New study in JCSM shows effective treatment for elderly insomniacs

Brief behavioral treatment for insomnia (BBTI) appears to be a promising intervention for older adults who suffer from insomnia.

The study, conducted by Anne Germain, PhD, and colleagues of the University of Pittsburgh School of Medicine, focused on 17 older adults who were randomly assigned to receive BBTI, and 18 selected to receive an information-only control (IC) condition. All participants completed clinician-administered and self-report measures of sleep quality, as well as a sleep diary. Interventions were delivered in a single individual session with a booster session administered two weeks later. Postintervention assessments were completed after four weeks.

The results showed significant improvements in sleep measures and in daytime symptoms of anxiety and depression in 71 percent of those individuals who received BBTI, compared to 39 percent favorable response among IC participants. Furthermore, 53 percent of BBTI participants met criteria for remission, while 17 percent of those in the IC group met the same criteria.

"These preliminary findings are consistent with previous studies that have shown that brief behavioral insomnia interventions can be efficacious and remain efficacious in older adults who present with the typical psychiatric and medical comorbidities associated with aging," the authors wrote.

Sleep needs change over a person's lifetime. However, older adults need about the same amount of sleep as younger adults -- seven to nine hours of sleep per night.

Not sleeping well can lead to a number of problems. Older adults who have poor nighttime sleep are more likely to have a depressed mood, attention and memory problems, excessive daytime sleepiness, more nighttime falls and use more over-the-counter or prescription sleep aids. Poor sleep is also associated with a poorer quality of life.

Insomnia is the most common sleep complaint at any age. It affects almost half of adults 60 and older.

Periodic leg movements during sleep (PLMS), a common condition in older women, can lead to long-term health problems. Those suffering from PLMS should not delay scheduling a visit with a sleep specialist.

David M. Claman, MD, of the University of California, San Francisco, surveyed 455 older women, at an average age of 82.9 years, who completed in-home polysomnography. PLMS measurements included the number of leg movements per hour of sleep and the number of leg movements disturbing one's sleep.

According to the results, in a single hour, 66 percent of the participants experienced five or more leg movements, and 52 percent had 15 or more. In addition, leg movements disturbed the sleep of 27 percent of those surveyed on five or more occasions per hour, while six percent were awakened on 15 or more occasions in one hour. Those whose PLMS caused a disruption in their sleep had a significantly higher arousal index, lower sleep efficiency, a higher percentage of sleep stages 1- 2 and a lower percentage of stages 3-4 and REM.

"The importance of understanding determinants and measurement issues related to sleep disturbances in older women is underscored by the high prevalence of subjective symptoms of sleep problems and the frequency of chronic comorbidities in this population," wrote Claman.

Periodic limb movements consist of episodes of simple, uncontrollable, repetitive muscle movements that severely disrupt a person's sleep during the night, causing you to be very tired during the day. The movements tend to involve the tightening or flexing of a muscle, and occur most often in the lower legs. They can occur at two different times: while you sleep (PLMS) and while you are awake (PLMW). PLMS is much more common, and can disrupt your sleep many times.

PLMS occurs in both children and adults. The chance of having it increases with age, making it very common in the elderly. PLMS occurs in up to 34 percent of people over 60 years old.

JCSM is the official publication of the American Academy of Sleep Medicine (AASM). It contains published papers related to the clinical practice of sleep medicine, including original manuscripts such as clinical trials, clinical reviews, clinical commentary and debate, medical economic/practice perspectives, case series and novel/interesting case reports.

SleepEducation.com, a Web site maintained by the AASM, provides information about the various sleep disorders that exist, the forms of treatment available, recent news on the topic of sleep, sleep studies that have been conducted and a listing of sleep facilities.

To arrange an interview with an AASM spokesperson regarding either study, please contact Jim Arcuri, public relations coordinator, at (708)492-0930, ext. 9317, or jarcuri@aasmnet.org.