Prevalence of Insomnia increases with age

Feb 5, 2020

By Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

"Trevor M." is the best phrase I hear all day. I'm sure hearing I won the lottery would be nice. Hearing that Salma Hayek's limo has pulled up for our dinner date would be fine. But I've never heard those things announced over the pharmacy PA, and frankly they seem unlikely. But the phrase "Trevor M." makes me smile, or do a little fist pump every time. It really is a bright spot in my day.

What doesn't brighten my day is when I can't sleep at night. Trouble sleeping is also more common as we get older. Prevalence estimates for insomnia double from about 10% of people ages 15 to 24 to about 20% aged 75 and over. As the Canadian population ages, insomnia will become more and more of an issue. Insomnia also seems to be more severe in the elderly. Older adults complain often of not being able to stay asleep and waking up too early. When older adults can't sleep, we worry about it causing memory problems, trouble concentrating, trouble with tasks requiring a lot of attention, and problems driving. Insomnia also increases the risk for falls.

There are some general rules you should follow to help get a good night's sleep. Go to sleep and get up at the same time every day. Get regular exercise during the day, but avoid exercise too close to bedtime. Go to bed only when you are sleepy. Use the bedroom only for sleep and sex. Put your worries away before you go to bed. Do something relaxing and enjoyable before bed. Make your bedroom quiet, cool and comfortable. Don't keep your cell phone in the bedroom. Don't read, knit, work, or watch TV in the bedroom. Do not drink coffee, tea or cola 4-6 hours before sleep, and try to drink as little of these caffeinated beverages as possible during the day. Avoid alcohol, and nicotine before bed. If you cannot sleep after 15 to 20 minutes, get out of bed and go to another room and read in a dimly lit area. Avoid watching TV, iPad, phone or computer while trying to get back to sleep, as the bright light from the screen may wake you up more. Go back to bed only when feeling sleepy again. Avoid watching the clock. Some people even turn the clock face away them. Finally, avoid daytime naps.

If you still aren't sleeping well after adopting good sleep habits, and the problem isn't the snoring person beside you, you might need a medication. If that is the case, talk to your doctor. First your doctor will check you for any underlying health problems. For example, insomnia can be a symptom of another condition like painful arthritis. If we treat the arthritis pain, sometimes the insomnia will go away on its own.

If your doctor decides you need a sleep medication, there are several to choose from. Many over the counter sleep medications contain diphenhydramine. It is safe in many patients, but it doesn't work as well as the prescription sleep aids. It starts working in 30-60 minutes, but probably shouldn't be used more than 3 nights in a row or the patient will become tolerant to the effects. One of the common prescription medications for sleep problems are the benzodiazepines. A common benzodiazepine used for sleep is temazepam. Temazepam takes 1-2 hours to kick in and lasts 6-10 hours. Benzodiazepines work well for sleeping, but can become habit forming. Because temazepam can last for 10 hours in some people, morning drowsiness can be a problem. A different prescription sleep aid is zopiclone. Zopiclone starts working in 15-30 minutes and lasts 8 hours or longer. Because it is not a benzodiazepine, it is less likely to be habit forming. It has the interesting side effect of leaving a bitter, metallic taste in the mouth. If you drink something acidic like orange juice in the morning, that usually washes the taste away. If you drink something plain like water it can make it worse.

There are potential problems with our standard treatments for insomnia. Medications like benzodiazepines and zopiclone increase the risk of falls and fractures as they can make people unsteady, especially if the person gets up during the night. Patients can experience mental fogginess, they can experience withdrawal symptoms and rebound insomnia if they stop the benzo or zopiclone, and they can still be groggy the next morning after using a benzo or zopiclone.

Some alternative sleep aids for older adults are trazadone, mirtazapine and melatonin. Melatonin may reduce the time needed to fall asleep by about 10 minutes which is similar to most other sleeping meds. The usual dose is to start with 3 mg 30 to 60 minutes before bed as needed. Most people won't need over 5 mg. Melatonin doesn't cause a hangover, groggy effect the next morning and shouldn't cause excess sedation unless it is mixed with other sleeping pills. Like all sleeping medications, don't use melatonin for more than a couple of weeks with out talking to your doctor.

A general warning with all the sleeping medications, is don't mix your sleeping medication with alcohol. Alcohol can prolong the effects of a sleeping medication, effect your breathing, and mixing alcohol and sleeping medications have lead to very dangerous things like driving and having no memory of doing so.

"Trevor M." refers to Trevor Marczylo. Marczylo is a perfectly pleasant guy who works at the pharmacy. For me the phrase "Trevor M." isn't really even about Marczylo. Let me explain. I've got seven prescriptions stacked up in front of me ready to check. The prescriptions are all for sick babies who are screaming in unison because their ears hurt. I can't check those yet because I have a physician on the doctor's phone. She is asking me what medication for bladder infections gave Mrs. Smith a rash three years ago. I can't tell the physician the info she wants because the computer has just crashed. The phones are ringing. A co-worker asks me if Mr. Jones can fill his medication early. Mr. Jones is leaving town for work. And then the pharmacy PA fires up. "Trevor M. Line 4. Second Page." "Trevor M. Line 4. Second Page." That is the BEST phrase ever. That. Right there. "Trevor M." Line 4 is now not my problem. I've stroked that phone call off my to do sheet without even answering it. Line 4 is Marczylo's problem, not mine. Smirk. Smile. Fist pump. Now if I run to the other side of the dispensary, will I find a working computer to answer the physician's question?

The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.

As always if you have any questions or concerns about these or other products, ask your pharmacist.

 


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