JUNE 01, 2006

"Falling" Asleep: Insomnia and Injury in the Elderly

The elderly typically experience a variety of age-related medical conditions, some of which may be correlated. A review of data from nursing homes in Michigan, published in the Journal of the American Geriatric Society (June 2005), found a link between insomnia and falls, which are a particularly common problem in the elderly.

Researchers used statistical analyses to assess the relationships between insomnia, the use of hypnotic medications, falls, and hip fractures in patients >65 years of age. Even after taking into account confounding factors (eg, age, sex, and illness), insomnia—but not hypnotic use—was determined to be predictive of falls. The patients whose insomnia was untreated or was treated unsuccessfully with hypnotics also experienced more falls, compared with healthy sleepers. Surprisingly, neither insomnia nor the use of hypnotics was associated with subsequent hip fractures. The study authors suggested that future research may confirm the value of appropriate hypnotic use in preventing falls in the aging population.

Sleep: Health Indicator and a New "Vital Sign"?

Individuals may understand how critical sleep is to their feeling of well-being, but many physicians underestimate the impact of sleep disorders on their patients. According to an article in the Annals of Internal Medicine (May 2005), this underestimation is problematic, because sleep plays such an important role in general health.As the link between sleep and health continues to be defined, some sleep specialists want to address this oversight by including sleep as one of the "vital signs"that are currently used to evaluate overall health. (Other vital signs include body temperature and pulse rate.)

A variety of research data bolsters the notion that sleep deprivation has meaningful and lasting effects on an individual's health. To raise physician and public awareness, the National Institutes of Health and the American Academy of Sleep Medicine have planned campaigns that will emphasize the key role that sleep plays in general health.

Are Herbal Extracts Really Useful for Relieving Insomnia?

The herbal extract valerian (Valeriana officinalis) is the most commonly used OTC dietary supplement for self-managing insomnia. Yet, only inconclusive and often contradictory evidence supports this agent's effectiveness. A recent Internet- based study, published in the July 2005 issue of Medicine, assessed the value of valerian as an insomnia therapy.

Patients given a placebo were compared with those dosed with either valerian or kava (Piper methysticum), which is another popular herbal supplement used to treat anxiety. As assessed by Insomnia Severity Index (ISI) scores, those taking placebo, valerian, or kava exhibited similar improvements in sleep after 4 weeks of treatment. The study authors acknowledged that higher doses or longer periods of use of the 2 herbs might have produced greater effects in patients. They concluded, however, that neither kava nor valerian was more effective than placebo in reducing insomnia.

Insomnia May Indicate Psychiatric Disorders

Brazilian physicians reported in the November 2005 issue of Sleep Medicine that 56.5% of the patients in a general hospital setting complained of insomnia, and 50% of all patients had at least one psychiatric disorder. Their study of inpatients appears to confirm previous research that points to a relationship between insomnia and psychiatric problems, particularly depression and anxiety, in the general population.

Statistical analysis of the inpatient study data demonstrated that major depressive episode (MDE), generalized anxiety disorder, and suicide risk were significantly associated with insomnia. The researchers determined that insomnia had a strong predictive value for MDE. Because the detection rate for psychiatric problems often is low in the hospital population, the researchers suggested that insomnia may be a useful diagnostic marker for MDE.

Researchers Study Teen Insomnia and Suicide

During adolescence, sleep patterns change noticeably, and suicide risk increases dramatically. These phenomena may not be coincidental, according to a review article published in the May 2005 issue of Current Opinion in Psychiatry.

Research has revealed that suicidal teens experience more sleep disturbances, compared with their nonsuicidal peers. Epidemiologic studies have linked insomnia, nightmares, and sleep insufficiency with an elevated risk of suicide. The authors have suggested that sleep problems may influence adolescent suicidal activity by (1) increasing stress level, (2) increasing or exacerbating psychopathology, and (3) interacting with other psychological factors to make the individual more susceptible to suicidal behavior. More comprehensive studies are needed, however, to define the complex underlying relationship between sleep disorders and suicidal activity.