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Cognitive behavioural interventions for sleep problems in adults aged 60+

  • Review
  • Intervention

Authors


Abstract

Background

The prevalence of sleep problems in adulthood increases with age. While not all sleep changes are pathological in later life, severe disturbances may lead to depression, cognitive impairments, deterioration of quality of life, significant stresses for carers and increased healthcare costs. The most common treatment for sleep disorders (particularly insomnia) is pharmacological. The efficacy of non-drug interventions has been suggested to be slower than pharmacological methods, but with no risk of drug-related tolerance or dependency. Cognitive and behavioural treatments for sleep problems aim to improve sleep by changing poor sleep habits, promoting better sleep hygiene practices and by challenging negative thoughts, attitudes and beliefs about sleep.

Objectives

To assess the efficacy of cognitive-behavioural interventions in improving sleep quality, duration and efficiency amongst older adults (aged 60 and above).

Search methods

The following databases were searched: The Cochrane Library (Issue 1, 2002); MEDLINE (1966 - January 2002); EMBASE (1980 - January 2002), CINAHL (1982 - January 2002); PsycINFO (1887 to 2002); National Research Register (NRR) (2002, Issue 1_. Bibliographies of existing reviews in the area, as well as of all trial reports obtained, were searched. Experts in the field were consulted.

Selection criteria

Randomised controlled trials of cognitive behavioural treatments for primary insomnia where 80% or more of participants were over 60. Participants must have been screened to exclude those with dementia and/or depression.

Data collection and analysis

Abstracts of studies identified in searches of electronic databases were read and assessed to determine whether they might meet the inclusion criteria. Data were analysed separately depending on whether results had been obtained subjectively or objectively.

Main results

Six trials, including 282 participants with insomnia, examined the effectiveness of cognitive-behavioural treatments (CBT) for sleep problems in this population. The final total of participants included in the meta-analysis was 224. The data suggest a mild effect of CBT for sleep problems in older adults, best demonstrated for sleep maintenance insomnia.

Authors' conclusions

When the possible side-effects of standard treatment (hypnotics) are considered, there is an argument to be made for clinical use of cognitive-behavioural treatments. Research is needed to establish the likely predictors of success with such treatments. As it may well be the case that the treatment efficacy of cognitive-behavioural therapy itself is not durable, the provision of "top-up" ("refresher" sessions of CBT training to improve durability of effect are worthy of investigation.

摘要

背景

以認知行為介入處理60歲以上成人睡眠問題的

成人睡眠問題的盛行率隨著年齡而增加。在老年期,並不是所有的睡眠改變都是病態的,但是嚴重的障礙仍可能造成憂鬱、認知障礙、生活品質惡化、照顧者的壓力和健康照護增加成本。對於睡眠問題,尤其是失眠,最常見的治療方式是藥物治療。非藥物的治療效果,一般認為要比藥物治療來的緩慢,但可以免除藥物相關的耐受性和依賴性的問題。認知和行為治療的目的在於,藉由改變不好的睡眠習慣、改善睡眠衛生、挑戰並質疑負面的想法、態度和信念,來改善睡眠。

目標

評估認知行為治療對於改善老年人 (年齡大於60歲以上) 之睡眠的品質、期間長短及效率的成效。

搜尋策略

搜尋的資料庫包括:MEDLINE (1966年2001年十月) ;EMBASE (1980年2002年一月) ,CINAHL (1982年2002年一月) ;PsychINFO 1887年2002年;The Cochrane Library (Issue 1, 2002) ;National Research Register (NRR [2002]) 。關於這個領域的現有回顧之參考文獻、和所有試驗報告都在搜尋範圍內。並且徵詢這個領域的專家意見被徵詢。

選擇標準

認知行為治療,針對受試者患有原發性失眠,且80% 以上之參與者為60歲以上之隨機對照試驗 (randomised controlled trial) 。受試者必須經過篩選以排除有失智者或有憂鬱症者。

資料收集與分析

經過電子資料庫搜尋後的研究摘要,經過閱讀評估以決定是否符合納入條件。資料再依照結果為「主觀」或「客觀」獲取來分類,個別進行分析。

主要結論

總共有6個試驗,包括282名有失眠的參與者,接受針對睡眠問題的認知行為治療來驗證其效果。最終共有224名參與者被納入統合分析中。結果顯示,行為認知治療對於老年人的睡眠問題,有輕微的效果,特別是在睡眠維持障礙部份。

作者結論

當考慮到標準治療 (安眠藥) 的可能副作用時,臨床上是否要選擇認知行為治療是有爭議的。進一步研究,是需要尋找什麼樣的因子可用來預測這類治療是否可成功。既然行為認知治療的效果被認為並不持久,提供行為認知治療的補強訓練,來加強治療的效果持續度,是值得探討的。

翻譯人

本摘要由成功大學附設醫院紀美宏翻譯。

此翻譯計畫由臺灣國家衛生研究院 (National Health Research Institutes, Taiwan) 統籌。

總結

睡眠問題隨著年齡增加變得更為普遍,並影響到個人和家庭的生活品質,也會增加健康照護的成本。老年人常會因健康問題 (包括睡眠) 而被開立藥物,而許多都有副作用。這篇回顧是評估認知行為治療的效果;藉由改變不好的睡眠習慣,挑戰關於睡眠的負面想法、態度與信念,來改善睡眠。回顧者報告只能取得有限的證據,而且認知行為治療只有微弱的效果。

Plain language summary

Cognitive behavioural therapy for older adults (aged 60+) with sleep problems

Sleep 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 (including with sleep) many of which have side effects. This review considered the effectiveness of cognitive and behavioural treatments (CBT). These aim to improve sleep by changing poor sleep habits and by challenging negative thoughts, attitudes and beliefs about sleep. Reviewers report that there is only limited evidence available, and what data there is suggests a mild effect of CBT.

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