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The Best Treatment for Sleep Problems in Elderly Adults - with Dr. Daniel Wachtel

May 27, 2020




You may be surprised to hear that the best sleep aid for older adults with insomnia is not a medication. It's a type of psychotherapy, called CBT-I for Insomnia, or Cognitive Behavioral Therapy for Insomnia (CBT-I).


Insomnia is one of the most common sleep disorders experienced by older adults. Insomnia essentially means that a person has trouble falling or staying asleep, or experiences non-restorative sleep. This, of course, can lead to issues during the day like cognitive problems and mood and emotional issues.


Did you know that as many as 50% of older adults complain about difficulty falling asleep or staying asleep? And in fact, older adults (people 65 and older) are more likely to experience insomnia than younger or middle aged adults.


But here's the thing... Sleep problems in elderly adults are treatable. In as little as one to ten (1-10 sessions) of CBT-I, older adults sleep better!


Today's guest, Dr. Daniel Wachtel is a Clinical Psychologist and Geropsychologist. He works in private practice and is currently a clinical psychologist for the Home Based Primary Care Program at the Atlanta VA Health Care System, where he provides psychotherapy to chronically and terminally ill veterans and support to their families and caregivers. Dr. Wachtel has advanced training in sleep disorders and provides treatment for insomnia and related difficulties with sleep. 


In this episode of the Psychology of Aging Podcast, Dr. Wachtel tells us about the number one treatment for insomnia in elderly adults - Cognitive Behavioral Therapy for Insomnia (CBT-I)


Here’s a look inside my interview with Dr. Daniel Wachtel:

  • [05:24] Dr. Wachtel reveals the surprising statistics that explain exactly why sleep such an important topic when it comes to older adults
  • [07:59] Insomnia is one of those terms that people commonly use. Get the real definition of insomnia here.
  • [08:45] Dr. Wachtel reveals why insomnia is more prevalent in older adults than adults of any other age group
  • [15:43] Sleep is essential to health and well-being. Discover what happens when older adults don't get enough sleep.
  • [17:54] Learn some of the biggest obstacles to helping older adults sleep well
  • [24:21] The best sleep aid for older adults with insomnia is not a medication, it's Cognitive Behavioral Therapy for Insomnia, also known as CBT-I. Dr. Wachtel breaks it down.
  • [33:46] Want to improve your sleep today? Check out these sleep hygiene tips (a fancy term for healthy sleep behaviors)
  • [45:02] Not getting enough sleep can cause memory and concentration problems, leading older adults to worry that they may have dementia. Learn more here.
  • [47:13] Discover where can older adults and their families learn more about sleep issues and how to find treatment.

By the end of this episode, you'll really get why sleep is so important in older adults, have tools for helping older adults sleep better, and have a keen understanding of the best treatment for insomnia in older adults.


FAQ's About Older Adults and Sleep


What is Insomnia?

Insomnia is defined as dissatisfaction with sleep, and is usually associated with one or more of the following:

  1. Difficulty falling asleep
  2. Difficulty staying asleep (waking up frequently, or having problems returning to sleep after you wake up)
  3. Waking too early and not being able to return to sleep

The fifth edition of the Diagnostic and Statistical Manual for Mental Disorders (DSM-5) says that a sleep disturbance causes clinically significant distress or functional impairment, and occurs at least 3 nights a week for at least 3 months.

The International Statistical Classification of Diseases and Related Health Problems, 10th revision (ICD-10) requires at least 1 month of symptoms not explained by another sleep-wake disorder, illicit substance use, or coexisting medical and psychiatric disorders.


Why are older adults more likely to experience insomnia?

Researchers found that 93% of older adults who experience insomnia, also experience other conditions at the same time, like: 

  • Depression
  • Chronic pain
  • Cancer
  • Chronic obstructive pulmonary disease (COPD)
  • Cardiovascular diseases
  • Medication use, and
  • Factors associated with aging (like retirement)
  • Losing mobility and becoming more inactive
  • Limited social interactions
  • Caregiving

I want to talk about caregiving for a minute, because I see this a lot in my clinical practice, especially for older women caring for their spouses with dementia and with functional impairments. Here are two examples:

  • Sometimes, in the dementia process, the person with dementia will wake at night and pace, rummage through drawers, or get dressed thinking it's daytime and they have to go to work.  This, naturally, wakes up the caregiver, who has to redirect the person living with dementia to keep them safe and assist them with returning to sleep.
  • I also see this with caregivers who are assisting loved ones with going to the bathroom in the night. These older adults don't necessarily have dementia, but may be at risk of falling and require assistance. Caregiving is no joke!


Are there differences between men and women when it comes to insomnia?

Older women tend to report more sleep issues than men. This is thought to be due to women being more often the primary caregivers for their children, parents, or partner, in addition to working outside of the home, which affects their total sleep time.


How many hours should an older adult expect to sleep at night?

Significant physiological changes occur in sleep and circadian rhythm across the lifespan, including in older adulthood.

Children are expected to sleep 10 to 14 hours a night, then as we become teenagers and young adults our need for sleep drops to 6.5 to 8.5 hours a night, then drops to 5 to 7 hours a night when we reach 60 and beyond.

These sleep time frames reveal that we need less sleep as we age. Many older adults who are not aware of this phenomenon and see their sleep time shortening may have unrealistic expectations about how much they should be sleeping. This may  have the effect of producing anxiety that could cause or worsen insomnia. Ahh. The vicious cycle.


How is insomnia treated?

The best sleep aid for older adults with insomnia is not a medication, rather behavioral and therapeutic interventions.There are many that sleep clinicians use. I will focus on two of them here, Sleep Hygiene and Cognitive Behavioral Therapy for Insomnia (CBT-I).


Sleep Hygiene

When I think of hygiene, I think of grooming, don't you? Well that's essentially what this is, you're cleaning up and grooming your sleep rituals and routines. The idea with sleep hygiene is that you set yourself up for healthy sleep and a non-disruptive sleep environment.

Some of these strategies include: 

  • Avoiding daytime naps
  • Maintaining a regular sleep schedule
  • Limiting substances such as caffeinated beverages, nicotine, and alcohol (they negatively affect sleep)
  • Avoiding exercise at least 6 hours before bedtime


Cognitive Behavioral Therapy for Insomnia (CBT-I)

When sleep hygiene is not effective, Cognitive Behavioral Therapy for Insomnia (CBT-I), which is effective in older adults, is recommended. The American College of Physicians recommends CBT-I as first-line management (before medications) for insomnia in adults.

CBT-I typically includes 6 to 10 sessions with a trained therapist that focus on cognitive beliefs and counterproductive behaviors that interfere with sleep.


Reference: Insomnia in the Elderly: A Review (2018, Journal of Clinical Sleep Medicine)


Links and Resources


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I'm Dr. Regina Koepp

I'm a Board Certified Clinical Psychologist and Gerontologist specializing with older adults and families! As founder and CEO of Gero Champions, LLC and the Psychology of Aging Podcast, my mission is to help mental health and senior care providers meet the mental health and sexual health needs of older adults using up to date, evidence-based, and culturally thoughtful care.


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