© 2007 The Royal College of Psychiatrists
Correspondence |
Limitations of cognitive–behavioural therapy for sleep disorders in older adults
Geriatric Clinic and Services, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore 560029, India. Email: op{at}nimhans.kar.nic.in
EDITED BY KIRIAKOS XENITIDIS and COLIN CAMPBELL
When the possible side-effects of hypnotics are considered, there is an argument for alternative treatments of sleep disorders in older adults. Sivertsen & Nordhus (2007) emphasised the role of cognitive–behavioural therapy (CBT) in the management of sleep disorders in this population. However, there are also limitations to this approach.
Mental health practitioners or physicians with formal sleep medicine training currently deliver CBT, but they are few in number and could not cater for all that need therapy (Wetzler & Winslow, 2006). This could be the main reason for the prescribing of hypnotics for older adults despite knowledge of their side-effect profile and potential for misuse. Therefore, more workshops are needed for training of mental health professionals in CBT so that they can incorporate these techniques in their routine care of older adults.
There are no clear guidelines about the optimum number and duration of treatment sessions for sleep disorders, particularly for the elderly. It is also unclear how long CBT continues to be effective. Moreover, CBT refers to a number of non-pharmacological treatments for insomnia, but which are the most effective needs more research. There is insufficient evidence to recommend sleep hygiene education, imagery training and cognitive therapy as single therapies or as additions to other specific approaches (Morgenthaler et al, 2006).
Research groups are also working on other effective non-pharmacological interventions for older adults such as acupressure (Chen et al, 1999). Exercise (Montgomery & Dennis, 2004), although not appropriate for all in this population, may also help in inducing sleep. Nevertheless, Sivertsen & Nordhus gave a new insight into this neglected area and provided an impetus for more studies in the elderly.
REFERENCES
- Chen, M. L., Lin, L. C., Wu, S. C., et al (1999) The effectiveness of acupressure in improving the quality of sleep of institutionalized residents. Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 54, M389 -394.
- Montgomery, P. & Dennis, J. (2004) A systematic review of non-pharmacological therapies for sleep problems in later life. Sleep Medicine Reviews, 8, 47-62.[CrossRef][Medline]
- Morgenthaler, T., Kramer, M., Alessi, C., et al (2006) Practice parameters for the psychological and behavioral treatment of insomnia: an update. Sleep, 29, 1415 -1419.[Medline]
- Sivertsen, B. & Nordhus, I. H. (2007)
Management of insomnia in older adults. British Journal of
Psychiatry, 190, 285
-286.
[Abstract/Free Full Text] - Wetzler, R. G. & Winslow, D. H. (2006) New solutions for treating chronic insomnia: an introduction to behavioral sleep medicine. Journal of the Kentucky Medical Association, 104, 502 -512.[Medline]
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||