Cognitive behavioral therapy may provide a greater benefit than sleeping pills to elderly people in improving sleep and maintaining improvement, according to an article in the January issue of the Cochrane Database Systematic Review (Oxford University).

According to the review, between 12 and 40 percent of older people (roughly age 65 years or older) have significant problems such as difficulty falling asleep, early morning awakening, or inability to return to sleep. Such chronic problems can negatively affect mood, energy, and general performance. Probably fewer than 15 percent of affected people receive therapy, with medication the usual treatment of choice. However, side effects of medication can be felt during the day in this potentially fragile population, increasing the risk for conditions ranging from constipation to falls and fractures.

A literature review was conducted on clinical trials of cognitive behavioral therapy for people over 60 years old. Such treatment aims to improve sleep by changing poor sleeping habits and challenging negative thoughts, attitudes, or beliefs about sleep. The researchers found that studies carried out in the most scientifically rigorous manner consistently reported improvements in maintaining good sleep for those who had cognitive behavioral therapy.

Therapy as studied in the trials used a variety of specific regimens. Some programs focused on teaching good sleep habits, for example, making sure that people reduce their caffeine intake after 4 pm and that they prepare for rest properly in a number of ways. Other approaches emphasized muscle relaxation skills or skills to help people overcome anxiety associated with insomnia.

Paul Montgomery, MD, lead author of the review, said “Older people are often prescribed a range of drugs for their health problems, many of which have side effects. Such side effects are just one reason why there is an argument to be made for clinical use of non-pharmacological treatments. Further research into which elements of cognitive behavioral therapy are most useful is needed. To increase the long-term effect, it may be necessary to do ‘top-up’ sessions at regular intervals. Cognitive behavioral therapy may also be useful in preventive education for sleep disorders.”