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Recent Developments in the Management of Insomnia in Later Life

  • Geriatric Disorders (K Zdanys, Section Editor)
  • Published:
Current Treatment Options in Psychiatry Aims and scope Submit manuscript

Abstract

Purpose of review

Insomnia impacts a significant proportion of older adults yet is not an inevitable consequence of aging and is amenable to intervention. The aim of this narrative review is to provide an overview of recent recommendations and empirical findings regarding the management of insomnia in older adults.

Recent findings

The treatment of insomnia with cognitive behavioral therapy for insomnia (CBT-I) continues to be empirically supported and the recommended first-line intervention for adults. Accumulating evidence indicates that other non-pharmacological therapies for insomnia, such as mindfulness-based therapies, light therapy, and physical activity interventions, as well as treatment delivered by non-clinician “sleep coaches” also positively impact insomnia symptoms. Finally, recent systematic reviews offer guidelines and recommendations for pharmacological management of insomnia.

Summary

CBT-I remains the recommended first-line treatment for insomnia across adult ages. There is a continued need to increase the availability and optimize the delivery of CBT-I and other therapies for older adults with insomnia to maximize treatment benefits. There is also evidence for some benefit of pharmacological agents to treat insomnia; however, these are not without risks, particularly in the geriatric population.

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Abbreviations

ACP:

American College of Physicians

AASM :

American Academy of Sleep Medicine

BBTI:

Brief behavioral treatment for insomnia

CBT-I:

Cognitive behavioral therapy for insomnia

IC:

Information control

ISI :

Insomnia Severity Index [57]

MBSR:

Mindfulness-based stress reduction

MBTI:

Mindfulness-based therapy for insomnia

OTC:

Over-the-counter

PSQI :

Pittsburgh Sleep Quality Index [58]

RCT:

Randomized controlled trial

SDB :

Sleep disordered breathing

SE :

Sleep efficiency

SOL :

Sleep onset latency

TST:

Total sleep time

TWT :

Total wake time

WASO:

Wake after sleep onset

WL:

Wait list

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Funding

Dr. Tighe is supported by the Advanced Fellowship Program in Mental Illness Research and Treatment, VISN 4 MIRECC (Director: D. Oslin; Pittsburgh Site Director: G. Haas), VA Pittsburgh Healthcare System. Dr. Bramoweth is supported by Career Development Award 13-260 from the Department of Veterans Affairs, Health Services Research and Development Service. The contents of this paper do not represent the views of the Department of Veterans Affairs or the United States Government.

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Authors and Affiliations

  1. VISN 4 Mental Illness Research, Education and Clinical Center (MIRECC), VA Pittsburgh Healthcare System, Research Office Building (151R-U), University Drive C, Pittsburgh, PA, 15240, USA

    Caitlan A. Tighe PhD & Adam D. Bramoweth PhD

  2. Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA

    Caitlan A. Tighe PhD

  3. Center for Health Equity Research and Promotion (CHERP), VA Pittsburgh Healthcare System, Pittsburgh, PA, USA

    Adam D. Bramoweth PhD

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  1. Caitlan A. Tighe PhD
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Correspondence to Adam D. Bramoweth PhD.

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Conflict of interest

Adam D. Bramoweth reports grants from the US Department of Veterans Affairs, Health Services Research and Development Service, during the conduct of the study.

Caitlan A. Tighe declares that she has no conflict of interest.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on Geriatric Disorders

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Tighe, C.A., Bramoweth, A.D. Recent Developments in the Management of Insomnia in Later Life. Curr Treat Options Psych 5, 195–210 (2018). https://doi.org/10.1007/s40501-018-0145-1

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