Review of Treatment of late-life insomnia.

Abstract

KENNETH L. LICHSTEIN and CHARLES M. MORIN (EDS.) Treatment of Late-Life Insomnia Thousand Oaks, CA: Sage Publications, 2000, 370 pages (ISBN 0-7619-1507-9, US$ 33.95, Softcover) Reviewed by STEFAN DEMJEN On average, the older you get the less you sleep. The number of hours one needs to sleep varies from one individual to another. Some of us are lucky and get as much sleep as we need. Others fare less well and are unable to get the required amount of sleep. One of the most common of all sleep disorders is insomnia. It can beset us at any age, but appears to get worse in old age. Lichstein and Morin have assembled an array of researchers and clinicians addressing problems of insomnia in late life. The book is organized into three parts. Part I provides an excellent overview of assessment strategies, and tackles the problems in defining the crucial constructs involved in this book, namely, insomnia and old age. Part II entails clear and authoritative articles presenting the main cognitive-behavioural and pharmacological treatment approaches. Part III presents topics that would be of interest to anyone dealing with insomnia: discontinuation of sleep medications, secondary insomnia, and insomnia in dementia and in residential care. The working definition of insomnia is a persistent difficulty in initiating and maintaining sleep. The duration, depth, and rhythm of sleep progressively decline in later life. These changes present a challenge to both researchers and clinicians in the area, as they have to learn to distinguish between normal ontogenetic change and pathological changes. The second important issue tackled in Part I pertains to the definition of insomnia. The three classificatory systems for sleep disorders (ICSD, American Sleep Disorders Association, 1990; DSM-IV-TR, American Psychiatric Association, 2000; ICD-10, World Health Organization, 1992) require the of insomnia, rather than just poor sleep. The measures of complaint and have been poorly operationalized. One of the results is a paradoxical group of individuals termed low-distress poor These individuals exhibit minimal distress over their poor sleep, and on measures of distress they approximate good sleepers. These observations, combined with the lack of consistency between subjective and behavioural measures of poor sleep and lack of evidence for causative influence for lifestyle factors, led to the proposal of a Cognitive Model of Insomnia (Fichten & Libman, 1991). This model proposes that cognitive activity interferes with sleep and also acts as an important mediator of insomnia complaints. The third important issue is the prevalence rather than incidence of insomnia in late life. The older individuals diagnosed with insomnia may have been suffering from poor sleep since they were young. The last but not least important issue is the definition of old age. The studies on older adults use participants age 55 to well over 90. This age range spans more than 35 years and involves two generations. Future research may perhaps show some age differences within this age span. On the practical side, Part I of this book stresses the multidimensional nature of insomnia complaints in older adults and presents clear guidelines on how to assess different parameters of this disorder. Part II deals with cognitive-behavioural and pharmacological approaches to treatment. A separate chapter is devoted to each of the following: sleep hygiene, sleep restriction therapy, stimulus control, relaxation, cognitive therapy, and pharmacologic treatment. …