Nonpharmacological treatment of late-life insomnia

This article reviews the evidence regarding the efficacy of nonpharmacological interventions for the treatment of late-life insomnia. Outcome data from more than a dozen treatment studies conducted with community-dwelling older adults indicate that behavioral approaches produce reliable and durable therapeutic benefits, as evidenced by improved sleep efficiency and continuity and enhanced satisfaction with sleep patterns. Treatment is also helpful for reducing hypnotic usage among older adults who are dependent on sleep medications. Treatment methods such as stimulus control and sleep restriction, which target maladaptive sleep habits, are especially beneficial for older insomniacs, whereas relaxation-based interventions, aimed at decreasing arousal, produce more limited effects. Cognitive and educational interventions are instrumental in altering age-related dysfunctional beliefs and attitudes about sleep. Integrated behavioral and pharmacological therapies have received very little empirical attention thus far. Although a limited number of older adults resume "normal" sleep patterns after treatment, outcome is clinically meaningful as most patients report greater satisfaction with their sleep patterns, use less medications, and display less psychological distress and concerns about sleep. (C) 1999 Elsevier Science Inc.