Behavioral and Pharmacological Therapies for Late-Life Insomnia

Abstract

LEEP DISTURBANCE IS A PREVAlent problem in late life. Between 12% and 25% of healthy seniors report chronic insomnia, and these estimates are even higher among older adults with coexisting medical or psychiatric illness. 1-4 In addition to normal age-related changes in the physiological aspects of sleep, the increased incidence of health problems and medication use, combined with lifestyle changes associated with retirement, place older adults at increased risk for disrupted sleep. 5 Insomnia, the most common sleep disorder, may involve trouble falling asleep, frequent or prolonged nocturnal awakenings, or early morning awakenings with an inability to return to sleep. 6 Older adults report primarily, although not exclusively, difficulty in maintaining sleep. Although not all sleep changes are pathologic in late life, 7,8 severe sleep disturbances are associated with daytime fatigue and impaired functioning, reduced quality of life, and increased health care costs. 9,10 When left untreated, chronic insomnia may increase vulnerability to major depression 2 and, among older adults with cognitive impairments, may hasten nursing home placement. 11 Despite its high prevalence and negative impact, less than 15% of individuals with chronic insomnia receive treatment. 4 When treatment is initiated, pharmacotherapy is the most common method for insomnia management. 3,12,13 Although short-term use of hypnotic medi

Association between memory impairment and insomnia among older adults

“…Both the safety and the effectiveness of sleeping pills for treatment of insomnia in chronic older adult insomniacs are questionable (Endeshaw 2001;Morin et al 1991;Ray et al 2000). Daytime carryover effects observed with longeracting sleep medications (Johnson and Chernik 1982) are likely to produce additional, potentially serious, decrements in daytime function among chronic older adult insomniacs.…”

Sleep, Sleep Disorders, and Mild Traumatic Brain Injury. What We Know and What We Need to Know: Findings from a National Working Group

“…CBTI is considered first-line treatment for chronic insomnia and can be successfully utilized in patients with mTBI [100][101][102][103][104][105]. Previous reports have shown that CBTI reduced daytime fatigue and improved nocturnal sleep quality among patients with TBI [48].…”

Mind-body interventions for the treatment of insomnia: a review

“…The effects of pharmacotherapy were essentially limited to the period during which patients were taking the drug. 18 Use of a mind-body intervention can be combined with pharmacotherapy in the treatment of insomnia. Studies examining the relative advantages of CBT and pharmacotherapy have found that improvements may be achieved more quickly with drug treatment; however, improvements are more sustained with CBT.…”