Psychological Interventions for Late-life Insomnia: Current and Emerging Science

A systematic review and meta-analysis of psychological treatments to improve sleep quality in university students

OBJECTIVE

This paper reviews the literature evaluating psychological treatments to improve sleep quality in young adult university students.

METHOD

Participants (N = 6179) were young adult (aged 18-30 years) university students. Databases (PubMed, PsychInfo, EMBASE and Medline) were searched for randomized controlled trials evaluating psychological treatments for sleep disturbance in university students. The search date was 20 September 2024.

RESULTS

22 original trials met inclusion criteria. Meta-analysis showed that psychological interventions outperformed control groups (n = 14) on improving sleep quality (g = 0.50, 95%CI:0.26-0.73). There were significantly different effect sizes found between studies that evaluated cognitive behaviour therapy for insomnia (CBT-I; n = 6, g = 0.72, CI: 0.43-1.02) versus studies that evaluated mindfulness interventions (n = 5, g = 0.16, 95% CI: -0.18-0.51).

CONCLUSIONS

Psychological treatments improve sleep quality for young adult university students. While CBT-I showed larger effect sizes than interventions focused on mindfulness, further research is needed to verify if this reflects a true difference in the efficacy of the interventions.

Sleep Deficiency in the Elderly

With aging, there are normative changes to sleep physiology and circadian rhythmicity that may predispose older adults to sleep deficiency, whereas many health-related and psychosocial/behavioral factors may precipitate sleep deficiency. In this article, we describe age-related changes to sleep and describe how the health-related and psychosocial/behavioral factors typical of aging may converge in older adults to increase the risk for sleep deficiency. Next, we review the consequences of sleep deficiency in older adults, focusing specifically on important age-related outcomes, including mortality, cognition, depression, and physical function. Finally, we review treatments for sleep deficiency, highlighting safe and effective nonpharmacologic interventions.

Sleep and Healthy Aging: A Systematic Review and Path Forward

OBJECTIVES

The purpose of this systematic review was to synthesize research examining the cross-sectional and longitudinal associations between sleep and healthy aging in late-life.

METHODS

A systematic search was conducted via both PubMed and PsychINFO databases using terms related to "sleep" and "healthy aging." Studies which examined the association between healthy aging and one or more sleep parameters were included in the present review.

RESULTS

Fourteen relevant studies, nine cross-sectional and five longitudinal, were identified. Overall, cross-sectional studies revealed that positive indicators of sleep were generally associated with a greater likelihood of healthy aging. In contrast, a limited number of existing longitudinal studies revealed mixed and inconclusive results.

CONCLUSIONS

Findings suggest that adequate sleep is more likely to coincide with relevant markers of healthy aging in late-life and underscores the need for additional research investigating the longitudinal associations between sleep and healthy aging.

CLINICAL IMPLICATIONS

Healthy sleep, consisting of moderate sleep duration and good quality, shows promise for the promotion of healthy aging. Consequently, poor sleep should be identified and intervened upon when necessary.

Sleep health and aging: Recommendations for promoting healthy sleep among older adults: A National Sleep Foundation report

OBJECTIVES

Sleep is a key health indicator in older adults; however, many older adults may experience less than ideal levels of sleep health. The objective of this report is to summarize the proceedings of the National Sleep Foundation's Sleep Health and Aging Conference.

METHODS

The National Sleep Foundation held a Sleep Health and Aging Conference with sleep scientists and stakeholders in the field of aging. The primary goal of this conference was to identify critical sleep health recommendations for older adults.

RESULTS

Essential recommendations aimed at promoting sleep health in older adults focus on light exposure, physical activity, meal timing, environmental conditions, and sleep schedules. Suggestions for promoting sleep health behavior change in older adults include tailored messaging and community support.

CONCLUSIONS

There are unique challenges and opportunities around promoting sleep health in older adults, efforts toward change should include individual, community, and societal foci.

Preferences of University Students for a Psychological Intervention Designed to Improve Sleep: Focus Group Study

BACKGROUND

Many university students have difficulties with sleep; therefore, effective psychological treatments are needed. Most research on psychological treatments to improve sleep has been conducted with middle-aged and older adults, which means it is unclear whether existing psychological treatments are helpful for young adult university students.

OBJECTIVE

This study aimed to discover university student preferences for a psychological intervention to improve sleep quality.

METHODS

Focus groups were conducted over 3 stages to examine students' views regarding content, format, and session duration for a psychological intervention to improve sleep. A thematic analysis was conducted to analyze participant responses.

RESULTS

In total, 30 participants attended small focus group discussions. Three key themes were identified: (1) program development, (2) help-seeking, and (3) student sleep characteristics. Program development subthemes were program format, program content, and engagement facilitators. Help-seeking subthemes were when to seek help, where to access help, stigma, and barriers. Student sleep characteristics subthemes were factors disturbing sleep and consequences of poor sleep.

CONCLUSIONS

Students emphasized the need for a sleep intervention with an in-person and social component, individualized content, and ways to monitor their progress. Participants did not think there was a stigma associated with seeking help for sleep problems. Students identified the lack of routine in their lifestyle, academic workload, and the pressure of multiple demands as key contributors to sleep difficulties.

Pain Experiences in Individuals with Reported and Suspected Sleep Disorders

The purpose of the present study was to examine whether individuals with varying reported and/or suspected insomnia and sleep apnea presentations differed with respect to pain.Data included 3,161 adults who participated in an online study investigating sleep and health. Participants reported a lifetime history of prior sleep disorder diagnoses while the presence of suspected sleep disorders was determined using the Insomnia Severity Index and the STOP-Bang. Average pain intensity was assessed using a visual analogue scale and pain interference was determined using two items from the PHQ-15. Participants who reported diagnoses of insomnia and/or sleep apnea reported greater pain intensity and interference compared to those with no sleep disorder; however, no differences in pain were observed between the various reported sleep disorders. Of participants who did not report either insomnia or sleep apnea diagnoses, 24% were suspected of having either insomnia, sleep apnea, or both disorders based on responses to questionnaires. Participants with one or more suspected sleep disorders reported higher pain intensity and interference than those without a suspected disorder. Additionally, having either suspected insomnia or suspected comorbid insomnia and sleep apnea was associated with greater pain intensity compared to only having suspected sleep apnea. Sleep disorders go commonly undiagnosed and are associated with adverse pain experiences. While results do not support a synergistic effect of suspected insomnia and sleep apnea on pain, findings indicate that screening for sleep disorders is warranted and may have important implications for pain treatment.

Mindfulness-based Cognitive Therapy to Improve Sleep Quality in Older Adults with Insomnia

There is a high prevalence of insomnia in older adults, which has negative consequences for their well-being and quality of life. The recommendation for first-line treatments is to administer non-pharmacological interventions. The objective of this research was to verify the effectiveness of Mindfulness-Based Cognitive Therapy in older adults with subclinical and moderate insomnia, studying its impact on sleep quality. One hundred and six older adults participated and were assigned to the subclinical insomnia (n = 50) or moderate insomnia (n = 56) groups; subsequently, they were randomly assigned to the control and intervention groups. Subjects were evaluated at two times with the Insomnia Severity Index and the Pittsburgh Sleep Quality Index. Significant results were obtained on both scales, with a reduction in insomnia symptoms in the subclinical and moderate intervention groups. The administration of a treatment that combines mindfulness and cognitive therapy is effective for treating insomnia in older adults.

Sleep Deficiency in the Elderly

With aging, there are normative changes to sleep physiology and circadian rhythmicity that may predispose older adults to sleep deficiency, whereas many health-related and psychosocial/behavioral factors may precipitate sleep deficiency. In this article, we describe age-related changes to sleep and describe how the health-related and psychosocial/behavioral factors typical of aging may converge in older adults to increase the risk for sleep deficiency. Next, we review the consequences of sleep deficiency in older adults, focusing specifically on important age-related outcomes, including mortality, cognition, depression, and physical function. Finally, we review treatments for sleep deficiency, highlighting safe and effective nonpharmacologic interventions.

The Sleep Regularity Questionnaire: development and initial validation

BACKGROUND/OBJECTIVE

Sleep is a critically important behavior which influences diverse aspects of health, functioning, and longevity. An increasing literature suggests the importance of sleep regularity, also referred to as sleep inconsistency, sleep variability, or intraindividual variability in sleep. Given there is no brief, subjective measure of sleep regularity, the purpose of this study was to develop the Sleep Regularity Questionnaire (SRQ) and to begin the process of examining its psychometric properties using a construct-validation approach.

PARTICIPANTS/METHODS

In an online study of sleep and health, participants (n = 3249; M_age (SD) = 42.77 (16.73); 48.5% female; 77.3% white) completed the in-development SRQ, as well as the Insomnia Severity Index and the Pittsburgh Sleep Quality Index.

RESULTS

An exploratory factor analysis followed by a confirmatory factor analysis revealed a two factor structure, represented by circadian regularity and sleep continuity regularity, with good model fit indices (X² = 50.9, df = 7, p < 0.001; RMSEA = 0.06; CFI = 0.99; NFI = 0.99; IFI = 0.99; TLI = 0.98). Test-retest reliability, as well as concurrent, convergent and incremental validity were examined, with promising results.

CONCLUSIONS

Preliminary psychometrics suggest that the SRQ is a valid and stable instrument for the assessment of sleep regularity in adults that is related to, but distinct from, other established sleep constructs. Future research will benefit from assessing the validity of the SRQ in various clinical samples and how it compares to measures of sleep regularity calculated from prospective daily assessments.

Trading likes for sleepless nights: A lifespan investigation of social media and sleep

OBJECTIVES

The present study sought to examine the association between social media use and sleep and whether the association differed by age.

METHODS

Total 3,284 adults (M age = 42.74, SD = 16.72; 48.5% female; 80.8% White) participated in an online study of sleep and health across the lifespan. Sleep quality and duration were assessed using the Pittsburg Sleep Quality Index (PSQI). Participants reported the total time they spent using social media daily.

RESULTS

Greater social media use was associated with poorer sleep quality (P < .001) and shorter sleep duration (P= .002). Age moderated the relationship between social media use and sleep quality (P= .006), as well as duration (P= .001). The strength of the associations between social media and sleep increased with age.

CONCLUSION

The findings highlight potential adverse sleep outcomes associated with social media use. They also provide preliminary evidence suggesting the need for further exploration of age-related processes involved in social media use and sleep.

Sleep Disturbance Mediates the Association Between Loneliness and Health in Older Americans

BACKGROUND

As the research documenting loneliness as a risk factor for morbidity and mortality continues to grow, it becomes increasingly critical to understand the mechanics of this relationship. This study assessed whether sleep disturbance mediates the relationship between loneliness and health.

METHOD

Data came from the 2006, 2010, and 2014 waves of the Health and Retirement Study, a longitudinal study of older Americans; participants ≥ 65 who completed the Psychosocial and Lifestyle Questionnaire in 2006 were included (n = 5067). Measures include the Hughes loneliness scales, a modified version of the Jenkins sleep scale, and self-reported health. Cross-lagged mediation models (i.e., path analysis) were used to model the relationships between loneliness, sleep disturbance, and self-reported health over the 8-year span.

RESULTS

Loneliness predicted subsequent sleep disturbance, which in turn predicted subsequent self-reported health. Moreover, there was evidence of both direct and indirect effects (via sleep disturbance) of loneliness on self-reported health. These effects remained after controlling for demographics, isolation, and depression.

CONCLUSION

Sleep disturbance partially mediates the relationship between loneliness and self-reported health over 8 years. These findings are not attributable to isolation or depression. Further research is necessary to develop and assess a more comprehensive model of how loneliness shapes health. This study indicates that targeting sleep disturbance may mitigate the health risks of loneliness in older Americans.

Sleep, caregiver burden, and life satisfaction in Parkinson's disease caregivers: a multinational investigation

PURPOSE

The primary aim of this study was to examine the pattern of associations among PD patient and caregiver sleep problems, caregiver burden, and caregiver life satisfaction. A secondary aim was to assess whether the pattern of associations differed between Mexican and U.S. caregivers.

MATERIALS AND METHODS

Analyses were performed on data obtained from 253 caregivers (M age = 59.92). A composite score was produced for caregiver and patient sleep problems. The Zarit Burden Interview and Satisfaction with Life Scale measured caregiver burden and life satisfaction, respectively. A structural equation model with an invariance design was developed to examine and compare the pattern of associations.

RESULTS

The model was generally invariant across U.S. and Mexican caregivers. Three significant indirect effects were found: caregiver sleep problems were negatively associated with life satisfaction via caregiver burden (p = 0.003); PD patient sleep problems were positively related to caregiver burden via caregiver sleep problems (p = 0.005) and life satisfaction via caregiver burden and caregiver sleep problems (p = 0.002).

CONCLUSIONS

PD patient sleep problems were associated with caregiver sleep problems, leading to increased burden in caregivers and poorer life satisfaction. The findings highlight a potential opportunity for empirically supported sleep interventions.Implications for rehabilitationParkinson's disease is a progressive neurological condition that impacts patient and caregiver quality of life.Patient sleep problems contribute to greater caregiver burden, sleep problems, and reduced life satisfaction.The findings suggest patient and caregiver sleep may be a worthwhile target for intervention in order to reduce risk of caregiver burden and improve life satisfaction.

Reciprocal Effects Between Loneliness and Sleep Disturbance in Older Americans

Objectives: To model the relationship between loneliness and sleep disturbance over time. Method: Data came from the Health and Retirement Study (2006, 2010, 2014 waves; age ≥ 65 years; n = 5,067). Loneliness was measured via the Hughes Loneliness Scale and sleep disturbance via a four-item scale assessing sleep and restedness. Cross-lagged panel modeling (path analysis) was used to jointly examine reciprocal effects between loneliness and sleep disturbance. Results: Higher loneliness correlated with higher sleep disturbance at baseline. There was evidence of reciprocal effects between loneliness and sleep across timepoints. These associations overall remained when accounting for demographics, objective isolation, and depression. Discussion: Although causality cannot be established, the findings indicate that the relationship between loneliness and sleep disturbance is bidirectional. This requires revision to the current theory on sleep disturbance as a mechanism for the relationship between loneliness and health and indicates that effective treatment of sleep disturbance may reduce loneliness.