Abstract
Many older adults take benzodiazepines and sedative-hypnotics for the treatment of sleep disorders. With a view to considering the possible discontinuation of hypnotics, the objectives of the present study were to describe bedtime habits and sleep patterns in older adults and to identify the sleep medications taken. An expert group developed a structured interview guide for assessing the patients’ bedtime habits, sleep patterns, and medications. During an internship in a community pharmacy, 103 sixth-year pharmacy students conducted around 10 interviews each with older adults (aged 65 or over) complaining of sleep disorders and taking at least one of the following medications: benzodiazepines, benzodiazepine derivatives (“Z-drugs”), antihistamines, and melatonin. A prospective, observational study was carried out from 4 January to 30 June 2016. The pharmacy students performed 960 interviews (with 330 men and 630 women; mean ± standard deviation age: 75.1 ± 8.8). The most commonly taken hypnotics were the Z-drugs zolpidem (n = 465, 48%) and zopiclone (n = 259, 27%). The vast majority of patients (n = 768, 80%) had only ever taken a single hypnotic medication. The median [interquartile range] prescription duration was 120 (48–180) months. About 75% (n = 696) of the patients had at least 1 poor sleep habit, and over 41% (n = 374) had 2 or more poor sleep habits. A total of 742 of the patients (77%) reported getting up at night—mainly due to nycturia (n = 481, 51%). Further, 330 of the patients (35%) stated that they were keen to discontinue their medication, of which 96 (29%) authorized the pharmacist to contact their family physician and discuss discontinuation. In France, pharmacy students and supervising community pharmacists can identify problems related to sleep disorders by asking simple questions about the patient’s sleep patterns. Together with family physicians, community pharmacists can encourage patients to discuss their hypnotic medications.
Highlights
IntroductionOlder adults have a longer sleep onset latency and more nocturnal awakenings
Physiological sleep processes change as people age
Each student was asked to interview about 10 older adults, complaining sleep disorders and taking at least one of medications: (i) benzodiazepines, (ii) Z-drugs, (iii) antihistamines, and (iv) melatonin
Summary
Older adults have a longer sleep onset latency and more nocturnal awakenings. The prevalence of sleep disorders (restless legs syndrome, parasomnia, sleep apnea, etc.) [2] and comorbid conditions that reduce sleep quality and quality of life increase with age; these difficulties are due (as least in part) to changes in circadian rhythms and lower melatonin levels [3,4]. BSHs have harmful long-term effects, such as deregulation of the sleep architecture and a further increase in sleep disorders. This is why BSH prescriptions are limited to 4 weeks: beyond that time, the harm outweighs the benefits [8]. The polypharmacy often observed in older adults [11]
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