My parents and my father-in-law especially mentioned that they slept less as they got older. They seemed to wake up earlier and go to sleep earlier in the evening. Our generation has the quick and easy way to get sleep assistance through medication, and the sleep medication seems to be handed out like candy, not considering that sleeping less may just be one more consequence of aging.
This Grandma recently read that the sleep aid, Ambien, is prescribed at a higher dose for women than may be safe. It seems that the testing was done on men and the dose not adjusted for a woman’s body. I have heard of detriment this has caused to women. See for example.
In the New York Times, July 30, 2014, Paula Span, in her article, “More on Sleeping Pills and Older Adults,” continues the dialogue and raises more concerns for us Boomer grandmas. It seems that we have much to be worried about concerning sleep aids:
Just a week after I posted here about medical efforts to help wean older patients off sleeping pills – causing a flurry of comments, many taking exception to the whole idea as condescending or dismissive of the miseries of insomnia – researchers at the Centers for Disease Control and Prevention and Johns Hopkins published findings that reinforce concerns about these drugs.
I say “reinforce” because geriatricians and other physicians have fretted for years about the use of sedative-hypnotic medications, including benzodiazepines (like Ativan, Klonopin, Xanax and Valium) and the related “Z-drugs” (like Ambien) for treating insomnia. . . .
In 2013, the American Geriatrics Society put sedative-hypnotics on its first Choosing Wisely campaign list of “Five Things Physicians and Patients Should Question,” citing heightened fall and fracture risks and automobile accidents in older patients who took them.
Now the C.D.C. has reported that a high number of emergency room visits are associated with psychiatric medications in general, and zolpidem – Ambien – in particular. They’re implicated in 90,000 adult E.R. visits annually because of adverse reactions, the study found; more than 19 percent of those visits result in hospital admissions.
Among those taking sedatives and anxiety-reducing drugs, “a lot of visits were because people were too sleepy or hard to arouse, or confused,” said the lead author, Dr. Lee Hampton, a medical officer at the C.D.C. “And there were also a lot of falls.”. . . .
But the consequences were worse for older people. About a third of those older than 65 (32 percent) who went to E.R.s with adverse responses to sedatives were hospitalized, compared with about 13 percent of those 19 to 44 (and 27.2 percent of those 45 to 64).
The data also showed that Ambien, the use of which has soared in recent years, accounted for one in five E.R. visits among those older than 65, more than any other medication.
The other particular concern for older people is falls, a leading cause of death and disability. A 2010 analysis of falls says 22 percent of “community dwelling” Medicare beneficiaries older than 65 (excluding nursing home residents) fell in a year. The C.D.C. estimates that a third of older adults fall annually. Twenty to 30 percent of those falls result in injuries that require medical attention.
“There’s a constellation of risks that contribute to falls, and medications are clearly part of it,” said Dr. Jerry H. Gurwitz, a geriatrician at the University of Massachusetts Medical School who has studied drug safety in older people. “And high on the list of those medications related to falls and fall-related injuries are sedative-hypnotics.”
Ms. Span mentions the dose difference for men and women:
The Food and Drug Administration, concerned about “next-morning impairment” from Ambien, last year halved the recommended dose for women, to 5 milligrams from 10 milligrams, and to 6.25 milligrams from 12.5 milligrams for extended-release versions like Ambien CR.
It seems that once we begin taking sleeping pills, we have difficulty weaning off them as well.
Can patients gradually wean themselves from sedatives, using a chart like the one in the brochure Dr. Tannenbaum and colleagues sent patients? In their study, which looked only at benzodiazepine use, the brochure urged recipients to consult health care professionals before embarking on detoxification.
Of the group that attempted to gradually stop the drug, more than half succeeded, and another 22 percent reduced their dosage. Among those who didn’t make the attempt, the greatest reason – get this – was discouragement from their physicians or pharmacists.
Then, of course, we are beginning to have more than just GG (now almost 91) telling us there is a difference between young old and old old (after age 84):
A final caveat: Yes, older people are different. A 65-year-old speedwalker has a different risk profile from an 85-year-old with poor vision or osteoporosis.
We must be careful. With regard to sleeping aids, whether we are young old or old old does not seem to matter:
But the physicians I consulted couldn’t countenance extended sedative use, even for the former.
It seems women are second class citizens when it comes to drug testing and it means we must be more vigilant in inquiring of our doctors whether the dose prescribed is based on testing on men or women. We must question whether we should take the dose recommended by the manufacturer for any drug.
We also must question ourselves. Do we really need aids to sleep? Or should we just accept that we are of long years, getting longer, and with that comes changes we must adapt to.
I remember when my grandchildren were babies and I rocked them in the middle of the night watching HGTV, the only show worth watching at 3 AM. We must be thankful HGTV is on in the middle of the night and hope the station recognizes, in the future, it should consider first run showings in the middle of the night for us Boomer Grandmas who are going to make up a large amount of the population and are sleeping less.
Joy,
Mema