Pharmacy Times, Volume 0, 0

"Falling" Asleep: Insomnia and Injury in the Elderly

The elderly typically experience a variety of age-related medicalconditions, some of which may be correlated. A review ofdata from nursing homes in Michigan, published in the Journalof the American Geriatric Society (June 2005), found a linkbetween insomnia and falls, which are a particularly commonproblem in the elderly.

Researchers used statistical analyses to assess the relationshipsbetween insomnia, the use of hypnotic medications, falls,and hip fractures in patients >65 years of age. Even after takinginto account confounding factors (eg, age, sex, and illness),insomnia—but not hypnotic use—was determined to be predictiveof falls. The patients whose insomnia was untreated or wastreated unsuccessfully with hypnotics also experienced morefalls, compared with healthy sleepers. Surprisingly, neitherinsomnia nor the use of hypnotics was associated with subsequenthip fractures. The study authors suggested that futureresearch may confirm the value of appropriate hypnotic use inpreventing 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 manyphysicians underestimate the impact of sleep disorders on their patients. According to an articlein the Annals of Internal Medicine (May 2005), this underestimation is problematic, becausesleep plays such an important role in general health.As the link between sleep and health continuesto be defined, some sleep specialists want to address this oversight by including sleepas one of the "vital signs"that are currently used to evaluate overall health. (Other vital signsinclude body temperature and pulse rate.)

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

Are Herbal Extracts Really Useful for Relieving Insomnia?

The herbal extract valerian (Valerianaofficinalis) is the most commonly usedOTC dietary supplement for self-managinginsomnia. Yet, only inconclusive andoften contradictory evidence supportsthis agent's effectiveness. A recent Internet-based study, published in the July2005 issue of Medicine, assessed thevalue of valerian as an insomnia therapy.

Patients given a placebo were comparedwith those dosed with either valerianor kava (Piper methysticum), which isanother popular herbal supplement usedto treat anxiety. As assessed by InsomniaSeverity Index (ISI) scores, those takingplacebo, valerian, or kava exhibited similarimprovements in sleep after 4 weeksof treatment. The study authors acknowledgedthat higher doses or longer periodsof use of the 2 herbs might have producedgreater effects in patients. Theyconcluded, however, that neither kavanor valerian was more effective thanplacebo in reducing insomnia.

Insomnia May Indicate Psychiatric Disorders

Brazilian physicians reported in theNovember 2005 issue of Sleep Medicinethat 56.5% of the patients in ageneral hospital setting complainedof insomnia, and 50% of all patientshad at least one psychiatric disorder.Their study of inpatients appears toconfirm previous research that pointsto a relationship between insomniaand psychiatric problems, particularlydepression and anxiety, in the generalpopulation.

Statistical analysis of the inpatientstudy data demonstrated that majordepressive episode (MDE), generalizedanxiety disorder, and suicide riskwere significantly associated withinsomnia. The researchers determinedthat insomnia had a strong predictivevalue for MDE. Because thedetection rate for psychiatric problemsoften is low in the hospital population,the researchers suggestedthat insomnia may be a useful diagnosticmarker for MDE.

Researchers Study Teen Insomnia and Suicide

During adolescence, sleep patterns change noticeably, andsuicide risk increases dramatically. These phenomena maynot be coincidental, according to a review article published inthe May 2005 issue of Current Opinion in Psychiatry.

Research has revealed that suicidal teens experiencemore sleep disturbances, compared with their nonsuicidalpeers. Epidemiologic studies have linked insomnia, nightmares,and sleep insufficiency with an elevated risk of suicide.The authors have suggested that sleep problems mayinfluence adolescent suicidal activity by (1) increasing stresslevel, (2) increasing or exacerbating psychopathology, and(3) interacting with other psychological factors to make theindividual more susceptible to suicidal behavior. More comprehensivestudies are needed, however, to define the complexunderlying relationship between sleep disorders andsuicidal activity.