Sleep medication is the most common treatment for insomnia in older adults. However, prolonged use of hypnotics has several negative side-effects and can lead to a pattern of tolerance and dependence. Recent research has found promising results for interventions that included both supervised gradual medication withdrawal and cognitive behavior therapy (CBT) for the treatment of hypnotic-dependent insomnia. Furthermore, there is increasing evidence that incorporating mindfulness meditation can result in a more potent CBT intervention for insomnia. In this article, the authors describe and discuss the effects of a broadly focused intervention for treating hypnotic-dependent insomnia in an older adult. The treatment simultaneously targets insomnia symptoms, comorbid symptoms such as pain, dependency issues, and the discontinuation of hypnotic medication.
AvidanA. Y. (2003). Insomnia in the geriatric patient. Clinical Cornerstone, 5, 51-60.
2.
BaerR. A.KrietemeyerJ. (2006). Overview of mindfulness-and acceptance-based treatment approaches. In BaerR. A. (Ed.), Mindfulness-based treatment approaches: Clinician’s guide to evidence base and application (pp. 3-27). London, England: Academic Press.
3.
BaerR. A.SmithG. T.HopkinsJ.KrietemeyerJ.ToneyL. (2006). Using self-report assessment methods to explore facets of mindfulness. Assessment, 13, 27-45.
4.
BencaR. M.Ancoli-IsraelS.MoldofskyH. (2004). Special considerations in insomnia diagnosis and management: Depressed, elderly and chronic pain populations. Journal of Clinical Psychiatry, 65, 26-35.
5.
BjellandI.DahlA. A.HaugT. T.NeckelmannD. (2002). The validity of the Hospital Anxiety and Depression Scale: An updated literature review. Journal of Psychosomatic Research, 52, 69-77.
6.
BonnetM. H.ArandD. L. (1998). The consequences of a week of insomnia II: Patients with insomnia. Sleep, 21, 359-368.
7.
BuysseD. J.Ancoli-IsraelS.EdingerJ. D.LichtsteinK. L.MorinC. M. (2006). Recommendations for a standard research assessment of insomnia. Sleep, 29, 1155-1173.
8.
ChiesaA.SerretiA. (2014). Are mindfulness-based interventions effective for substance use disorders? A systematic review of the evidence. Substance Use & Misuse, 49, 492-512.
9.
ColeM. G.DendukuriN. (2003). Risk factors for depression among elderly community subjects: A systematic review and meta-analysis. American Journal of Psychiatry, 160, 1147-1156.
10.
DahlJ. C.WilsonK. G.LucianoC.HayesS. C. (2005). Acceptance and commitment therapy for chronic pain. Reno, NV: Context Press.
11.
DalrympleK. L.FiorentinoL.PolitiM. C.PosnerD. (2010). Incorporating principles from acceptance and commitment therapy into cognitive-behavioral therapy for insomnia: A case example. Journal of Contemporary Psychotherapy, 40, 209-217.
12.
DundasI.VøllestadJ.BinderP.-E.SivertsenB. (2013). The Five Factor Mindfulness Questionnaire in Norway. Scandinavian Journal of Psychology, 54, 250-260.
13.
FarrarJ. T.YoungJ. P.LaMoreauxL.WerthJ. L.PooleR. M. (2001). Clinical importance of changes in chronic pain intensity measured on an 11- point numerical pain rating scale. Pain, 94, 149-158.
14.
GarciaA. D. (2008). The effect of chronic disorders on sleep in the elderly. Clinics in Geriatric Medicine, 24, 27-38.
15.
GouldR. L.CoulsonM. C.PatelN.Highton-WilliamsonE.HowardR. J. (2014). Interventions for reducing benzodiazepine use in older people: Meta-analysis of randomized controlled trials. The British Journal of Psychiatry, 204, 98-107.
16.
HayesS. C.StrosahlK. D.WilsonK. G. (1999). Acceptance and commitment therapy: An experiential approach to behavior change. New York, NY: Guilford.
17.
HerrK. A. (2005). Pain assessment in the older adult with verbal communication skills. In GibsonS. J.WeinerD. K. (Eds.), Pain in older persons: Progress in pain research and management (Vol. 35, pp. 111-133). Seattle, WA: IASP Press.
18.
IrwinM. R.ColeJ. C.NicassioP. M. (2006). Comparative meta-analysis of behavioral interventions for insomnia and their efficacy in middle-aged adults and in older adults 55+ years of age. Health Psychology, 25, 3-14.
19.
Kabat-ZinnJ.LipworthL.BurneyR. (1985). The clinical use of mindfulness meditation for the self-regulation of chronic pain. Journal of Behavioral Medicine, 8, 163-190.
20.
KyleS. D.CrawfordM. R.EspieC. A. (2013). From bedside to bench? A commentary on the future of cognitive behavioral therapy for insomnia. What important research remains to be done?Journal of Clinical Psychology, 69, 1022-1025.
21.
LaidlawK.ThompsonL. W.Gallagher-ThompsonG. (2004). Comprehensive conceptualization of cognitive behavior therapy for late life depression. Behavioural and Cognitive Psychotherapy, 32, 389-399.
22.
LauM. A.McMainS. F. (2005). Integrating mindfulness meditation with cognitive and behavioural therapies: The challenge of combining acceptance and change-based strategies. Canadian Journal of Psychiatry, 50, 863-869.
23.
LichsteinK. L. (2006). Behavioral intervention for special insomnia populations: Hypnotic-dependent insomnia and comorbid insomnia. Sleep Medicine, 7S1, S27-S31.
24.
LichsteinK. L.NauS. D.WilsonN. M.AguillardN. R.LesterK. W.BushA. J.McCraeC. S. (2013). Psychological treatment of hypnotic-dependent insomnia in a primarily older adult sample. Behavior Research and Therapy, 51, 787-796.
25.
MelzackR. (1987). The short-form McGill Pain Questionnaire. Pain, 30, 191-197.
26.
MontgomeryP.DennisJ. (2003). Cognitive behavioural interventions for sleep problems in adults aged 60. Cochrane Database Systematic Reviews, CD0031617.
27.
MorinC. M.BastienC.GuayB.Radouco-ThomasM.LeblancJ.VallieresA. (2004). Randomized clinical trial of supervised tapering and cognitive behavior therapy to facilitate benzodiazepine discontinuation in older adults with chronic insomnia. American Journal of Psychiatry, 161, 332-342.
28.
MorinC. M.BastienC.SavardJ. (2003). Current status of cognitive-behavior therapy for insomnia: Evidence for treatment effectiveness and feasibility. In PerlisM. L.LichsteinK. L. (Eds.), Treating sleep disorders: Principles and practice of behavioral sleep medicine (pp. 262-285). Hoboken, NJ: John Wiley.
29.
OhayonM. M. (2002). Epidemiology of insomnia: What we know and what we still need to learn. Sleep Medicine Reviews, 6, 83-96.
30.
OngJ. C.ShapiroS. L.ManberR. (2008). Combining mindfulness meditation with cognitive-behavior therapy for insomnia: A treatment-development study. Behavior Therapy, 39, 171-182.
31.
OngJ. C.UlmerC. S.ManberR. (2012). Improving sleep with mindfulness and acceptance: A metacognitive model of insomnia. Behavior Research and Therapy, 50, 651-660.
32.
PallesenS.BjorvatnB.NordhusI. H.SivertsenB.HjørnevikM.MorinC. M. (2008). A new scale for measuring insomnia: The Bergen Insomnia Scale. Perceptual and Motor Skills, 107, 691-706.
33.
ProchaskaJ. O.DiClementeC. C. (1984). The transtheoretical approach: Crossing traditional boundaries of treatment. Homewood, IL: Dow Jones-Irwin.
34.
RollnickS.MillerW. R.ButlerC. C. (2008). Motivational interviewing in health care: Helping patients change behavior. New York, NY: Guilford.
35.
SivertsenB.OmvikS.PallesenS.BjorvatnB.HavikO.KvaleG.. . .NordhusI. H. (2006). Cognitive behavioral therapy vs zopiclone for treatment of chronic primary insomnia in older adults. Journal of the American Medical Association, 295, 2851-2858.
36.
StepanskiE.ZorickF.RoehrsT. (1988). Daytime alertness in patients with chronic insomnia compared with asymptomatic control subjects. Sleep, 11, 54-60.
37.
VeehofM. M.OskamM.-J.SchreusK. M. G.BohlmeijerE. T. (2011). Acceptance-based interventions for the treatment of chronic pain: A systematic review and meta-analysis. Pain, 152, 533-542.
38.
WatersS. J.WoodwardJ. T.KeefeF. J. (2005). Cognitive-behavioral therapy for pain in older adults. In GibsonS. J.WeinerD. K. (Eds.), Pain in older persons. Progress in pain research and management (Vol. 35, pp. 239-261). Seattle, WA: IASP Press.
39.
ZigmondA. S.SnaithR. P. (1983). The Hospital Anxiety and Depression Scale. Acta Psychiatrica Scandinavica, 67, 361-370.
