IC on an in-lab sleep study. This makes sense, as many patients do not sleep as well in the lab, as at home - whether they have insomnia or not.

The study authors concluded that BBTI provides a clinically and statistically meaningful improvement in insomnia that is sustained for six months. Also, since BBTI is not readily available, this study showed that it could be delivered by a nurse with no formal sleep training. This means that more patients could receive effective non-pharmacological treatment for their insomnia.

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