Cognitive Behavioral Therapy for Insomnia in Older Adults: Background, Evidence, and Overview of Treatment Protocol

Obtaining adequate sleep is a major factor contributing to mental and physical well-being. Sleep need and function does not change across the adult lifespan, but obtaining adequate sleep becomes more difficult with advancing age due to gradual changes in circadian functioning and sleep structure. Moreover, small deficits in sleep often develop into chronic insomnia as a result of cognitive and behavioral responses to these normative age-related changes. Fortunately, these intensifying and perpetuating factors can be reversed with cognitive behavioral therapy for insomnia (CBT-I). The evidence now indicates that CBT-I is equally effective in the short term and more effective in the long term relative to pharmacotherapy. It has fewer side effects and, therefore, should be the first line of treatment for all individuals with insomnia, regardless of age or comorbid conditions. Unfortunately, few clinicians are informed about how effective CBT-I is and how it differs from standard sleep hygiene recommendations. Even fewer have access to referral sources for CBT-I. The goal of the current article is to familiarize clinicians with the background, evidence, and protocol for using CBT to treat chronic insomnia in older adults. Several modifications of CBT-I designed to meet the unique needs and circumstances of older adults are presented. Additionally, a description of a stepped care approach to disseminate CBT-I on a much wider basis is presented.