Background: Insomnia occurs frequently in older adults. The underlying factors for the disorder are physiological changes of the sleep-wake cycle, comorbid diseases and drug treatment. Cognitive behavioural therapy (CBT I) combined with light therapy and physical activity can be effective in the treatment of comorbid insomnia in older adults. Methods: Sixty-three (63) insomnia patients (47 female, 16 male) with an average age of 66.6 years participated in the program. Before and after the treatment, the participants completed questionnaires to assess their sleep quality (PSQI), day-time sleepiness (ESS), mood (BDI) and well-being (WHO-5-Index). In addition, they kept sleep diaries for six weeks. Results: Pre-post comparisons revealed a significant improvement in sleep latency and sleep quality, as well as a significant reduction of day-time sleepiness. In patients with both insomnia and depression, all depression scores improved slightly but significantly. Conclusions: Non-pharmacological combination treatment using CBT I, light therapy and physical activity seemed to be effective in older adults with comorbid insomnia and improve additionaly depressive symptoms.
References
[1]
Bloom, H.G., Ahmed, I., Alessi, C.A., Ancoli-Israel, S., Buysse, D.J., Kryger, M.H., Phillips, B.A., Thorpy, M.J., Vitiello, M.V. and Zee, P.C. (2009) Evidence-Based Recommendations for the Assessment and Management of Sleep Disorders in Older Persons. Journal of the American Geriatrics Society, 57, 761-789. http://dx.doi.org/10.1111/j.1532-5415.2009.02220.x
[2]
Lichstein, K.L. and Morin, C.M. (2000) Treatment of Late-Life Insomnia. Sage Publications Inc., Thousand Oaks.
[3]
Monane, M. (1992) Insomnia in the Elderly. Journal of Clinical Psychiatry, 53, 23-28.
[4]
Montgomery, P. and Dennis, J. (2003) Cognitive Behavioural Interventions for Sleep Problems in Adults Aged 60+. Cochrane Database of Systematic Reviews, 1, Article ID: CD003161.
[5]
Ring, D. (2001) Management of Chronic Insomnia in the Elderly. Clinical Excellence for Nurse Practitioners, 5, 13-16.
[6]
Ford, D.E. and Kamerow, D.B. (1989) Epidemiologic Study of Sleep Disturbances and Psychiatric Disorders: An Opportunity for Prevention? The Journal of the American Medical Association, 262, 1479-1484. http://dx.doi.org/10.1001/jama.1989.03430110069030
[7]
Morin, C.M. and Benca, R. (2012) Chronic Insomnia. Lancet, 379, 1129-1141. http://dx.doi.org/10.1016/S0140-6736(11)60750-2
[8]
Kaneda, R. and Furuta, H. (2009) Insomnia in Old Age. Nippon Rinsho, 67, 1548-1552.
[9]
Moller, H.J., Barbera, J., Kaymov, L. and Shapiro, C.M. (2004) Psychiatric Aspects of Late-Life Insomnie. Sleep Medicine Reviews, 8, 31-34. http://dx.doi.org/10.1016/S1087-0792(03)00022-4
[10]
Zee, P. and Bloom, H.G. (2006) Understanding and Resolving Insomnia in the Elderly. Geriatrics, 61, 1-12.
[11]
Hemmeter, U.M., Thum, A. and Krieg, J.C. (2007) Altersinsomnie. Somnologie, 11, 84-98. http://dx.doi.org/10.1007/s11818-007-0306-8
[12]
Wolkove, N., Elkholy, O., Baltzan, M. and Palayew, M. (2007) Sleep and Aging: 1. Sleep Disorders Commonly Found in Older People. Canadian Medical Association Journal, 176, 1299-1304. http://dx.doi.org/10.1503/cmaj.060792
[13]
Foley, D.J., Monjan, A.A., Brown, S.L., Simonsick, E.M., Wallace, R.B. and Blazer, D.G. (1995) Sleep Complaints among Elderly Persons: An Epidemiologic Study of Three Communities. Sleep, 18, 425-432.
[14]
Ancoli-Israel, S. (2009) Sleep and Its Disorders in Aging Populations. Sleep Medicine, 10, S7-S11. http://dx.doi.org/10.1016/j.sleep.2009.07.004
[15]
Graham, D. and McLacham, A. (2004) Declining Melatonin Levels and Older People. How Old Is Old? Neuro Endocrinology Letters, 25, 415-418.
[16]
Pandi-Perumal, S.M., Srinivasan, V., Spence, D.W. and Cardinali, D.P. (2007) Role of the Melatonin System in the Control of Sleep: Therapeutic Implications. CNS Drugs, 21, 995-1018. http://dx.doi.org/10.2165/00023210-200721120-00004
[17]
Franzen, P.L. and Buysse, D.J. (2008) Sleep Disturbances and Depression: Risk Relationships for Subsequent Depression and Therapeutic Implications. Dialogues in Clinical Neuroscience, 10, 473-481.
[18]
Norra, C., Richter, N. and Juckel, G. (2011) Sleep Disturbances and Suicidality: A Common Association to Look for in Clinical Practice and Preventive Care. EPMA Journal, 2, 295-307.
[19]
Spiegelhalder, K., Regen, W., Nanovska, S., Baglioni, C. and Riemann, D. (2013) Comorbid Sleep Disorders in Neuro-psychiatric Disorders across the Life Cycle. Current Psychiatry Reports, 15, 364. http://dx.doi.org/10.1007/s11920-013-0364-5
[20]
Espie, C.A., MacMahon, K.M., Kelly, H.L., Espie, C.A., MacMahon, K.M., Kelly, H.L., Broomfield, N.M., Douglas, N.J., Engleman, H.M., McKinstry, B., Morin, C.M., Walker, A. and Wilson, P. (2007) Randomized Clinical Effectiveness Trial of Nurse-Administrated Small-Group Cognitive Behavioral Therapy for Persistent Insomnia in General Practice. Sleep, 30, 574-584.
[21]
Morin, C.M. (1993) Insomnia: Psychological Assessment and Management. Guilford, New York.
[22]
Morin, C.M., Colecchi, C., Stone, J., Sood, R. and Brink, D. (1999) Behavioural and Pharmacological Therapies for Late Life Insomnia. JAMA, 281, 991-999. http://dx.doi.org/10.1001/jama.281.11.991
[23]
Morin, C.M., Hauri, P.J., Espie, C.A., Spielman, A., Buysse, D.J. and Bootzin, R.R. (1999) Nonpharmacologic Treatment of Chronic Insomnia. An American Academy of Sleep Medicine Review. Sleep, 22, 1134-1156.
[24]
Spielman, A.J., Saskin, P. and Thorpy, M.J. (1987) Treatment of Chronic Insomnia by Restriction of Time in Bed. Sleep, 10, 45-56.
[25]
Happe, S. and Paulus, W. (2006) Schlafst?rungen im Alter. In: Deuschl, G. and Reichmann, H., Eds., Gerontoneurologie, Georg Thieme Verlag, Stuttgart, 85-96.
[26]
Joshi, S. (2008) Nonpharmacological Therapy for Insomnia in the Elderly. Clinics in Geriatric Medicine, 24, 107-119. http://dx.doi.org/10.1016/j.cger.2007.08.005
[27]
Fetveit, A. (2009) Late-Life Insomnia: A Review. Geriatrics & Gerontology International, 9, 220-234. http://dx.doi.org/10.1111/j.1447-0594.2009.00537.x
[28]
Irwin, M.R., Cole, J. and Nicassio, P.M. (2006) Comparative Meta-Analysis of Behavioral Interventions for Insomnia and Their Efficacy in Middle-Aged Adults and in Older Adults 55+ Years of Age. Health Psychology, 25, 3-14. http://dx.doi.org/10.1037/0278-6133.25.1.3
[29]
McCurry, S.M., Logsdon, R.G., Teri, L. and Vitiello, M.V. (2007) Evidence-Based Psychological Treatments for Insomnia in Older Adults. Psychology and Aging, 22, 18-27. http://dx.doi.org/10.1037/0882-7974.22.1.18
[30]
Riedel, B.W., Lichstein, K.L. and Dwyer, W.D. (1995) Sleep Compression and Sleep Education for Older Insomniacs: Self-Help versus Therapist Guidance. Psychology and Aging, 10, 54-63. http://dx.doi.org/10.1037/0882-7974.10.1.54
[31]
Bootzin, R. and Epstein, D. (2000) Stimulus Control. In: Lichstein, K.L. and Morin, C.M., Eds., Treatment of Late-Life Insomnia, Sage Publications Inc, Thousand Oaks.
[32]
Morgan, K. (2003) Daytime Activity and Risk Factors for Late-Life Insomnia. Journal of Sleep Research, 12, 231-238. http://dx.doi.org/10.1046/j.1365-2869.2003.00355.x
[33]
Montgomery, P. and Dennis, J. (2002) Physical Exercise for Sleep Problems in Adults Aged 60+. Cochrane Database of Systematic Reviews, 4, Article ID: CD003404.
[34]
Mucha, C. (2010) Körperliche Aktivität gegen Schlafstörungen. Klinikarzt, 39, 568-571. http://dx.doi.org/10.1055/s-0031-1271968
[35]
Campbell, S.S., Dawson, D. and Anderson, M.W. (1993) Alleviation of Sleep Maintenance Insomnia with Timed Exposure to Bright Light. Journal of the American Geriatrics Society, 41, 829-836.
[36]
Lack, L., Wright, H., Kemp, K. and Gibbon, S. (2005) The Treatment of Early-Morning Awakening Insomnia with 2 Evenings of Bright Light. Sleep, 28, 616-623.
[37]
Montgomery, P. and Dennis, J. (2002) Bright Light Therapy for Sleep Problems in Adults Aged 60+. Cochrane Database of Systematic Reviews, 2, Article ID: CD003403.
[38]
Lichstein, K.L., Wilson, N.M. and Johnson, C.T. (2000) Psychological Treatment of Secondary Insomnia. Psychology and Aging, 15, 232-240. http://dx.doi.org/10.1037/0882-7974.15.2.232
[39]
Buysse, D.J. (2004) Insomnia, Depression and Aging. Assessing Sleep and Mood Interactions in Older Adults. Geriatrics, 59, 47-51.
[40]
Taylor, D.J., Lichtenstein, K.L., Weinstock, J., Sanford, S. and Temple, J.R. (2007) A Pilot Study of Cognitive-Behavioral Therapy of Insomnia in People with Mild Depression. Behavior Therapy, 38, 49-57. http://dx.doi.org/10.1016/j.beth.2006.04.002
[41]
Rybarzyk, B., Stepanski, E., Fogg, K., Lopez, M., Barry, P. and Davis, A. (2005) A Placebo-Controlled Test of Cognitive-Behavioral Therapy for Comorbid Insomnia in Older Adults. Journal of Consulting and Clinical Psychology, 73, 1164-1174. http://dx.doi.org/10.1037/0022-006X.73.6.1164
[42]
Jakobson, E. (1929) Progressive Relaxation. University of Chicago Press, Chicago.
[43]
Buysse, D.J., Reynolds, C.F., Monk, T.H., Berman, S.R. and Kupfer, D.J. (1989) The Pittsburgh Sleep Quality Index (PSQI): A New Instrument for Psychiatric Practice and Research. Psychiatry Research, 28, 193-213. http://dx.doi.org/10.1016/0165-1781(89)90047-4
[44]
Johns, M.W. (1991) A New Method for Measuring Daytime Sleepiness: The Epworth Sleepiness Scale. Sleep, 14, 540-545.
[45]
Hautzinger, M., Bailer, M., Worall, H. and Keller, F. (1995) BDI Beck-Depressions-Inventar. Testhandbuch 2, überar-beitete Auflage. Verlag Hans Huber, Bern.
[46]
Hautzinger, M., Keller, F. and Kühner, C. (2009) BDI-II. Beck-Depressions-Inventar. Revision. 2. Auflage. Pearson Assessment, Frankfurt.
[47]
Heun, R., Burkart, M., Maier, W. and Bech, P. (1999) Internal and External Validity of the WHO Well-Being Scale in the Elderly General Population. Acta Psychiatrica Scandinavica, 99, 171-178. http://dx.doi.org/10.1111/j.1600-0447.1999.tb00973.x
