Sleep revisited: Sedative-hypnotics and older adults
A couple of weeks ago, I met with the “Chief Pharmacist” at The Everett Clinic to discuss his concerns about the use of sedative-hypnotic sleep medications (like Ambien) for older adults. At this meeting, I naively asked him at what “age” does older adulthood begin. I learned, to my surprise, that I am on the doorstep of older adulthood! Admission begins at age 65!
Recent medical reports have called into question the safety of these sleep medications for all adults, but particularly for those of us who are getting older. Older adults, even those of us in our 60’s, are more prone to falling. Going to the bathroom in the middle of the night can be an obstacle course that ends up in the Emergency Room! Indeed, studies show that over 90,000 E.R. visits every year are associated with adverse reactions to Ambien. More than 19% of those visits resulted in hospital admissions. This is serious.
A recent article in The New York Times (“More on Sleeping Pills and Older Adults” by Paula Span, July 30, 2014) cites some interesting research on this issue. While older adults didn’t have more ER visits than younger adults, the consequences were worse. According to Span, “About a third of those older than 65 who went to E.R.’s with adverse responses to sedatives were hospitalized, compared with about 13 percent of those 19-44 years of age.”
As we get older, the risk of falling increases. Use of these drugs can clearly be a contributing factor to taking a tumble. Breaking a hip can result in disability and even death in the very old.
I have used Ambien occasionally when I travel. Time zone changes and general discomfort often keep me up when I’m on the road. But after I read these recent studies, I decided to discontinue using Ambien. Loss of a couple of hours of sleep is more benign than the risk of falling in the middle of the night. The fact is that cognitive behavioral methods for coping with insomnia (called “sleep hygiene”) are just as effective as using sleeping pills and don’t have any side effects. Check out Paula Span’s article for links to helpful information on getting a good night’s sleep. Falling asleep and staying asleep is a struggle, especially as we age. We tend to sleep more lightly, are awakened more easily, and with older bladders, we have to make more pit stops to the bathroom. It can make for a longer night.
Once an adult starts using these drugs for sleep on a regular basis, it becomes difficult to stop. They quickly become “habit forming” and we experience sleeplessness when we stop using them. Anxiety over having a bad night’s sleep can inhibit adults from getting off of these medications. We can become convinced that we “need” them in order to sleep. My mother, who was in hospice earlier this year, was still taking a sleeping pill even though she was sleeping 20 hours a day towards the end of her life! Since it had become a “maintenance” medication, no one took her off her sleeping pill through her hospitalization, rehabilitation center stay, and hospice care. She fell in the middle of the night, going to bathroom, which caused her significant misery. It’s likely that her sleeping pill contributed to her confusion in the middle of the night.
If you are in your 60’s and over, talk to your physician about the risks and benefits of sleeping medication. Work on a plan with him or her to reduce or eliminate its use. Ask for a referral to a behavioral health specialist who can teach you the tricks to falling and staying asleep. Sometimes, according to Dr. Ronald Green, a pulmonologist who specializes in sleep at The Everett Clinic, there may be other problems contributing to a poor night’s sleep. A more comprehensive medical evaluation by a sleep specialist may be in order.
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