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.

Is it time for a nap yet?

I’m an unabashed napper. I nap any time of the day if I need it. I have to because I have horrible insomnia. One of my friends feels that I can’t sleep at night because I nap, but I’ve tried going nap-less for several days in a row and I *still* won’t sleep well at night.

I don’t take long naps; they’re power naps of 10 to 20 minutes. I can jump right up when I wake, although I do have to admit that on a grey, lazy day, I just may be tempted to cuddle under a quilt and stay a lot longer.

I’ve never been a good sleeper and then, becoming a nurse and working shift work really blew out of the water any ability I had to sleep at night. For several years, I did shift work and have, at times, worked all three shifts within seven or eight days. Then, to try and regulate my body, I tried working only night shifts. Not good for the body, I’m sure. Then there were the years of babies waking in the night, followed by young children who woke up with nightmares and then get up early. None of my three kids slept entirely through the night until they were at least 2 years old. They would go right back to sleep, but they’d wake up, we’d hear them and sometimes they’d call out of fear or just wanting reassurance.

Now, unless we get a phone call in the middle of the night from one of the off spring who call to tell us they’re not coming home, we don’t get disturbed by them – but I still can’t sleep. I may fall asleep quickly sometimes, but I’m lucky if I stay asleep for more than an hour and a half; that’s my longest stretch to stay asleep. And for the rest of the night, it’s sleep 40 to 50 minutes, wake up, sleep 40 to 50 minutes, wake up… and then by 6 a.m., forget it. I’m awake for the day.

There’s some interesting research going on about chronic insomnia. While we know about the medicinal sleep aids that are available, there’s a big push on to teach people good sleep habits and good sleep hygiene. That means using the bedroom only for sleeping and sexual activity, for example. Following a relaxing routine before sleep, no heavy meals before bed time, no heavy exercising either. Another technique is not allowing yourself to stay in bed if you’re not sleeping. If you wake up and can’t get back to sleep, get up until you’re sleepy again. Don’t lie there and think about not being able to sleep.

Keeping a sleep diary is helpful to some people. By keeping track of what time you go to bed, what you were doing beforehand, how long it takes to go to sleep, how many times you wake up, etc., you may be able to recognize a pattern or trigger that wasn’t obvious before.

Now that I work from home full-time, my sleepiness during the day isn’t that huge a problem. I can be inconvenient when I need to go places or do interviews, but I can work around it. But I can tell you, it was hell when I had to work outside of the house. By 10 a.m., I’m just crying for a quick nap. I so admire the companies that now promote naps at work. I am a firm, firm believer in them.

So, is it time for a nap yet?

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