Older insomniacs helped by brief behavior therapy

NEW YORK, Oct 3 (Reuters) Older adults who suffer from insomnia may find it easier to drift off to sleep following brief behavioral therapy in which they learn about mechanisms that regulate sleep, factors that influence sleep, and behaviors that promote or interfere with sleep.

Sleep specialists from Pennsylvania found that 12 of 17 elderly insomniacs (17 per cent) who participated in a single behavioral therapy session and a booster session slept better and had less anxiety and depression. Nine participants (53 per cent) met criteria for remission of insomnia following treatment.

By contrast, only 7 of 18 insomniacs (39 percent) assigned to an ''information-only'' control group saw improvements in sleep and reductions in anxiety and depression and just three (17 per cent) met criteria for remission of their insomnia.

Insomnia is a ''chronic and prevalent'' problem in adults older than 65 years, note Dr. Daniel J. Buysse and colleagues from the University of Pittsburgh School of Medicine in the Journal of Clinical Sleep Medicine. Hypnotics can help but these medications ''raise safety concerns'' in older adults and standard behavioral therapy is time consuming, with standard programs given over 6 to 8 weeks.

The brief behavioral therapy intervention (BBTI) the Pittsburgh team developed comprises a single, 45-minute educational session with a follow up 30-minute booster session two weeks later.

During the sessions, a trained nurse provides individually tailored advice on getting to sleep and staying asleep. For example, subjects are encouraged not to do to bed until sleepy and not to stay in bed unless asleep and to get up at the same time each day.

''We tried,'' Buysse said, ''to identify the active elements from treatments that have been previously described and kind of boil them down into just the basics so that we could present a treatment to people quickly, give them specific recommendations on how they might change their behavior to improve their sleep and it seems to be promising.'' According to the researchers, the ''BBTI group showed large improvements in overall sleep quality, sleep latency, wake time after sleep onset, and sleep efficiency as well as marked reductions in depression and small changes in anxiety, whereas the information-only control group did not.'' The magnitude of the sleep improvements with BBTI were comparable with those reported for traditional longer behavioral and cognitive-behavioral interventions for insomnia, they also note.

Reuters AKJ DB1018