March 13, 2013

Sleep and Seniors and Pills

An estimated 22% of Americans struggle with insomnia every night. Those of us age 65 and older are one-and-a-half times more likely to battle the condition.

A prime suspect just so happens to be something that's supposed to help: prescription sleep aids. "You get benefits early on, but if you continue to use them long-term you can adapt to them, they're less effective and can interfere with sleep," according to Dr. Lawrence Epstein, an instructor at Harvard Medical School. He adds:
Some people feel it's easier to take a pill than to try other methods to treat insomnia, and many physicians continue giving them prescriptions because they aren't trained in sleep medicine or they feel pressured to help their patients get sleep immediately. 
Sleep complaints result in millions of over-the-counter sleep aids sales, and 25 million prescriptions for stronger drugs every year. But every drug marketed to help with sleep has significant downsides, especially if used for more than several weeks. I'm living proof. See my post yesterday about my battles with insomnia.

Primer on Sleeping Pills
I have a file on "Insomnia." Here are the highlights from the clips in that file:
  • Sleeping pills have limited effectiveness.
  • All carry potential risks.
  • None have been tested for long-term safety, which is why most of the pills have been approved for short-term use only.
  • Many also cause lingering daytime sleepiness or fatigue by reducing the time you spend in deep, restorative sleep.
  • Long-term use can cause strange behaviors while the brain is still asleep: walking, binge eating, or taking the car out for a drive.
  • The FDA now requires the makers of Ambien and similar products to lower their dosages, based on studies suggesting links to higher risk of injury from morning drowsiness. 
Seniors and Sleep
Here's what my clippings say about the special difficulties for seniors:
  • Older people (aged 64-74) were four times more likely to wake up throughout the night than younger people (ages 21-30), according to a recent study.
  • As people age, they experience less time sleeping and in the sleep stage associated with dreaming (REM --rapid eye movement).
  • Elderly people do not recover from sleep deprivation as quickly as younger people.
Sleeping Aids and Memory
This issue is a particular concern of mine, since I have problems with short-term memory. Some of the research makes me wonder how much my use (and abuse) of Ambien and Tylenol PM may have contributed to this problem. 

Research findings agree: all sleeping aids can adversely affect memory.

Among the prescription sleep drugs, this concern particularly applies to benzodiazepine-type sedatives like Valium, Restoril, Ativan, Serax and Xanax. Older people are particularly at risk. A study published last fall found that patients over 65 who began taking this drug showed a 50% increased risk of developing dementia within 15 years, compared with people who never used the products.

Among the over-the-counter sleep aids, probably the most frequently used is the antihistamine diphenhydramine (Benydryl), an ingredient in many sleep aids labeled "PM," like the one I used (and abused) for years: Tylenol PM. They are often recommended to older people because of a perception the pills are safe. But the opposite is true. These drugs can cause short-term memory loss.

So I'm doubly glad my two sleeps a night  -- one before and another after my "joy of quiet" hour -- are working so well. 

I haven't mentioned in this three-part series what role the over-the-counter serotonin booster 5-HTP may be playing. I'll cover that topic next week.

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