Americans appear to be quite sleep deprived, so says the latest National Sleep Foundation Survey of working adults (2008). Sleep deprivation seems to be linked to obesity as well as driving and work accidents. We’re insomniacs for many reasons. One key reason is our electronic appetite. With 24/7 electronics we stay up later and then stay up longer when we do get up in the night because of insomnia.
Sadly, once we retire and have the freedom to sleep longer, we can’t. Some 30-60% of older persons have sleep complaints. Does anything help? Commonly, doctors prescribe sleep aids, exercise, Cognitive Behavioral Therapy, and sleep hygiene education. While sleep aids are quite attractive they often have significant side effects and tend to be less effective if used regularly. Susan McCurry and her colleagues at University of Washington reviewed 20 key studies published between 1990 and 2006 to determine if any psychological treatments (they eliminated drugs, massage, etc.) would meet standards for evidenced-based treatment. They determined that two treatments have strong evidence of success among the older population:
1. Sleep Restriction/Sleep Compression. This treatment “is based on the principle that curtailing time spent in bed helps solidify sleep.” (p. 20). So, if you are in bed for 8 hours but only sleep 5, then restrict your time in bed to only 5 hours. The idea is that if you do so, you will sleep more soundly for those 5 hours and likely begin to sleep longer until you read your optimal (not necessarily desired) sleep time.
2. Mulitcomponent CBT. This interventions combines sleep hygiene education (information about how to schedule sleep, dietary matters, activity recommendations, etc.), stimulus control(strengthening the association that bed is for sleep and avoiding napping and lying down awake), sleep restriction, and relaxation training (relaxation to induce drowsiness).
Stimulus control may in fact be beneficial by itself but more study is necessary.
It has been generally accepted that most individuals with secondary sleep problems need sleep hygiene education. In other words, they make matters worse by how they deal with their insomnia (staying in bed awake too long, napping, drinking alcohol, not enough exercise or too late in the evening, etc.). As of yet, we do not have actual research (meeting evidenced-based criteria) to prove that education helps in the elderly population–though some exists for the 40-50s crowd. There also may be some benefit to bright light exposure, exercise, and massage but these authors didn’t explore these nonpsychological interventions.
Bibliography: McCurry, Logsdon, Teri, & Vitiello (2007). Evidence-Based Psychological Treatments for Insomnia in Older Adults. Psychology and Aging, 22, 18-27.