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To Sleep, Perchance to Rest: Cognitive behavioral therapy for insomnia can help you sleep better.

Do you have a hard time falling asleep? Do you wake in the middle of the night or too early in the morning? Do you stress out during the day or evening, wondering if this will be the night that you actually get some real sleep? Many seniors struggle with these issues. While aging can negatively impact sleep, simply being older isn't the reason for poor slumber.

"As people grow older they are more likely to be on multiple medications and have medical conditions that can disrupt sleep," explains Alon Avidan, MD, MPH, Director of the UCLA Sleep Disorders Center. "For example, a man with an enlarged prostate can't hold as much urine and has to make frequent trips to the bathroom. Postmenopausal women can be awakened by night sweats for years after menopause. And sleep apnea disrupts sleep in both men and women and often leads to unexplained awakening at night, severe sleepiness, depression and poor quality of life."

Treating the underlying cause of sleep disruption is the first step in helping people get needed nightly rest. Sometimes that solves the sleep issue. But insomnia is also a distinct sleep disorder. Cognitive behavioral therapy for insomnia (CBT-I) is a non-medication method that can improve sleep for people with underlying conditions and those who have insomnia as a primary disorder. It is considered the first-line and ideal treatment by the National Institutes of Health.

"Most of my patients are intrigued by the cognitive therapy approach," says Dr. Avidan. "Oftentimes patients have incorporated behaviors, such as solving puzzles on an electronic tablet, that are detrimental to their sleep. CBT-I targets these habits that perpetuate insomnia and should be discontinued."

Better Sleep With CBT-I

Though sudden stressful life experiences, such as divorce or the death of a loved one, can trigger insomnia, the disorder often develops as a result of a complexity of factors. Unwinding disruptive thoughts and behaviors can take time. CBT-I is like a sleep rehab program requiring patients to essentially "learn how to sleep again."

CBT-I is typically conducted by a health-care professional, such as a psychologist, psychiatrist, or certified social worker with special training in the area. Once the trained provider obtains a sleep history, he or she would prescribe a program tailored to the needs of patients. "Like dieting, CBT-I is not a quick fix, but would likely take a few weeks or more to produce positive results," says Dr. Avidan. "But over time positive change does take hold and your ability to fall and stay asleep will improve."

With CBT-I, patients will discover personal ingrained beliefs and habits that thwart their sleep, and develop skills to overcome them. Maintaining detailed sleep logs is an important component of the program. Therapists review these logs to pinpoint behaviors not conducive to sleep and to develop techniques to help patients resolve them.

Sleep logs are a diary of behaviors and seek such as information as:

* What time you went to bed and how long you think it took to fall asleep.

* What time you woke up to start your day.

* How many times you woke up during the night.

* How much caffeine or alcohol you consumed and when.

* The degree of your stress level.

* Medications taken and when they are taken.

You can find a sample log at

Providers and Resources

Seeing a cognitive and behavioral therapist for insomnia is ideal and CBT-I providers can be located by visiting the Society of Behavioral Sleep Medicine, (click on the provider search tab on the top right of the navigation menu). Innovative online CBT-I may be offered to patients who are unable to participate in face-to-face treatment, and that approach can provide up to 70 percent improvement. Examples include:

* provides weekly personalized feedback and guidelines for discontinuing sleep medications.

* SHUTi ( offers a self-help and professional portal where clinicians can monitor a patient's progress over time online.

* is free and open access CBT-I tool with excellent educational resources.


* Insomnia affects between 20 and 50 percent of older adults.

* Poor sleep can lead to depression, anxiety, and a reduced quality of life.

* CBT-I has been clinically proven to relieve insomnia.
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Title Annotation:SLEEP
Publication:Healthy Years
Date:Nov 1, 2018
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