Study Confirms CBT Good for Insomnia in Older Adults

About 30-50% of people in the United States have trouble sleeping, which makes insomnia one of the most common problems in adults.  For many older adults, it is a chronic problem closely related to other health conditions.  Unfortunately, the elderly who have insomnia are at higher risk of falls, stroke, memory lapse, cognitive dysfunction, and depression, seriously decreasing their quality of life.

Adding to this concern, older adults are more likely to take sleeping pills or sedatives to help them sleep, increasing their risk of fractures, falls, and death.

Research has found, however, that cognitive behavioral therapy for insomnia (CBTI) can be an effective way to treat this problem in older adults.  CBTI is a form of talk therapy where counselors help patients change their behavior, emotional responses, and thinking patterns that are related to sleep problems.

Many people do not receive CBTI, even though it is highly recommended as a primary form of therapy for insomnia.  This is likely due to there being few therapists who have been trained in CBTI techniques.  Furthermore, primary doctors have found it difficult to motivate their older patients to see a therapist.

A team of researchers decided to delve into this problem and see if there was a way around it.  They developed a new CBTI program using “sleep coaches” rather than therapists.  These sleep coaches have supervised weekly phone calls with patients, using a manual to help them with techniques.  The sleep coaches are health educators and social workers who undergo brief CBTI training.

This study was published in the Journal of the American Geriatrics Society. 

In this study, 159 patients were divided into one of three groups.  Participants were primarily male Caucasian veterans between the ages of 60 and 90 years.

Sleep coaches performed CBTI in the first two groups of participants.  One of the groups took therapy in a group setting, while the other had one-on-one sessions.  The third group of participants only received general sleep education.  Each group received five one-hour sessions given over a period of six weeks.

The two CBTI groups were taught in these sessions how to improve sleep habits and how to avoid things that could make sleeping more difficult.  New techniques were taught including using the bed for sleep only and limiting the amount of time they spent in bed.  In both of the CBTI groups, the participants had one weekly call with their sleep coaches and a trained CBTI psychologist to review how the patient was doing.

Sleep habits were analyzed at the start of the study and then again one week after the end of treatment.  The patients had 6- and 12-month follow-ups as well.

The participants who received CBTI reported that their sleep difficulties were significantly less following treatment.  The following statistics were reported:

  • Awake time was 18 minutes less after falling asleep
  • It took 23 minutes less to fall asleep
  • There was better quality of sleep
  • Total awake take was reported as about 68 minutes less through the entire night, so fewer awakenings

At the follow-up visits, both CBTI group participants had maintained improvement in their sleep.

There was no difference between the two CBTI groups in improvements, so it did not matter if they got one-on-one sessions or obtained the training through group therapy.

Since this was a limited study of mostly male veterans, there will need to be further studies on women and non-veterans; however, it is still notable that CBTI had a significant impact on insomnia for these older adults, and they believe it will be the same in other demographics as well.


Rachael Herman is a professional writer with an extensive background in medical writing, research, and language development. Her hobbies include hiking in the Rockies, cooking, and reading.

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