Tag Archives: sleep

Cognitive Behavior Therapy Conducted by Telephone May Ease Arthritis-Related Insomnia

Posted on by

Journal of the American Geriatrics Society Research Summary

A new study revealed that a talk therapy practice conducted by telephone could help older adults who have arthritis-related insomnia sleep better. The study was published in the Journal of the American Geriatrics Society.

Why does this matter?

Insomnia is a difficulty in falling or staying asleep. It affects more than 14 million Americans aged 65 and older. It may lead to daytime problems such as tiredness or fatigue, poor concentration, and daytime sleepiness.

Osteoarthritis (OA) is the most common form of arthritis. It can cause or worsen sleep problems. Older adults may develop arthritis after years of wear and tear on their joints, often due to normal physical activity or past injuries. About half of Americans over the age of 65 have been told they have arthritis by their healthcare provider.

What is Cognitive Behavior Therapy?

Cognitive behavioral therapy (CBT) is a type of talk therapy. It can be a fast-acting, long-lasting treatment for insomnia in older adults. In fact, studies suggest that CBT is one of the most effective therapies for insomnia. During CBT sessions, you learn to develop new sleep habits and to identify and change any unhelpful sleep habits.

What the Researchers Learned from this Study

The researchers’ interest in this study was inspired by earlier studies that showed strong evidence that  cognitive behavioral therapy is an effective treatment for insomnia. A growing body of evidence suggests that CBT is an especially successful treatment for insomnia that is related to arthritis discomfort.

However, CBT treatment typically requires weekly visits to a therapist’s office, often over several months. For older adults who have insomnia and arthritis, attending therapy sessions in person can be difficult or even impossible.

In this new study, researchers showed that having brief CBT sessions over the telephone was effective for improving arthritis-related insomnia and fatigue over 12 months. They said that the results of their trial showed that telephone CBT reduced the clinical and financial burdens of in-person, arthritis-related CBT insomnia treatment.

Research has shown that telephone CBT can also successfully treat smoking cessation and depression. These results have prompted some health insurance providers to cover CBT phone treatment for certain conditions.

How the Researchers Conducted this Study

The researchers recruited 325 adults aged 60 and over who had moderate to severe insomnia and arthritis pain. The participants were randomly selected to receive one of two treatments. One group received six CBT telephone sessions each week for eight weeks. These participants received coaching on sleep restriction, sleep hygiene, and learned how to restructure their sleep behavior. Participants also got homework assignments to perform.

Participants in the second treatment group received information about sleep and arthritis but did not receive any CBT sleep coaching. Both groups kept sleep diaries.

The researchers collected information on how the participants rated their general health and quality of life according to standard questionnaires. The participants ranked their insomnia status as well as their arthritis pain, stiffness, and ability to function.

After the sessions ended, the researchers said that the people in the CBT group showed improvements in sleeplessness and pain compared to those in the education-only group. They estimated that the cost for the CBT sessions was about $200 per person.

Study Limitations

According to the researchers, no studies exist to show whether CBT for arthritis-related insomnia is a cost-effective treatment. Experts say that there is a strong need for further study in this area. The researchers suggest that further study will help insurers and health care providers decide upon the best treatment decisions and evaluate the cost-effectiveness of CBT telephone treatment for arthritis-related insomnia.

What this Study Means for You

The researchers concluded that phone-delivered CBT significantly improved sleeplessness and pain without increasing total healthcare costs. The researchers said that their findings should encourage healthcare practitioners to consider telephone CBT treatment of insomnia for older adults who also have arthritis.

This summary is from “Cost-Effectiveness of Telephone Cognitive Behavioral Therapy for Osteoarthritis-Related Insomnia.” It appears online ahead of print in the Journal of the American Geriatrics Society. The study authors are Kai Yeung, PharmD, PhD; Weiwei Zhu, MS; Susan M. McCurry, PhD; Michael Von Korff, ScD; Robert Wellman, MS; Charles M. Morin, PhD; and Michael V. Vitiello, PhD.

Does Listening to Calming Music at Bedtime Actually Help You Sleep?

Posted on by

Journal of the American Geriatrics Society Research Summary

A new study published in the Journal of the American Geriatrics Society has found that listening to music can help older adults sleep better.

Researchers from the National Cheng Kung University Hospital in Taiwan combined the results of past studies to understand the effect that listening to music can have on the quality of older adults’ sleep. Their work suggests that:

  • Older adults (ages 60 and up) living at home sleep better when they listen to music for 30 minutes to one hour at bedtime.
  • Calm music improves older adults’ sleep quality better than rhythmic music does.
  • Older adults should listen to music for more than four weeks to see the most benefit from listening to music.

Why Older Adults Have Trouble Getting a Good Night’s Sleep

As we age, our sleep cycles change and make a good night’s sleep harder to achieve. What does it really mean to get a good night’s sleep? If you wake up rested and ready to start your day, you probably slept deeply the night before. But if you’re tired during the day, need coffee to keep you going, or wake up several times during the night, you may not be getting the deep sleep you need. [1] According to the National Institute on Aging, older adults need seven to nine hours of sleep each night.[2]

But studies have shown that 40 to 70 percent of older adults have sleep problems and over 40 percent have insomnia, meaning they wake up often during the night or too early in the morning.  Sleep problems can make you feel irritable and depressed, can cause memory problems, and can even lead to falls or accidents.

How the Researchers Studied the Effect of Music on Older Adults’ Quality of Sleep

For their study, the researchers searched for past studies that tested the effect of listening to music on older adults with sleep problems who live at home. They looked at five studies with 288 participants. Half of these people listened to music; the other half got the usual or no treatment for their sleep problems. People who were treated with music listened to either calming or rhythmic music for 30 minutes to one hour, over a period ranging from two days to three months.  (Calming music has slow tempo of 60 to 80 beats per minute and a smooth melody, while rhythmic music is faster and louder.) All participants answered questions about how well they thought they were sleeping. Each participant ended up with a score between 0 and 21 for the quality of their sleep.

 The researchers looked at the difference in average scores for:

  • people who listened to music compared to people who did not listen to music;
  • people who listened to calm music compared to people who listened to rhythmic music;
  • and people who listened to music for less than four weeks compared to people who listened to music for more than four weeks.

What the Researchers Learned

Listening to calming music at bedtime improved sleep quality in older adults, and calming music was much better at improving sleep quality than rhythmic music. The researchers said that calming music may improve sleep by slowing your heart rate and breathing, and lowering your blood pressure.[3] This, in turn helps lower your levels of stress and anxiety.

Researchers also learned that listening to music for longer than four weeks is better at improving sleep quality than listening to music for a shorter length of time.

 Limits of the Study

  • Researchers only looked at studies published in English and Chinese, meaning they may have missed studies in other languages on the effect of listening to music on sleep in older adults.
  • Results may not apply to older adults with Alzheimer’s disease or Parkinson’s disease.
  • In the studies researchers used, people who listened to music received more attention from researchers than did people who got standard or no treatment for their sleep problems. This means that sleep improvements in the music therapy group could be due to that extra attention.
  • Since the different studies used different kinds of music, researchers could not single out which type of calming music improved sleep the most.
  • All of the people in the study had similar kinds of sleep problems. This means listening to music may not help people with other kinds of sleep problems.

What this Study Means for You

If you’re having trouble sleeping, listening to music can be a safe, effective, and easy way to help you fall and stay asleep. It may also reduce your need for medication to help you sleep.

This summary is from “Effect of music therapy on improving sleep quality in older adults: A systematic review and meta-analysis.” It appears online ahead of print in the Journal of the American Geriatrics Society. The study authors are Chia-Te Chen, NP, MS; Yen-Chin Chen, RN, PhD; Heng-Hsin Tung RN, FNP, PhD; Ching-Ju, Fang, MLIS; Jiun-Ling Wang, MD; Nai-Ying Ko RN, PhD; and Ying-Ju Chang, RN, PhD.

[1] https://www.sleepfoundation.org/how-sleep-works/what-makes-good-night-sleep

[2] https://www.nia.nih.gov/health/good-nights-sleep

[3] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3011183/

 

 

 

The Effect of Sleep Quality on Peptic-Ulcer Relapse in Older Adults

Posted on by

Journal of the American Geriatrics Society Research Summary

Poor sleep quality and peptic ulcer disease (PUD, a condition when sores known as ulcers develop on the lining of your stomach or in the first part of your small intestine) are both major public health problems that affect the physical and psychological wellbeing of older adults.

Poor sleep quality can be caused by age-related increases in chronic health conditions, medication use, sleep behavior changes, and other issues. It affects around one-third of all older adults. Peptic ulcers are common among older adults, too. They often result from the presence of a specific bacteria, Helicobacter pylori (H. pylori), in our gut. Thanks to the development of treatments for H. pylori infections, however, the rate of recurrent peptic ulcers (ulcers that consistently come back after treatment) has dropped dramatically. Few people who experience a recurrence of ulcers, for example, are infected with H. pylori.

However, that still doesn’t explain why some people experience recurrence.

Recently, a team of researchers designed a study to test their hypothesis that other factors besides the bacteria could cause peptic ulcer recurrence—and that poor sleep may be among them. They published their results in the Journal of the American Geriatrics Society. Continue reading →

How much sleep do older adults need?

Posted on by

setters

Belinda Setters, MD, MS, AGSF, FACP
Director, Mobile ACE & Transitional Care Programs
Associate Clinical Professor
Geriatric Medicine & Palliative Care
Robley Rex VA Medical Center

When most of us talk about sleep needs, we usually think about children. We know children need a certain amount of sleep to stay active and healthy and to grow into adulthood. Children have a bedtime and parents (and grandparents!) work hard to ensure they are in bed on time and get the sleep they need every night. But most of us don’t think about how much sleep we get or need as we grow older. And yet, sleep is just as critical to our health as we age.

As we age, our brains may tell us to go to sleep earlier. This is likely why so many folks fall asleep right after the evening news or dinner. Despite this, most older adults don’t always get a full 8 hours of sleep or awaken feeling refreshed. This may be because our brains don’t cycle through deep sleep as well or as much as they did when we were younger. Restless legs, arthritis, and breathing disorders can also keep us awake. And then there is the bladder. Older adults with prostate or bladder disorders often get up at night to use the bathroom. This disrupts sleep as well. Our bodies adapt as we age to adjust to these changes and as a result our sleep patterns adapt as well.

But do we really need 8 hours of sleep as we get older? Does napping make up for this lack of sleep at night? Is it possible to sleep too much?

The National Sleep Foundation says yes—to all of those questions. In an expert panel convened by the Foundation, sleep experts and other specialists reviewed extensive research on sleep needs by age groups, including older adults. Their February 2015 report reflects the most up-to-date recommendations on sleep needs. The panel found that while sleep patterns change with aging, adults 65-years-old and older still need between 7-8 hours of sleep nightly, and ideally over a continuous period of time.

The panel further determined that—while this range is ideal for older adults—some people may need slightly less or more sleep to meet their individual needs. Some people may have a sleep pattern that results in feeling fully refreshed with only 6 hours of sleep, for example.  Meanwhile other people may need an extra hour or so, for a total of 9 hours nightly. To account for these variations, the panel noted a range just outside the recommended hours most folks need. This can be seen in the diagram released with the report below. Continue reading →