Implementation and Effectiveness of Cognitive Behavioral Therapy for Insomnia in Geriatric Primary Care

ABSTRACT

Objectives

We evaluated a plan for implementation and effectiveness of cognitive behavioral therapy for insomnia (CBT-I) in geriatric primary care by a geropsychologist.

Methods

The flow of referrals to a geropsychologist was tracked and, among those eligible and interested in participating, success in deprescribing sleep medications and the effectiveness of CBT-I were documented.

Results

Seventy patients were referred for evaluation of whom 62 were eligible for CBT-I; 34 began CBT-I and 29 completed a full course of treatment. Almost two-thirds of treatment completers were the “old old” (76–84 years) and “oldest old” (85–93 years) with multiple medical problems. Most treatment completers taking sleep medications had them deprescribed at the beginning of treatment and, one year after treatment, did not have them re-prescribed. After CBT-I, two-thirds of patients met the insomnia severity index criteria for response; and three-fifths for remission from insomnia. Further, most patients had sustained improvement in their target insomnia symptom(s) and sleep efficiency.

Conclusions

CBT-I can be implemented in geriatric primary care with successful deprescribing of sleep medications and meaningful improvement in symptoms of insomnia in a group of older adults of advanced age with multiple medical problems.

Clinical Implications

Clinical gerontologists can play an important role in improving late life insomnia.

KEYWORDS:

• Dissemination
• evidence-based
• psychotherapy
• deprescribing

Acknowledgements

We thank Michael Perlis, PhD and Donn Posner, PhD for training in cognitive behavioral therapy for insomnia (CBT-I); and Donn Posner, PhD for his skillful consultation on initial CBT-I cases.

Disclosure statement

No potential conflict of interest was reported by the authors.

Data Availability Statement

Due to the nature of this research, data were drawn from a retrospective review of patient records. Therefore participants of this study did not agree for their data to be shared publicly, so supporting data are not available.

Additional information

Funding

This work was partially supported by a grant, “Adapting IMPACT to an Academic Geriatric Practice,” from the Fan Fox and Leslie R. Samuels Foundation (to Rosanne Leipzig, MD, PhD).