Isomnia: Study Awakens Possibilities for Sleep in Chronically Ill Elders
Although research in recent years has shown that insomnia is not a natural consequence of growing older, effective interventions have not been tested until now "with those who need it most-older adults with chronic disease," note investigators at Rush-Presbyterian-St. Luke's Medical Center in Chicago. Researcher Bruce Rybarczyk found that techniques for changing behavior can "make substantial improvements" in elderly people with chronic conditions.
According to the study, "Evaluating Behavioral Treatments for Geriatric Insomnia," providing treatments for older people with chronic disease is critical because improvements in sleep may lead to such benefits as increased quality of life, reduced depression, diminished anxiety and fatigue, and decreased healthcare utilization.
EXCLUDED FROM STUDIES
The few studies that have examined the efficacy of behavioral interventions with elders, the researchers report, "have systematically excluded older adults with insomnia comorbid with a medical condition," -the premise being that insomnia among chronically ill older people may not respond to behavioral treatments and that this group would be difficult to include in such studies. The report points out that drug therapies for insomnia in elders are recommended only on a short-- term, intermittent basis because of the numerous possible adverse effects from pharmacologic treatments.
Rybarczyk and his colleagues tested four interventions. The most effective was classroom cognitive-behavioral treatment (CBT), which included eight weekly group sessions lasting an hour and a half. A videotaped version of the course for home use was also effective, though somewhat less so; and an audiotape course, "Home-Based Behavioral Treatment for Insomnia," proved only modestly successful, though the study concluded that it may still be useful for large numbers of older people because of its wider potential availability.
The researchers tested participants using seven measures, such as self-reported sleep logs, the Geriatric Depression Scale, the Beck Anxiety Inventory and the ShortForm McGill Pain Questionnaire. The research team followed up with participants four months after initial testing, upon completion of the interventions.
Led by two geropsychologists, the CBT sessions focus on a range of behavioral issues. Participants were coached, for example, to go to bed only when feeling drowsy and to regulate their sleep pattern by awakening at the same time every morning. Another of the several techniques emphasized changing "unrealistic beliefs and irrational fears regarding sleep or the loss of sleep," the study says. …