From the Guidelines
Cognitive behavioral therapy for insomnia (CBT-I) is the most effective treatment for improving sleep quality in older adults, as it has been shown to improve Insomnia Severity Index (ISI) and Pittsburgh Sleep Quality Index (PSQI) scores compared with controls, with moderate-quality evidence supporting its use 1. To improve sleep quality while aging, it is essential to establish a consistent sleep schedule, create a relaxing bedtime routine, limit caffeine and alcohol, exercise regularly (but not close to bedtime), and keep your bedroom cool, dark, and quiet. Some key points to consider:
- Most older adults need 7-8 hours of sleep per night, though individual needs vary
- CBT-I can be delivered through various methods, including in-person individual therapy, in-person group therapy, telephone-based modules, Web-based modules, and self-help books
- Medical conditions common in older adults like arthritis, prostate issues, and sleep apnea can further disrupt sleep, so addressing underlying health problems is essential for improving sleep quality as you age
- If sleep problems persist, consider short-term use of medications like melatonin (0.5-2mg taken 1-2 hours before bedtime) or prescription options like trazodone (25-50mg) under medical supervision Aging affects circadian rhythms and sleep architecture, with decreased deep sleep and REM sleep, making it essential to prioritize sleep quality and seek professional help if needed 1.
From the Research
Sleep and Aging: An Overview
- Sleep patterns change with age, and older adults are more likely to experience sleep disorders such as insomnia, sleep disordered breathing, and restless legs syndrome 2.
- Insomnia is a common sleep disorder among older adults, affecting up to 75% of this population, and is associated with socioeconomic status, racial and ethnic classification, family relationships, medical and mental health disorders, cognitive function, and dementia 3.
Cognitive Behavioral Therapy for Insomnia (CBT-I)
- CBT-I is a multi-component treatment for insomnia that targets difficulties with initiating and/or maintaining sleep and is delivered over the course of six to eight sessions 4.
- CBT-I has been found to be an effective alternative to pharmacotherapy for individuals with insomnia, including older adults, and encompasses sleep hygiene, stimulus control, sleep restriction, cognitive therapy, and relaxation training 5.
- Sleep restriction therapy (SRT) is a component of CBT-I that has been shown to be effective in improving insomnia severity and sleep continuity in the short term, with large treatment effects comparable to multicomponent CBT-I 6.
Treatment Options and Considerations
- Healthcare providers should consistently assess for insomnia during baseline and annual assessments, evaluate medical and social factors associated with insomnia, minimize the use of sleep medications, and provide referrals to and/or collaborate with providers who perform CBT-I 3.
- Insomnia screening is important as it facilitates early intervention with behavioral management, reduces the potential for pharmacological management, and enables further assessment and early identification of outcomes such as cognitive impairment 3.
- More studies are needed to assess the long-term effects of SRT and to quantify its effects on daytime functioning and quality of life 6.