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Insomnia relief for older adults: Can short-term behavioral therapy help?

High success rate when using behavioral therapy to treat insomnia.

News of this study caught my eye recently, with its recommendations for a highly efficient line of treatment for older adults with insomnia. Researchers at the University of Pittsburgh tested a treatment known as Brief Behavioral Therapy Intervention (BBTI). BBTI is just what it sounds like: a short-term, highly targeted course of counseling targeted at changing a person’s behaviors. I’ve written about the effectiveness of Cognitive Behavioral Therapy (CBT) in treating insomnia, and in many cases it can be as effective as drug therapy (and last longer). For a variety of reasons, including lack of access to treatment and cost, CBT is not always an available, sustainable option for patients. BBTI, with its limited and intensely focused course of treatment, could provide a more accessible and cost-effective alternative.

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The researchers worked with a group of 79 men and women (average age: 71.7), all of whom were suffering from chronic insomnia. Participants were divided into two groups: one study group received a course of BBTI, which included two individual in-person counseling sessions and two telephone sessions, all conducted by a nurse clinician. The entire course of BBTI treatment took place over a single month. The behavioral therapy sessions focused on helping participants to create sleep routines built on four fundamental goals:

  • Reducing the total amount of time spent in bed
  • Getting out of bed at the same time every day
  • Refraining from going to bed until you  feel sleepy
  • Not staying in bed if you’re not actually sleeping

Participants in a second group received the same basic information and instructions in the form of printed educational materials, but did not participate in counseling sessions with a health professional.

Both groups saw improvements to their sleep, but the difference in the degree of improvement between the two groups is pretty amazing. Two-thirds of participants who received BBTI saw improvements to their sleep, compared to 25 percent in the group who received only educational material with no behavioral counseling. Among those who received BBTI, 55 percent were able to eliminate their insomnia altogether, compared to 13 percent of participants in the materials-only group. And the improvements in insomnia didn’t go away—researchers followed up with their subjects six months after treatment, and found that participants had been able to maintain the changes they made.

This study was conducted with a relatively small group, so more research is likely needed. That said, there is a lot of promising news in these findings. Insomnia and disordered sleep are all-too-common problems among older adults, and the consequences to their health and well-being are quite serious. BBTI is a potentially attractive course of treatment for older adults, for several reasons. It provides a drug-free option to an age group that is already very likely to be taking medications for other conditions, and therefore reluctant, or at times unable, to rely on medication for sleep. Training practitioners could be accomplished with relative ease—and at low-cost—increasing the availability and accessibility of the treatment to include a wide population, where there may otherwise be barriers to longer-term, or other therapies.  The short-term nature of the therapy also means a limited, clearly defined cost to older patients. And the speed and ease of the treatment itself could provide a quick and easy solution to what is often a chronic, debilitating problem.

This is all potentially great news for older adults. There’s a takeaway for us all here, though. Establishing positive, sustainable sleep routines now will improve your health today, and also can set you up with the fundamental tools you need to manage your sleep as you age.

Sweet Dreams,

Michael J. Breus, PhD 
The Sleep Doctor™ 

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Michael J. Breus, Ph.D., is a Clinical Psychologist and a Diplomate of the American Board of Sleep Medicine. He is the author of Beauty Sleep.

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