Try Sleep Training

We’ve all heard of sleep training for infants and small children, but a recent clinical trial found the practice — a cognitive behavioral practice to break bad sleep habits and sleep better — can be beneficial in adults, too.

The study, published in November in the journal JAMA Psychiatry, found that sleep training could help older adults with insomnia prevent depression. Multiple studies have shown that insomnia is a major risk factor for depression, and “some 30% to 50% of older adults complain of insomnia,” said study author Michael Irwin, a professor of psychiatry and biobehavioral sciences in the David Gefen School of Medicine at the University of California, Los Angeles.

The randomized clinical trial was conducted on adults over age 60 who received cognitive behavioral therapy weekly for two months. One group of participants received eight weeks of basic sleep education, which taught sleep hygiene, characteristics of healthy sleep, sleep biology and how stress can impact sleep. 

The remaining participants received a form of behavioral sleep training called CBT-I, given in an in-person group setting by trained therapists for eight weeks. CBT-I has five components: stimulus control, sleep restriction, sleep hygiene, relaxation and cognitive behavioral therapy.

Researchers followed participants for three years after the study, checking in monthly to ask about symptoms of depression. The group that received CBT-I training with the help of a sleep coach often kept the training going in their own lives, and about a third of the people were still free of insomnia. The group that received sleep education showed modest improvements in insomnia, but they didn’t last.

“That’s why CBT-I is so effective in person, because the therapist is helping that individual navigate and negotiate with themselves — and it can be really hard work,” Irwin said. “I believe that’s also why CBT-I apps or online tools often don’t work — people get frustrated, disappointed or angry at themselves, and they basically stop the work.”

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