A prescription for better sleep

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When Sarah Woods reached her 60s, her sound sleeping habits changed. She was unable to get back to sleep after waking up during the night and became frightened when she found herself dozing off behind the wheel.

"I felt like I was losing sleep, and it was impacting my quality of life," said Ms. Woods, 74, of Murrysville.

After participating in the University of Pittsburgh AgeWise program 10 years ago, Ms. Woods still benefits from better sleep. The study, which is currently recruiting, uses cognitive behavioral treatment for insomnia to learn about the causes of the sleep disorder in older adults.

The eight-week therapies do not use medication. Patients are prescribed specific behavioral instructions while being educated about the scientific reasons behind them.

"It's not just simply saying you should do XYZ but telling the scientific reasons for underlying issues," said Timothy Monk, professor of psychiatry at Pitt.

The study has had "remarkable results," researcher Daniel Buysse said. Three out of four participants no longer meet the definition of insomnia after treatment while 80 percent significantly improved.

"We're really able to make a difference without the consequences of side effects," said Mr. Buysse, professor of psychiatry and clinical and translational science at Pitt.

He said insomnia is more common in older adults with 15 to 20 percent of the group suffering from the disorder. These people can experience daytime consequences including fatigue, depression and other adverse health problems. Medication can be effective, but side effects are often amplified in older adults.

As people get older, their sleep becomes more fragile and easily disrupted, Mr. Monk said. At the age of 63, he admits a cup of coffee after dinner affects his sleep now.

"We're all 19 inside, but we have to realize we're still sleeping like a 60-year-old," he said.

Behavioral changes AgeWise patients make include reducing their time in bed, setting a regular wake up time and not going to bed unless they are feeling tired in order to break the association with their bed and not feeling sleepy.

"People who develop insomnia feel lousy and end up spending a long time in bed chasing whatever hours they can get," Mr. Buysse said.

Trying to catch up on sleep, insomnia sufferers can end up spending more time in bed than the amount of time they're actually able to sleep. Researchers often found that people are frustrated with their inability to sleep, but they may not need as much sleep as they think. They can actually function well on a smaller amount of time in deep sleep.

Ms. Woods kept a sleep diary, which allowed researchers to decide what was causing her sleep problem.

"My habits I had come to surrounding sleep were sloppy," Ms. Woods said.

Her specific behavioral instructions were to stay awake until 11 p.m. and wake up at the same time each day in order to sleep in a more consolidated way. She was also no longer allowed to read in bed, which she found to be a "major change" as she had to find something to engage in to stay up late.

The program works like a sleep diet, Ms. Woods said. There are fad diets and just eating sensibly. Like the latter, the individualized sleep prescription has the advantage of working over a long period of time.

"There comes a time when you have to change your ways or else you'll sacrifice good sleep," she said.

Participants of the study must be at least 60 years old and have had chronic insomnia for the past six months including difficulty falling asleep, maintaining sleep or not feeling rested after sleep. Those interested in joining the study can call 866-647-8283.

Sara Payne: spayne@post-gazette.com.

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