Tuesday, July 10, 2007

Why don’t older people and some sleeping pills mix?

There’s a new study out that says more than half of elderly patients in hospitals who are prescribed sleeping pills (sedatives) are still using them 6 months later. This is disturbing and I would add the issue of all the other medications with sedative effects that this population tends to take and there’s a huge concern, in my opinion.

While it may not seem such a big deal, people taking sleeping pills to get a good night’s sleep, it’s not the sleeping part that is the problem. When we look at the older population, we see a larger number of people with problems that can affect their mobility, their cognition (thought process), and safety. Since sleeping pills are supposed to make you drowsy, if an older person has to go to the bathroom in the middle of the night, this drowsiness could easily make them lose their balance and fall (and breaking a bone or striking their head, for example), they could become disoriented as sedatives can do, or they can not wake up and be incontinent in bed – something that might not have happened otherwise.

There is also the issue of about daytime sleepiness. Many people, young or old, who take sleeping pills experience a daytime effect of lingering sleepiness. This could end up messing up the person’s body clock because of the temptation and need to sleep during the day, starting a vicious cycle of making it hard for them to sleep at night and requiring yet another sleeping pill. The daytime drowsiness could affect their safety and increase falls or, if the person is still driving, could even cause an accident. Someone who is sleepy from a sleeping pill could have cognitive problems, seeming confused and lost when normally he or she wouldn’t be. This could start a whole round of medical concerns from family and friends that aren’t necessary. Someone who is sleepy from sedatives could end up being housebound, increasing social isolation, and they can become less able to care for themselves, starting a downward spiral in self care.

While some of this may seem way off, sadly, it’s not. Medications often work differently in older people than they do in the younger population. Drug testing isn’t usually done in the older age group so it’s not always understood how drugs can affect them.

In this particular study, the sedatives are benzodiazepines. Benzodiazepines are also given for anxiety. According to the study findings, of almost 12,500 patients who had been prescribed a benzodiazepine while in the hospital, more than 6,100 were still taking them over the next 6 months.

So, how does this affect us? If you’re in the population mentioned in this study, be aware of what you are taking. Ask your pharmacist about the drug’s side effects; ask your doctor if there isn’t another type of medication that might be safer for you. If you are the child of someone who may be in this situation, keep in mind that excessive sleepiness, memory issues, falls, things like that, could be the result of your parent taking sleeping pills. If you’re a nurse or a healthcare worker, keep in mind that this can happen to your patients as they are discharged home, so maybe you can keep this in mind when discussing discharge planning.

Sleeping pills have their place – not much replaces a good night’s sleep. But we need to be careful how we go about getting it.

No comments: