Sleep's a distant dream for over-60 set
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Think of them as the $10 million questions: Why do so many older people have so much trouble sleeping, and is there any help for them that doesn't involve drugs?
The University of Pittsburgh has received a $9.8 million grant from the National Institute on Aging to look for answers. The five-year study, to be called AgeWise, will recruit some 400 seniors to help solve the riddle.
About 25 percent of people over 60 have trouble getting to sleep or staying asleep. If the insomnia is severe enough, it can impair function and increase the risk of other medical problems.
It also can lead people to overmedicate themselves with prescription or over-the-counter drugs.
The goal of the study is to better understand the biological causes of insomnia and then find the most effective non-pharmaceutical solutions for each cause, said Timothy H. Monk, director of the Human Chronobiology Research Program at the Western Psychiatric Institute & Clinic and the study's lead investigator.
"The strength of this research project is that we simultaneously can attack the problem on several different fronts," Dr. Monk said.
"Insomnia in seniors can result from biological clock problems, sleep intensity problems, stress and arousal issues, the functional anatomy of the patient's brain, and particular issues of genetic makeup. All of these different research issues will be covered in our AgeWise study."
Sleep disorder breathing is excluded from the study, he said.
As for why these issues arise in older people who were not bothered by them before, Dr. Monk said, "There are a lot of things we don't do as well at 60 as we did at 20. I can't play tennis now as well as I did 40 years ago. One has to recognize sleep as one of those things, but there are tricks, attitudes and practices that can help."
Within each category of sleep problems, Dr. Monk said, researchers will look at how older adults with insomnia differ from those without it.
They also will study whether the success or failure of therapy is related to these categories.
Everyone will receive genetic testing because it only requires a blood sample, he said.
Other areas will involve eight sessions with a therapist using more intensive protocols over several days.
Subjects will be assigned to only one category on a statistically random basis within certain constraints, such as gender.
Researchers then will try various cognitive behavioral treatments. For example:
• How people think about sleep can play a role, especially when worrying about not sleeping exacerbates the problem.
• Stress and the reaction to it.
• Understanding the biological clock and changing the amount of time spent in bed to increase the intensity of sleep.
• Sleep hygiene, such as the sensible use of caffeine, making the bed and bedroom comfortable.
"We are trying to develop better therapies that don't involve pills and are more likely to be long-lasting," said Dr. Monk, who also is a professor of psychiatry at the Pitt School of Medicine.
This will be his second five-year study funded by the NIA. Earlier this decade, Dr. Monk had a similar grant that looked at how life challenges -- bereavement, caring for a spouse with Alzheimer's disease, advancing into the final years of life -- were affected by sleep and how those situations could be helped by sleep therapies not involving pills.
The AgeWise study was a logical follow-up, he said.
"We hope to arrive at a better idea of which therapies do what. Eventually we can refine them and identify which aspects should be emphasized with which individuals. That way we can better treat insomnia in older people."
In addition to Dr. Monk, the study will be led by six other University of Pittsburgh researchers: Drs. Daniel Buysse, Anne Germain, Martica Hall, Robert Krafty, Sati Mazumdar, and Vishwajit Nimgaonkar.
First Published September 2, 2010 12:00 am