Everyone faces an occasional restless night, but researchers have learned that 44 percent of adults age 55 and older experience difficulty falling asleep or staying asleep at least a few times each week.
If you are among them, you may be at greater risk for chronic conditions, according the Centers for Disease Control and Prevention, including diabetes, cardiovascular disease, obesity and depression. In older adults, insufficient sleep is also associated with decreased cognitive ability, greater mobility problems, reduced ability to drive safely and greater risk of falls.
Over 2 Million Americans
Increasingly, seniors are using over-the-counter (OTC) sleep aids to manage chronic insomnia, with more than 2 million Americans taking these drugs regularly, according to a 2013 survey by Kantar Health.
This is an alarming trend, according to Michael Vitiello, MD, professor of gerontology and geriatric medicine at the University of Washington, Seattle.
Vitiello, who co-directs both the Center for Research on Management of Sleep Disturbances and the Northwest Geriatric Education Center, stated “Just because they’re over-the-counter doesn’t mean they’re without risks.”
He spoke on a Gerontological Society of America panel last fall presenting new findings about the growing problem of sleep disturbance among older adults.
Vitiello warned that self-treating insomnia with OTC sleep aids, may put people at risk for serious health consequences. Sleep disturbances not given proper attention by a health care professional often leads to troubling long-term, chronic use of these medications.
For one thing, adequate studies of the effects of long-term OTC use have never been conducted. Additionally, older adults are more likely to be using a number of prescription and OTC medications, as well as nutritional supplements. Such medication cocktails increase the likelihood of adverse drug reactions.
Ingredients Bad for Some
It’s especially import to realize that the active ingredients in sleep aids are often contraindicated in older adults and in individuals of any age with certain conditions.
Two drugs, both antihistamines, are used in many OTC sleep aids. Diphenhydramine, also the active ingredient in Benedryl, is contained in Nytol, Sominex, Unisom SleepGels, Zzzquil and several pain relievers, such as Tylenol PM. The other drug, doxylamine, is used in Unisom SleepTabs, Equaline Sleep Aid and Good Sense Sleep Aid.
While the sedating effect of these drugs do improve sleep onset for some people, oiler adults should avoid these antihistamines, according to the 2012 Beers Criteria, a guide first developed in 1991 by geriatrician Mark H. Beers, MD, and most recently updated by the American Geriatrics Society in 2012. The danger, according to the criteria, can include greater risk of confusion, dry mouth, constipation, drug tolerance and toxicity.
Emerging research also suggests the use of these anticholinergic medications can cause memory loss and symptoms of mild cognitive impairment. One study, conducted by Noll Campbell, Pharm.D., and Malaz Boustani, M.D. both of the Regenstrief Institute and the Indiana University Center for Aging Research, showed these adverse affects can occur with as little as 60 days of continuous use of anticholinergic drugs.
“Millions of older adults are taking sleeping pills or prescription drugs year after year that may be impacting their organizational abilities and memory,” Campbell said. The group’s research is now exploring whether the cognitive impairment these drugs induce may be reversible.
The first step to identify and improve the condition is to talk to your health care provider. Chronic insomnia and other forms of sleep disturbance, according to several studies, are underdiagnosed and undertreated.
Part of the reason may be that doctors don’t routinely ask about a patient’s sleep quality, so bringing it to his or her attention is important. Your doctor can determine if underlying physical conditions are responsible for your sleep issues, and discuss appropriate treatments.
Medication is an option in some cases. However, numerous clinical studies have shown that non-pharmacalogical treatments, including good sleep hygiene, relaxation strategies and cognitive behavioral therapy, are not only effective, but are sustainable.
Dawn Williams wrote this article for Chicago’s Senior News 50 and Better through the MetLife Foundation Journalist in Aging Fellows Program, a project of New America Media and the Gerontological Society of America. For more on this topic, also see “Over-the-Counter Drugs: A Dangerous Prescription for Confusion.”