Cognitive behavioral program in treating insomnia among elderly patients
Introduction: Insomnia is a most common in elderly patients. World wide experience showed that Cognitive behavioral program in treating insomnia is one of the best effective model.
Objectives: The present study aim to present clinical experience from University Clinic Nuremberg, Centre for Sleeping Medicine with application of Cognitive behavioral program in treating insomnia among elderly.
Material and Methods: The sample consists of 22 patients with chronic insomnia (10 primary insomnia, 12 secondary insomnia; 16 women, 6 men; mean age 64.6 years) treated in two consecutive group sessions. Participants compliance was 82%. Treatment program was consists of: 6 Group meetings, 1 Activation week, with total duration during 10 week. It include: Sleep hygiene and stimulus control; Sleep restriction; Progressive Muscle Relaxation; Mental Relaxation, Cognitive restructuring; Light Therapy; Sport; Excursions and cultural program. In order to assess the results of the Sleep diary and for the total and possibly sub-scores of the questionnaires pre-post comparison were made with the Wilcoxon signed-rank test, as a non-parametric statistical hypothesis test used for comparing two matched samples. Statistical analyzes depending on the machining rate on subgroups (15 to 17 people).In order to asses : sleep quality, daytime sleepiness, depressive symptoms, cognitive performance, before and after the training, the participants were examined with Pittsburgh Sleep Quality Index, (PSQI); Epworth Sleepiness Scale (ESS); Beck Depression Inventory (BDI);Syndrome Short Test (SKT). In addition, sleep diary were conducted and completed an evaluation questionnaire at the last meeting of the patient.
Results: The high attendance compliance of 82% indicates a great motivation of the participating patients. The decisive factor here is probably a high psychological strain caused. The "poor" sleep quality of our sample showed both psycho-metric (PSQI) and in the sleep diary (sleep efficiency: 67.7%). Of the accompanying symptoms mentioned above in a means "light" depressive symptoms could be objectified, whereas daytime sleepiness and cognitive impairment were on the clinical border relevance.
Conclusion: The results of the pre-post comparisons lead us to the conclusion that sleep quality, daytime sleepiness, sleep time, and mood positively changed during the day among older insomnia patients under the described cognitive-behavioral group program. Is draw special-lift that just often complained of the elderly long sleep onset and increased daytime sleep were reduced. However, important parameters such as sleep efficiency and total sleep time were unaffected, suggesting the need for a more intensive therapy settings.
Key words: cognitive-behavioral, program, elderly, insomnia.