Searching for the Sandman

Timothy H. Monk, PhD, DSc

As a 61 year old myself, I can confirm from personal experience that I do not sleep as well now as I did when I was 21. As a sleep researcher too, though, I know that there are many different reasons for this, as well as many different levels of distress regarding sleep that seniors like myself experience. For some seniors, sleep is not really very much of a problem, for others (up to 10% of older adults) it can involve a great deal of distress and a significant worsening of health and quality of life. Both medical and mental health problems can often be associated with (and in some cases worsened by) an individual’s sleep problems. In some cases, sleep problems can even precipitate institutionalization of the individual into a nursing home or care facility. It is very important that an older adult’s sleep be “got right.”

For many seniors with sleep troubles, sleeping pills are simply prescribed by their doctor. Although these pills may provide some relief when used occasionally, they may not provide much help in the long run. Often, the pills lose their effectiveness, or may not be appropriate to that individual’s particular situation. Some people are still taking the same sleep medications that they were initially prescribed many years ago. This is unfortunate, as there are now much safer and more effective sleeping pills on the market. It really is worth “talking to your doctor” about the right sort of sleep medication for you. For some seniors there is a concern regarding falls resulting from bathroom visits while under the influence of sleeping pills. That is not to say that sleeping pills may never be useful, but sometimes better for fighting insomnia are behavioral therapies which do not involve any sleep medications at all. These therapies involve not only teaching patients some of the underlying background to their sleep and insomnia, but also teaching them to do things differently in regard to the night’s sleep. During several sessions with a therapist, different issues are discussed and behaviors related to sleep (including bedtimes and rise-times) addressed. One aim of the therapy is to change the patient’s mindset in regard to sleep. Sleep should be regarded as something which a person does, rather than something which fills the time when they are not doing anything else. Changes are also encouraged in the patient’s attitude to sleep and the bedroom, so that negative feelings about them are replaced by positive ones. Unfortunately, such therapies are very expensive and often unavailable except in the context of research studies.

In order to work most effectively, behavioral therapies should target some or all of the underlying causes of the problem. It is therefore very important that research allows us to understand these causes, how such factors differ between seniors with- and without insomnia, and what happens to these factors when the insomnia is successfully treated.

As I mentioned earlier, there are lots of different underlying factors that may interfere with a senior’s ability to sleep well at night. Some factors relate to changes in the 24h biological clock, others to sleep intensity, others to responses to stress and arousal, others to genetic factors, as well as to the different ways in which various parts of the brain function during sleep. All of these factors (plus a few more besides) are important and worthy of study. We need to know not only how these factors are different in seniors with insomnia as compared to seniors who sleep well, but also how these factors change when an individual’s insomnia is successfully treated.

Our aim should be to provide a better understanding of the factors underlying insomnia, so that this serious health problem can be successfully treated. There are way too many folks needing such help – a number which will unfortunately increase with the ever-aging baby boom generation. For them the Sandman can indeed be hard to find.

Timothy H. Monk, PhD, DSc Professor, University of Pittsburgh School of Medicine Principal Investigator, AgeWise Sleep Research Study