The Effectiveness of the Behavioural Components of Cognitive Behavioural Therapy for Insomnia (CBTI) in Older Adults: A Systematic Review

Insomnia is more prevalent in older adults than in the general population. Cognitive Behavioural Therapy for Insomnia (CBTI) is the gold standard treatment, however, 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) treated insomnia in older adults; (c) used sleep restriction and/or stimulus control; (d) reported outcomes pre-and-post intervention. Database searches returned 1,689 articles. Fifteen 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 CBTI is not appropriate.