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Sleeping with pain - breaking the vicious cyc -

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It's generally accepted that the older we get the less we sleep, but many older people don't get as
much sleep as they should - or could - and chronic pain is often the culprit. But, as Tanya Ha
finds out, cognitive behavioural therapy, CBT, can help interrupt the feedback loop of pain causing
loss of sleep causing more pain.

NARRATION

For some people, ageing is a lot of fun.

Tanya Ha

But as we get older, we can experience many different changes, including how we sleep.

Bob Newman

I'm probably sleeping a little more during the day, because I, I get more tired. So I'll have a
two-hour nap, and then I can go for the rest of the night.

Professor Leon Lack

The sleep of the older population and the elderly is quite different than that of, particularly of
children and even adolescents. Most people don't appreciate that sleep is more like a roller
coaster across the night. You go down into deep sleep, then come into light sleep about ninety
minutes later, then back into deep sleep, back into light sleep, and so on across the whole night.

Tanya Ha

So how does that roller coaster ride change as we age?

Professor Leon Lack

Well the ride gets shorter of course, and much less sleep in the older person. And it gets less
exciting as well. So we don't go down into such deep troughs where the rollercoaster's really
speedy. There's more lighter sleep, and more awakenings across the night, as you can see. Probably
a majority of the older population deals with these changes without any difficulty. Ah, most of the
older population don't actually report any sleeping difficulty, so we don't want to give the
impression that everybody's going to have poor sleep and suffer from that as we get older.

Bob Newman

I find having dancing as an activity keeps me fit and young, and enables me to sleep well. Because
when I come home, I've had a good exercise, and it's just lovely to lay down, curl up and go to
sleep.

Barbara Kilpatrick

Come on. There you go.

NARRATION

But as we get older, we're more likely to experience pain, and then sleep doesn't come so easily.
Four years ago, Barbara Kilpatrick had a major operation to remove a tumour.

Barbara Kilpatrick

Unfortunately when they had me open on the table, they found it wasn't growing out of my ovary, it
was growing out of my S2 nerve. He couldn't get the base of the tumour out, so he had to cut the S2
in half. It was a terrible time, just a continual terrible nerve pain in my leg. After the
operation, it was always very broken sleep, because as soon as I would go to bed of a night, the
pain would be worse. I was on sleeping medication, but I didn't like taking that.

Associate Professor Michael Nicholas

Just about everybody knows that when you've got an ongoing pain, it can disturb your sleep. But
what we've also found, and research in many places has found that if you have poor sleep, it can
make your pain worse.

Tanya Ha

Dr Michael Nicholas recently ran a unique trial to test the effectiveness of cognitive behaviour
therapy, or CBT, in managing the pain of people over sixty-five. Barbara was part of the trial.

Associate Professor Michael Nicholas

By the time people come here, they've got lots of problems - not just pain.

Barbara Kilpatrick

They were very, very um, good in how they worked with us. There was always lots of talking and
questions and answers.

Associate Professor Michael Nicholas

In the program, we tried to teach people better self-management strategies for their pain. For
example, if you start thinking in what we call catastrophic ways, when you wake up in the night and
think, 'It's terrible, I can't go on like this,' that actually will make you more agitated, and,
and have more trouble sleeping.

So if you could identify that and change that way of thinking, then you'll sleep better. The same
behaviourally - if you change the way you go about going to bed, that will help to improve your
sleep.

NARRATION

Encouraging exercise was also a key component of the program.

Barbara Kilpatrick

I noticed a marked improvement in me. I was more mobile, and I think that was due to the exercise.
It sounds a little bit trite, but it's not trite when I say accepting the pain. I've got to learn
to cope with it. After the trial, I stopped, I wasn't taking any sleeping medication.

Associate Professor Michael Nicholas

Many people wonder if this approach could mean that people don't need to take medication for sleep.
Um, the answer of course is yes.

NARRATION

Dr Nicholas's research has shown that as we age, lifestyle therapy can be effective in easing that
vicious cycle between sleep and pain.

Topics: Health

Reporter: Tanya Ha

Producer: Geraldine McKenna

Researcher: Dominique Pile, Nicky Ruscoe

Camera: Greg Ashman

Dennis Brennan

Sound: Tony Hill

Steve Ravich

Editor: Chris Spurr

Story Contacts

Professor Leon Lack

Prof. Leon Lack

Psychologist

Flinders University

Assoc. Professor Michael Nicholas

Clinical Psychologist

University of Sydney

Related Info

Sleep Well, Live Better - 3 Steps To Good Sleep

Laying insomnia to rest with Flinders advice

School of Psychology Psychophysiology/Neuroscience Research

The Elderly Always Sleep Worse, and Other Myths of Aging

Pain Management Group