From the Guidelines
Older adults should prioritize cognitive behavioral therapy for insomnia (CBT-I) as the initial treatment for chronic insomnia disorder, as it has been shown to improve sleep outcomes and reduce symptoms of insomnia. This recommendation is based on moderate-quality evidence from studies such as 1 and 1, which demonstrate the effectiveness of CBT-I in improving sleep onset latency, wake after sleep onset, and sleep efficiency in older adults.
Key Recommendations for Older Adults
- Aim for 7-8 hours of sleep per night, maintaining a consistent sleep schedule by going to bed and waking up at the same time daily
- Create a relaxing bedtime routine that might include reading or taking a warm bath, and ensure your bedroom is cool, dark, and quiet
- Limit daytime napping to 30 minutes before 3 PM
- Avoid caffeine, alcohol, and large meals close to bedtime, and stop using electronic devices at least an hour before sleep
- Regular physical activity during the day promotes better sleep, but avoid exercising too close to bedtime
Importance of CBT-I
CBT-I has been shown to be an effective treatment for chronic insomnia disorder in older adults, with moderate-quality evidence demonstrating its ability to improve global outcomes, including increased remission and treatment response, and reduced Insomnia Severity Index (ISI) and Pittsburgh Sleep Quality Index (PSQI) scores compared with controls 1. Additionally, CBT-I has been shown to improve sleep outcomes in older adults, including reduced sleep onset latency and wake after sleep onset, and improved sleep efficiency 1.
Considerations for Healthcare Providers
Healthcare providers should consider CBT-I as the first-line treatment for older adults with chronic insomnia disorder, as it is a non-pharmacological intervention with a low risk of harm. If sleep problems persist, healthcare providers can work with patients to develop a personalized treatment plan that may include other interventions, such as sleep medications, but only after CBT-I has been tried.
From the Research
Sleep Cycle Guidelines for Older Adults
There are several studies that provide guidelines for sleep cycles in older adults, particularly those with insomnia.
- The American Academy of Sleep Medicine recommends that adults aged 65 and older aim for 7-8 hours of sleep each night 2.
- A study published in the Annals of Behavioral Medicine found that cognitive behavioral therapy for insomnia (CBT-I) can be an effective treatment for improving sleep duration in older adults, with a small average effect size of approximately 30 minutes 3.
- Another study published in Sleep Medicine Reviews found that CBT-I can be an effective treatment for patients with mental disorders and comorbid insomnia, including older adults, with moderate to large effect sizes for reducing insomnia severity 4.
- A study published in Sleep Medicine found that treating insomnia with CBT-I can also alleviate co-occurring depressive symptoms and depressogenic features in postmenopausal women, a population that is at increased risk for insomnia and depression 5.
- Additionally, a study published in Sleep found that CBT-I can be a safe and effective treatment for patients with comorbid insomnia and sleep apnea, including older adults, with no significant differences in changes in daytime sleepiness during treatment between CBT-I and control groups 6.
Key Findings
- CBT-I can be an effective treatment for improving sleep duration and reducing insomnia severity in older adults.
- CBT-I can also alleviate co-occurring depressive symptoms and depressogenic features in postmenopausal women.
- CBT-I can be a safe and effective treatment for patients with comorbid insomnia and sleep apnea, including older adults.
- The American Academy of Sleep Medicine recommends that adults aged 65 and older aim for 7-8 hours of sleep each night.
Sleep Parameters
- Total sleep time (TST): 7-8 hours per night
- Sleep onset latency (SOL): less than 30 minutes
- Wake after sleep onset (WASO): less than 30 minutes
- Sleep efficiency (SE%): greater than 85%