The effectiveness of the behavioural components of cognitive behavioural therapy for insomnia in older adults: a systematic review

McLaren, D. M. , Evans, J. , Baylan, S. , Smith, S. and Gardani, M. (2023) The effectiveness of the behavioural components of cognitive behavioural therapy for insomnia in older adults: a systematic review. Journal of Sleep Research, 32(4), e13843. (doi: 10.1111/jsr.13843) (PMID:36802110)

Abstract

Insomnia is more prevalent in older adults (< 60 years) than in the general population. Cognitive behavioural therapy for insomnia is the gold-standard treatment; however, it may prove too cognitively taxing for some. This systematic review aimed to critically examine the literature exploring the effectiveness of explicitly behavioural interventions for insomnia in older adults, with secondary aims of investigating their effect on mood and daytime functioning. Four electronic databases (MEDLINE – Ovid, Embase – Ovid, CINAHL, and PsycINFO) were searched. All experimental, quasi-experimental and pre-experimental studies were included, provided they: (a) were published in English; (b) recruited older adults with insomnia; (c) used sleep restriction and/or stimulus control; (d) reported outcomes pre-and-post intervention. Database searches returned 1689 articles; 15 studies, summarising the results of 498 older adults, were included – three focused on stimulus control, four on sleep restriction, and eight adopted multicomponent treatments comprised of both interventions. All interventions brought about significant improvements in one or more subjectively measured facets of sleep although, overall, multicomponent therapies demonstrated larger effects (median Hedge's g = 0.55). Actigraphic or polysomnographic outcomes demonstrated smaller or no effects. Improvements in measures of depression were seen in multicomponent interventions, but no intervention demonstrated any statistically significant improvement in measures of anxiety. This corroborates with the existing consensus that multicomponent approaches confer the most benefit, and adds to the literature by demonstrating this to be the case in brief, explicitly behavioural interventions. This review guides future study of treatments for insomnia in populations where cognitive behavioural therapy for insomnia is not appropriate.

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Smith, Miss Sarah and Gardani, Dr Maria and Evans, Professor Jonathan and McLaren, Declan and Baylan, Dr Satu
• Authors: McLaren, D. M., Evans, J., Baylan, S., Smith, S., and Gardani, M.
• College/School: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Mental Health and Wellbeing; College of Medical Veterinary and Life Sciences > School of Psychology & Neuroscience
• Journal Name: Journal of Sleep Research
• Publisher: Wiley
• ISSN: 0962-1105
• ISSN (Online): 1365-2869
• Published Online: 19 February 2023
• Copyright Holders: Copyright © 2023 The Authors
• First Published: First published in Journal of Sleep Research 32(4):e13843
• Publisher Policy: Reproduced under a Creative Commons License

Project Code	Award No	Project Name	Principal Investigator	Funder's Name	Funder Ref	Lead Dept
303166		Scottish Graduate School Science Doctoral Training Partnership (DTP)	Mary Beth Kneafsey	Economic and Social Research Council (ESRC)	ES/P000681/1	SS - Academic & Student Administration