Awake at 4 a.m.: treatment of insomnia with early morning awakenings among older adults


  • Preparation of this article was supported by NIH NIA K23 AG028452, NIMH T32 MH 019925-1; VA Greater Los Angeles Healthcare System, Geriatric Research, Education and Clinical Center; and the UCLA Cousins Center for Psychoneuroimmunology.


Insomnia is a common problem among older adults. In particular, older adults experience insomnia coupled with early morning awakenings due to an interaction between age-related changes in circadian rhythm timing coupled with behavior changes that contribute to sustained poor sleep. Cognitive–behavioral therapy for insomnia (CBT-I), at times coupled with circadian interventions (e.g., timed light exposure), are likely to be most successful in optimizing sleep quality. In delivering CBT-I to older adults, modifications are sometimes necessary to accommodate for medical problems, lifestyle, social factors, and patient preferences. Addition of circadian interventions can ameliorate the negative effects of inappropriately timed sleep as well. These treatment methods can be highly effective and benefits can be long-standing. A case example is used to illustrate these points. © 2010 Wiley Periodicals, Inc. J Clin Psychol: In Session 66:1–14, 2010.