Brief advice cuts insomnia in elderly

Treatment could reduce patients' risk of fracture and cardiovascular disease.

Chronic insomnia in elderly patients can be treated by brief behavioural therapy in primary care, potentially reducing hip fractures and cardiovascular events, a study has shown.

Treating just five patients would remedy two cases of insomnia, researchers found.

A team, led by Dr Daniel Buysse of the University of Pittsburgh School of Medicine, found one-on-one behavioural advice successfully treated many cases of chronic insomnia.

Insomnia affects 15-35% of older adults and is linked to an increased risk of falls and hip fractures in this age group. The condition also increases the risk of psychiatric disorders and cardiovascular disease.

Behavioural interventions, which educate patients about sleep, stimulus control and addressing stressful thoughts before bed, are known to be efficacious. But use is limited by the number of trained specialists and the cost of sessions.

The researchers tracked 79 older adults randomised to receive either the behavioural intervention or a control, which provided patients with printed information.

The behavioural treatment involved a 45- to 60-minute session with a nurse, a 30-minute follow-up session after two weeks and a phone call after one and three weeks.

The response to treatment was measured using self-reported questionnaires.

Over half of patients (55%) undergoing behavioural therapy no longer had insomnia four weeks after treatment began, compared with 13% given control therapy.

Overall, the behaviour therapy was 42% more likely to lead to normal sleep patterns, and improvements were maintained at six months.

'The brief behavioural treatment for insomnia delivered by a nurse clinician may be an efficacious and practical treatment for chronic insomnia in older adults,' the researchers said.

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