Curing Insomnia In The Elderly

(As reported 3/17/99)
A new study says behavioral changes can be more beneficial to senior citizens in the fight against chronic insomnia than prescription medication, reports Health Correspondent Dr. David Hnida of CBS News affiliate KCNC-TV in Denver.

The research, published in Wednesday's Journal of the American Medical Association, says older people with insomnia got more long-term help from eight weeks of psychotherapy than they did from eight weeks of sleeping pills or a combination of the two.

The psychotherapy -- called cognitive behavioral therapy -- involves changing people's habits, such as spending too much time in bed. It also addresses erroneous beliefs, such as the notion that everyone needs eight hours of sleep.

"With eight treatment sessions, most of the time, I think we can help people," said Charles Morin, a clinical psychologist at Laval University in Quebec who conducted the study.

The symptoms of insomnia include:

  • trouble falling asleep
  • frequent or prolonged awakenings
  • early morning awakenings

The researchers studied 78 adults whose average age was 65 and whose chronic insomnia was not caused by any underlying physical problem. Morin said similar research in younger adults has had the same outcome.

The subjects were divided into four groups. One received 90 minutes a week of group therapy; another received eight weeks of treatment with a prescription sleeping pill; a third got an eight-week combination of therapy and sleeping pills; and the fourth received a dummy pill.

Initially, the combination treatment appeared to work best, reducing nighttime awakenings -- the typical problem in older people -- by 65 percent, compared with a 55 percent reduction in the psychotherapy group and a 47 percent reduction in the sleeping-pill-only group.

But after two years, "only behavioral treatment provided durable changes," the researchers said.

Those who got medication alone fell back to their initial levels of sleeplessness. And to the researchers' surprise, those in the combination group had mixed experiences, with some worse than they were at the outset.

Morin was unsure why, but said sleeping pills -- even if combined with psychotherapy -- may make people vulnerable to relapse by leaving them feeling at a loss when not taking the drug.

"Most sleeping pills are designed to be used on a short-term basis," Morin said. "Here, we pushed the limit a little bit."

To correct insomnia using behavioral changes, doctors suggest that patients:

  • go to bed only when sleepy
  • use bedroom only for sleep and sex (watch television or read in another room)
  • go to another room when unable to sleep after 15 minutes
  • rise at same time every morning regardless of how much sleep you had the night before

An expert who did not take part in the study said Morin's findings confirm other research. But e said the type of psychotherapy that helps is not yet widely practiced.

"There are a lot of people out there that market themselves as counselors, but not that many clinicians know how to offer cognitive behavioral treatment for insomnia," said Dr. Jed Black, director of the Stanford Sleep Disorders Clinic in Palo Alto, California.