A systematic review of non-pharmacological therapies for sleep problems in later life

Steep problems become more common with age, affect quality of life for individuals and their families, and can increase healthcare costs. Older people are often prescribed a range of drugs for their health problems, many of which have side effects. Side effects are just one reason why there is an argument to be made for clinical use of non-pharmacological treatments. This review considers the effectiveness of three interventions, cognitive behavioural therapy (CBT), bright tight, and physical exercise. It considers steep quality, duration and efficiency as primary outcome measures. Randomised controlled trials were selected where 80% or more of participants were over 60 and had a diagnosis of primary insomnia and where investigators had taken care to screen participants for dementia and/or depression. The data suggest a mild effect of CBT for steep problems in older adults, best demonstrated for steep maintenance insomnia. It may be that the provisions of 'top-up' or 'refresher' sessions of CBT training to improve durability of effect are worthy of investigation. Evidence of the efficacy of bright light and exercise were so limited that no conclusions about them can be reached as yet; however, in view of the promising results of bright Light therapy in other populations with problems of steep timing, further research into its effectiveness with older adults would seem justifiable. Exercise, though not appropriate for all. in this population, may enhance steep. Research involving exercise programmes designed with the elderly in mind is needed. (C) 2003 Elsevier Ltd. ALL rights reserved.