Nonpharmacological treatment of late-life insomnia

This article reviews the evidence regarding the efficacy of nonpharmacologi cal interventions for the treatment of late-life insomnia. Outcome data fro m more than a dozen treatment studies conducted with community-dwelling old er adults indicate that behavioral approaches produce reliable and durable therapeutic benefits, as evidenced by improved sleep efficiency and continu ity and enhanced satisfaction with sleep patterns. Treatment is also helpfu l for reducing hypnotic usage among older adults who are dependent on sleep medications. Treatment methods such as stimulus control and sleep restrict ion, which target maladaptive sleep habits, are especially beneficial for o lder insomniacs, whereas relaxation-based interventions, aimed at decreasin g arousal, produce more limited effects. Cognitive and educational interven tions are instrumental in altering age-related dysfunctional beliefs and at titudes about sleep. Integrated behavioral and pharmacological therapies ha ve received very little empirical attention thus far. Although a limited nu mber of older adults resume "normal" sleep patterns after treatment, outcom e is clinically meaningful as most patients report greater satisfaction wit h their sleep patterns, use less medications, and display less psychologica l distress and concerns about sleep. (C) 1999 Elsevier Science Inc.