Older adults commonly experience insomnia, an inability to initiate or maintain sleep at night. The rate of sleeping problems in adults over the age of 65 is high. Fifty-two percent of a survey of 9,000 older adults reported having inadequate sleep or lack of daytime alertness, "most of the time." Poor sleep quality adversely affects energy, daytime alertness, mental performance, and motor functioning.

People with insomnia have more health problems and have higher health care utilization. Among individuals with chronic illnesses, insomnia has been shown to be an independent predictor of decreased quality of life.

Sleep disorders are associated with and complicate a number of medical conditions. This includes neurological, cardiopulmonary, inflammatory, and psychological disorders. Individuals with Alzheimer’s disease, Parkinson’s disease, multiple system atrophy, stroke, congestive heart failure and COPD, rheumatoid and osteoarthritis have increased sleep disturbances. Though it is well known that major depression and insomnia co-exist, there is epidemiological evidence that persistent insomnia may precipitate an episode of depression.

What are the treatment strategies for insomnia in older adults? First, treat the underlying cause, if possible. If episodes of acute pain are causing insomnia then a comprehensive pain management program is indicated.

Situational or acute onset insomnia is often treated using medication to break the cycle of sleeplessness. Common classes of medication used for this purpose are benzodiazepine hypnotics, non-benzodiazepine hypnotics, and tricyclic antidepressants. For the sedative hypnotic medications, the risks of use with older adults are residual sedation the following day, memory loss, and psychomotor impairment, e.g., in balance and walking.

For chronic insomnia the treatment of choice is Behavior Medicine Insomnia Intervention. The components of a comprehensive Behavior Medicine intervention include: (1) relaxation therapy, (2) stimulus control therapy, (3) cognitive therapy, (4) sleep restriction therapy, (5) bright light therapy, and (6) sleep hygiene education.

The objectives of the Behavior Medicine intervention are to reduce physiological reactivity, modify poor sleep habits, correct faulty beliefs and attitudes about sleep and insomnia, regulate sleep-wake schedules, and educate about good sleep hygiene practices.

Behavior Medicine intervention for insomnia has been shown to be as or more effective than sedative-hypnotic medication. In addition, many older adults prefer behavior medicine treatment to medication. They want to avoid medication side effects or the need to take more medication in the future.