Overprescribing Sleeping Pills Could Lead to Falls
According to recent reporting, sleeping pills are putting elders at risk of falls and other harmful consequences (such as traffic accidents and cognitive impairment). At the same time, the longer one relies on a sleeping pill, the less effective it becomes in promoting sleep. While sleeping tablets are an effective way to get a good night's rest, elders are staying on them far longer than they should. So why do elders stay on sleeping pills? Some of the reasons include:
- Doctors and elders don’t speak enough about how and when sleeping pills should be used. Doctors may think that elders don’t want to stop their pills and would resist if encouraged to do so.
- Doctors may feel they don’t have time to discuss sleeping pills because it’s not a priority during the office visit.
- Doctors and elders assume that sleeping medication are still helpful in getting to sleep; even though evidence shows that pills aren’t effective after a few weeks of taking them. More than one month of prolonged use of sleeping pills can cause significant side effects.
- Elders may not be aware of the side effects; they assume that because doctors don’t challenge them on their sleeping tablet use, it is not a concern.
Insomnia (described as difficulty falling asleep, difficulty staying asleep, waking up too early, frequent nighttime awakenings or not getting a good night’s sleep) affects more than half of all elders. Trouble with sleeping is associated with poor health outcomes; one of the most significant for elders is that of falling. Often, sleeping pills are presided as the first choice by health providers. However, the side-effects of sleep medications (dizziness, drowsiness, difficulty keeping balance, cognitive impairment, blurred vision, drunken movements, etc.) contribute to the risk of falls and fractures.
Alternatives to Sleeping Pills
Clearly, difficulty with sleeping is a major health concern for many elders, contributing to fall risk:
- Individuals with insomnia may get out of bed in the middle of the night, running into or tripping over objects in the dark or just becoming confused about their surroundings.
- Insomnia can cause daytime sleepiness and clumsiness, as well as cognitive deficits. It slows down a person's reaction time, which could reduce the likelihood of quick corrective maneuvers that might prevent a fall from happening.
However, there are several alternative approaches to using sleeping pills as the first choice. First, find out what’s causing trouble with sleeping. Often there's another reason why the person isn't sleeping and there are other treatments that can tackle these things better besides pills. Some of these include:
Medical Conditions
- Nervous system disorders, such as Parkinson's, Alzheimer's and other forms of dementia, can cause nighttime disorientation, wandering, and confusion.
- Sleep disorders, such as restless legs syndrome (nighttime leg cramps) and sleep-disordered breathing (snoring and sleep apnea) occur more frequently in elders.
- Pain can interfere with good sleep; disorders such as arthritis, bursitis, and spinal stenosis are associated with nighttime distress.
- A number of conditions (such as bladder/prostate problems and certain heart conditions) are associated with nighttime need to toilet, which can interfere with sleep.
- Medications
- Insomnia is a side effect of many common medications, including antidepressants, antihypertensives, and anti-seizure drugs.
- Stimulants (such as caffeine and nicotine) can interfere with falling asleep. Caffeine can be found in coffee, tea, cola drinks, chocolate, and some cold medicines.
- Taking some medicines at night (such as water pills) may cause individuals to wake up in the middle of the night and toilet.
- Emotional Disorders
- Psychological factors, such as grief, depression, and anxiety can cause sleeplessness. In fact, psychological factors are more likely to cause insomnia than illness or medications.
Sleep Habits and Environment
- Poor sleep habits (such as irregular sleep hours or too much late-night screen time with the television or computer) can cause insomnia.
- Light (too much or too little, depending on the time of day), noise, uncomfortable temperatures, and poor mattress quality can cause sleeplessness.
- A partner's sleep habits (such as snoring or restless legs syndrome) can impair sleep.
- Lack of Exercise
- A sedentary lifestyle, does not make one sleepy. Becoming active promotes sleep.
Here are a few tips on getting a good night’s sleep, which can help avoid the use of sleeping pills:
Lifestyle Changes
- Establish a regular time for going to bed and getting up in the morning.
- Use the bed for sleep only (not for reading, watching television, etc.)
- Do something relaxing an hour before bedtime.
- Keep the bedroom relatively cool and well ventilated.
- Do not look at the clock; obsessing over time makes it difficult to sleep.
Diet
- Avoid caffeine (from coffee, tea, soft drinks, etc.).
- Avoid alcohol as a sleeping aid (it might make you sleepy but actually disrupts your sleep).
- Avoid big meals or spicy foods before bedtime. Eat dinner at least 3 hours before bedtime.
- Avoid liquid intake at least 1 hour before bedtime (this helps avoid mid-night runs to the bathroom).
Exercise
Exercise is one of the best ways to promote healthy sleep (it’s as good, if not better, then using sleeping pills). Exercise releases chemical in the body that promote sleep.
- Regular aerobic exercise (walking, swimming, cycling) during the day, at least three hours before bedtime, is particularly useful.
- Yoga can benefit sleep. Yoga uses meditation, deep breathing techniques, and movements that emphasize stretching and balance.