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Brief behavioral therapy improves sleep in older adults with chronic insomnia
Clinical Question
Can brief behavioral therapy improve sleep in older adults with insomnia?
Bottom line
Although based on only a few studies, it appears that a brief 4-week behavioral therapy program will improve sleep quality in older adults with chronic insomnia. These findings underscore guidelines from the American College of Physicians and others to eschew drugs and use nonpharmacologic approaches for the initial management of insomnia. (LOE = 2a)
Overuse alert: This POEM aligns with the Canadian Geriatrics Society’s Choosing Wisely Canada recommendation: Don’t use benzodiazepines or other sedative-hypnotics in older adults as first choice for insomnia, agitation or delirium. Choosing Wisely Canada's hospital and primary care care toolkits provide tools to reduce inappropriate use of benzodiazepines.
Reference
Study design: Meta-analysis (randomized controlled trials)
Funding: Government
Setting: Various (meta-analysis)
Synopsis
These authors searched multiple databases and registries to identify randomized trials, systematic reviews, and meta-analyses that evaluated the effectiveness of brief behavioral interventions in community-dwelling adults at least 60 years of age with chronic insomnia. They identified only 4 trials with 190 participants. Overall, the risk of bias was medium to low. In these studies, a 4-week behavioral intervention program had a large effect size on sleep quality based on the Pittsburgh Sleep Quality Index and the Insomnia Severity Index (standardized mean difference -1.07; 95% CI -1.43 to -0.71) and improved total sleep time by 25.7 minutes. Similarly, the brief interventions improved several other measures of sleep efficiency. The authors found no heterogeneity among the data. Finally, the authors do not report any data on daytime sleepiness, quality of life, cognition, and so forth.
Reviewer
Henry C. Barry, MD, MS
Professor
Michigan State University
East Lansing, MI
Comments
Impact assessment
Excellent
CBT and Insomnia
Completely useless.
Sleep disorders in the elderly
Hard to swallow that a 4 week behavioural therapy would have impact on sleep quality in the elderly.
Full text articles available
I was pleased to find the specific techniques used in the study are available for free in the bibliography.