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magazine home > archives > fall 2001 > features

Older Americans are increasingly relying on sleep medications for a good night's rest - nearly $800 million a year is spent in the United States on prescription medications while another $300 million is spent annually on over-the-counter drugs. A U of M researcher is helping put this problem to rest with an innovative insomnia-treatment program.

Desperately Seeking Snoozin'
by Henry Hart

Dr. Kenneth Lichstein

Dr. Kenneth Lichstein

University of Memphis psychology professor Kenneth Lichstein doesn't get upset when people fall asleep while he is explaining his work; rather, The U of M researcher prefers it.

Dr. Lichstein, an international expert on sleep disorders, has spent much of his 24 years at the University conducting various research projects aimed at helping people overcome major insomnia problems. In international circles, Lichstein's name is synonymous with "sleep" - he has published 80 journal articles and book chapters on the subject.

"Insomnia is a major problem that affects about 10 percent of the population, and in older adults, it may affect about 25 percent of the population," Lichstein says. "It may result in disturbed mood and anxiety, and a perceived compromised quality of life."

Lichstein's latest project - "Treating Hypnotic Dependence in Older Adults" - focuses on treating adults age 50 years or older who have sleep disorders and are dependent on prescription sleep medications. His project introduces older insomnia sufferers to drug-free treatments designed to help them get a better night's sleep.

"Older adults with insomnia often turn to sleep medication, risking addiction, interactions with other drugs, increased sleep apnea and other side effects," says Lichstein. "This is a major problem I wanted to address."

Lichstein has so far tested 44 older adults for the study, which continues for two more years. Volunteers were recruited through newspaper, TV and radio advertisements.

One of the test subjects, Gail Landers, did not have to be convinced how major a problem insomnia can become. The 59-year-old depended heavily on prescription medications to get a restful night of sleep, often resulting in a "wrung-out" feeling the following morning.

"Before participating in the study, I had a severe insomnia problem," Landers says. "It usually resulted in feelings of fatigue and crankiness the next day. I would feel terrible throughout the day. I definitely needed help."

Lichstein says that older adults most often are bothered with "secondary insomnia" - a disorder caused by a medical or psychiatric problem. The other type of insomnia, termed primary, deals more with psychological causes and usually affects young to middle-aged adults.

Subjects in Lichstein's study undergo two treatment methods. The first involves a relaxation method in which subjects practice slow, deep breathing, passive body focusing and relaxing imagery. The goal is for a more relaxed mind and body, which is more conducive to sleep.

The second method involves stimulus control. "We teach subjects not to go to bed by habit; only to go to bed when they feel a strong sleep urge," Lichstein says. "Then, if they are in bed and awake for more than 15 to 20 minutes either at bedtime or in the middle of the night, we encourage them to get out of bed, exit the bedroom and not return until they feel a strong sleep urge. This method is designed to restrict the bedroom to sleep so that the individual becomes trained to automatically associate the bedroom with sleep."

Lichstein says the results of the study are too preliminary to discuss, but says three smaller scale sleep medication withdrawal studies have been consistent.

"When individuals slowly withdraw from chronic use of sleep medications, they may experience some temporary worsening of sleep," he says. "But by the time they are withdrawn from the medication, their sleep is no different from when they were chronic sleep-medication users.

"Long-term use of sleep medications reduces the effectiveness of the drug to zero," he adds.

Lichstein's study is being funded by a $1.6 million grant from the National Institute on Aging, a division of the National Institutes of Health.

For Landers, the study has meant relying less on prescription medications and a better quality of life. "While I don't think I'm totally free of the problem, since I still occasionally have a bad night, I really believe this treatment is effective," she says. "I would recommend it to anybody."

Individuals interested in participating in the study should call (901) 678-4168. Volunteers must be at least 50 years old, dependent on prescription sleep medication and have a current complaint of poor sleep.

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