Insomnia (primary) in older people: non-drug treatments
Insomnia affects up to 40% of older adults. The prevalence increases with age. Primary insomnia is chronic insomnia without specific underlying medical, psychiatric, or other sleep disorders.
Focus of the review
Due to the high prevalence of insomnia in older adults, and the potentially increased risk of sleeping medications in this population, we chose to focus this review on the evidence for non-drug interventions for primary insomnia. In addition, essentially all published guidelines focusing on older adults include that non-drug interventions are recommended as first-line treatment for insomnia.
Comments on evidence
The evidence for effectiveness of cognitive behavioural therapy for insomnia (CBT-I) is convincing, whereas the evidence for exercise programmes and timed exposure to bright light is less clear.
Search and appraisal summary
The update literature search for this review was carried out from the date of the last search, December 2010, to May 2014. For more information on the electronic databases searched and criteria applied during assessment of studies for potential relevance to the review, please see the Methods section. After deduplication and removal of conference abstracts, 112 records were screened for inclusion in the review. Appraisal of titles and abstracts led to the exclusion of 92 studies and the further review of 30 full publications. Of the 30 full articles evaluated, four RCTs were added at this update.
Although this review focuses on primary insomnia, it is important to mention that, in older adults, insomnia commonly occurs in the presence of other comorbid conditions and that CBT-I is also efficacious in treating such insomnia.
Substantive changes at this update
INTRODUCTION: Up to 40% of older adults have insomnia, with difficulty getting to sleep, early waking, or feeling unrefreshed on waking. The prevalence of insomnia increases with age. Other risk factors include psychological factors, stress, daytime napping, and hyperarousal. METHODS AND OUTCOMES: We conducted a systematic review and aimed to answer the following clinical question: What are the effects of non-drug treatments for primary insomnia in older people (aged 60 years and older)? We searched: Medline, Embase, The Cochrane Library, and other important databases up to May 2014 (BMJ Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). RESULTS: We found 14 studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. CONCLUSIONS: In this systematic review, we present information relating to the effectiveness and safety of the following interventions: cognitive behavioural therapy for insomnia (CBT-I), exercise programmes, and timed exposure to bright light.
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Management of Insomnia Disorder. Comparative Effectiveness Review No. 159. ( 17 February 2016 )
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