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Limitations of cognitive-behavioral therapy in sleep disorders in elderly
- Om Prakash (2 May 2007)
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Future Directions in Cognitive-Behavioural Therapy in Older Insomniacs
- Børge Sivertsen, Inger Hilde Nordhus (29 May 2007)
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Om Prakash, Assistant Professor of Psychiatry, Consultant in Adult & Geriatric Psychiatry M.D.
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op{at}nimhans.kar.nic.in Om Prakash
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Title: Limitations of cognitive-behavioral therapy in sleep disorders in elderly When the possible side effects of hypnotics are considered, there is an argument to be made for clinical use of alternative treatments in the elderly. In their editorial, Siversten & Nordhus1 emphasized the role of cognitive-behavioral approach in the management of sleep disorders in elderly. However, there are limitations in this approach too. Mental health practitioners or physicians with formal sleep medicine training currently deliver cognitive Behavioral Therapy (CBT), but they are few in number and could not cater to the needy ones2. This could be the foremost reasons for prescribing hypnotics in geriatric population despite knowing their side-effect profile and abuse potential. Therefore, more training workshops are needed to mental health professionals so that they can incorporate those techniques in their routine care of elderly clientele. No clear guideline exists about the optimum number and duration of sessions in sleep disorders more particularly for geriatric population. It is unclear how long it continued to have changes in sleep hygiene. CBT refers to a number of varied non-pharmacologic treatments for insomnia, but which portion is more effective or having more impact need more research. There was insufficient evidence to recommend sleep hygiene education, imagery training and cognitive therapy as single therapies or when added to other specific approaches3. In addition to CBT, research groups are also working on other effective non-pharmacological interventions for elderly population like acupressure4. Exercise5, though not appropriate for all in this population, may help in inducing sleep. Nevertheless, the editorial gave a new insight in this neglected area and formed an impetus to start more research for this geriatric population. References 1. Sivertsen, B., Nordhus, I.H. (2007). Management of insomnia in older adults. British Journal of Psychiatry, 190, 285-6. 2. Wetzler, R.G., Winslow, D.H. (2006). New solutions for treating chronic insomnia: an introduction to behavioral sleep medicine. The Journal of the Kentucky Medical Association, 104(11), 502-12. 3. Morgenthaler, T., Kramer, M., Alessi, C., et al (2006). Practice parameters for the psychological and behavioral treatment of insomnia:an update. An american academy of sleep medicine report. Sleep, 29(11), 1415- 9. 4. Chen, M.L., Lin, L.C., Wu, S.C., Lin, J.G. (1999). The effectiveness of acupressure in improving the quality of sleep of institutionalized residents. The journals of gerontology. Series A, Biological sciences and medical sciences, 54(8), M389-94. 5. Montgomery, P., Dennis, J.(2004). A systematic review of non- pharmacological therapies for sleep problems in later life. Sleep medicine reviews, 8(1), 47-62. |
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Børge Sivertsen, Psychologist University of Bergen, Inger Hilde Nordhus
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borge.sivertsen{at}psykp.uib.no Børge Sivertsen, et al.
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In a response to our editorial, Dr. Prakash calls for the need of more training workshops in order to improve implementation of Cognitive Behaviour Therpapy (CBT) for older insomniacs. Although we agree that there are much too few sleep specialists to cater for the needs, we believe that that the key to more effective implementation is to also provide the same training to other health professionals, including primary care nurses. While there is still no consensus on which component to be included in CBT for insomnia, our experience is that sleep restriction and stimulus control are both crucial and the most effective factors in improving sleep in this age cohort. These components can easily be adapted and used by most health professionals. In Norway, we are also pleased to see that the Norwegian Medical Association has started offering training workshop on CBT for insomnia for their members, and also the Norwegian Psychological Association will soon follow this important initiative. However, we share Dr Prakash concern that there is still insufficient research on how to optimize the treatment, and there is clearly a need for studies to disentangle which component works best and for whom. |
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