Tackling sleeplessness: psychological treatment options for insomnia in older adults

Figures & data

Table 1 Psychological techniques used in the treatment of late-life insomnia

Common sleep education components for older adults*

• Increased prevalence of sleep disturbance

• Increase in sleep onset latency (SOL)

• Increase in wake time after sleep onset (WASO)

• Increase in number of nighttime awakenings (NWAK)

• Increase in hypnotic use

• Increase in napping

• Decreased total sleep time (TST)

• Good sleep can be re-learned

Common sleep hygiene components

• Avoid caffeine after noon

• Avoid exercise within 2 hours of bedtime

• Avoid nicotine within 2 hours of bedtime

• Avoid alcohol within 2 hours of bedtime

• Avoid heavy meals within 2 hours of bedtime

Common relaxation practices**

• Progressive muscle relaxation

• Passive muscle relaxation

• Autogenic phrases

• Diaphragmatic/deep breathing

• Mental imagery

• Meditation

• Biofeedback

Stimulus control instructions***

• Go to bed only when tired

• Do not use the bed/bedroom for anything but sleep and sex

• If sleep is not obtained in 15–20 minutes, leave the bed/bedroom

• Only return to bed upon tiredness

• Repeat bullet #3 as necessary

• Wake at the same time every morning

• Avoid daytime napping

Sleep restriction instructions

• Calculate average time in bed (TIB) and TST for the previous 1–2 Weeks

• If average sleep efficiency (SE) > 90%, Increase TIB by 30 minutes****

• If average SE < 85%, Decrease TIB by 30 minutes****

• Retire at same time every night. Wake at the same time every morning

• Avoid daytime napping

Cognitive therapy guidelines/instructions

• Maladaptive thoughts, beliefs, and attitudes can precipitate and/or perpetuate insomnia

• Maladaptive thoughts, beliefs, and attitudes can cause negative emotional responses that may disrupt sleep

• Maladaptive thoughts, beliefs, and attitudes can be changed

• Cognitive restructuring or thought challenging is a technique to examine the evidence for/against thoughts, beliefs, and attitudes about sleep and aims to replace them with more adaptive/realistic thoughts, beliefs, and attitudes

Notes:

*Components are commonly observed age-related changes in sleep.

**All the above forms of relaxation aim to engender reductions in physiological and cognitive arousal.

***Sleep may initially worsen. This should be expected, but may result in a sleep debt that may facilitate later positive changes.

****If SE is between 85% and 90% do not adjust TIB. The above techniques can be effectively combined to created multicomponent psychological treatments for older adults with insomnia.

Abbreviations: SOL, sleep onset latency; WASO, wake after sleep onset; NWAK, number of nocturnal awakenings; TST, total sleep time.