Behavioral and cognitive treatments of geriatric insomnia.

Abstract

Geriatric insomnia is a prevalent problem that has not received adequate controlled evaluation of psychological treatments. The present study evaluated behavioral and cognitive methods, relative to a wait-list control condition, for treating 27 elderly subjects (mean age = 67 years) with sleepmaintenance insomnia. Both treatment methods, stimulus control and imagery training, produced significant improvement on the main outcome measure of awakening duration. Stimulus control yielded higher improvement rates than either imagery training or the control condition on awakening duration and total sleep-time measures. Sleep improvements were maintained by the two treatment methods at 3- and 12-month follow-ups. The results were corroborated by collateral ratings obtained from significant others. Subjective estimates of awakening duration and sleep latency correlated highly with objective measures recorded on an electromechanical timer. The findings suggest that geriatric insomnia can be effectively treated with psychological interventions and that behavioral procedures are more beneficial than cognitive procedures for sleep maintenance problems. Insomnia is a widespread health problem among the elderly. More than 25% of people aged 60 years or older report difficulty initiating and/or maintaining sleep (Mellinger, Baiter, & Uhlenhuth, 1985). Insomnia complaints increase with age, and disorders of maintaining sleep are especially prevalent among the elderly (Dement, Miles, & Carskadon, 1982; Webb & Campbell, 1980). Sleep-maintenance insomnia is a more pervasive and debilitating condition than onset insomnia and has proved refractory to treatment (Bootzin, Engle-Friedman, & Hazelwood, 1983). Pharmacotherapy is the most widely used method for treating insomnia. Thirty-nine percent of prescriptions for hypnotics are written for persons over 60 years of age (Institute of Medicine, 1979) and, in nursing facilities, 94% of the elderly have been prescribed sedative hypnotics (U.S. Public Health Service, 1976). Most sleeping medications are effective only temporarily, impair cognitive and psychomotor functions, and alter the sleep architecture (Morin & Kwentus, 1988). They are especially hazardous to health in older people because of the reduced metabolic functioning that results with age and the higher incidence of sleep-related respiratory impairments (Mendelson, 1980). Although their short-term use may be indicated as an adjunct for acute insomnia, alternative nonpharma

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