Seniors aged 74 years and older who are troubled by chronic insomnia can be successfully treated with standardized cognitive behavioral therapy, or CBT, a new study has found.

Insomnia in older adults is common and associated with increased mortality and other illnesses, including depression, anxiety, cognitive decline and increased risk for falls. CBT, an evidence-based psychological treatment, has been shown to help ease the condition. But most studies have focused on people aged 65 to 74 years old or older, reported investigators from the Icahn School of Medicine at Mount Sinai, New York City. 

“Frailty, pain, nocturia, cognitive limitations, and late evening/early morning medical/medication regimens can interfere with sleep — especially among very old patients — and may make insomnia more difficult to treat,” wrote Gregory Hinrichsen Ph.D., and Rosanne Leipzig, M.D., Ph.D., in the Journal of the American Geriatrics Society.

To see whether the therapy could benefit this oldest-old age group, the investigators analyzed treatment outcomes for 29 Mount Sinai patients with a mean age of 77, most of whom were aged 76 to 93 years. All met the psychiatric criteria for insomnia for at least five years, and all had multiple health problems. None had other sleep disorders, such as sleep apnea, and all were cognitively intact.  

Participants received CBT for insomnia, or CBT-I, from the manual “Cognitive Behavioral Treatment of Insomnia: A Session-by-Session Guide.” Treatment ended when patients had two weeks of sustained improvement based on their sleep diaries, although some required lengthier treatment.

The therapy was significantly beneficial, reported Hinrichsen and Leipzig. Total sleep time remained unchanged, but severity of insomnia was largely reduced, followed by markedly improved sleep efficacy, and a large decrease in the time it took to fall asleep and to awaken later on. “Sleepiness, depression, anxiety, and early morning awakening also decreased significantly,” the authors wrote.

The patient group was quite complex medically. “Nonetheless, among a group of predominantly old-old and oldest old patients, we found that CBT-I is a highly effective treatment for chronic insomnia,” they concluded.