Self Treatment of Insomnia in the Elderly

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Self Treatment of Insomnia in the Elderly

• Ashdin Tavaria M.D., Nalaka S. Gooneratne M.D.,
  Clara Kwan M.D., Nirav Patel M.D.,
• Lavanya Madhusudan, Kathy C. Richards, Ph.D.
• May 18, 2010

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Acknowledgement

• Supported by
• The Hartford Foundation
• Penn Center of Excellence
• National Institute of Health

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Introduction

• Sleep disorders are common in the elderly, with
  up to 57 of older adults complaining of
  difficulties with their sleep1

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Prevalence of Insomnia by Age
-Ohayon, J Psychiat Res 1997
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Introduction

• Sleep disorders can be associated with an
  increased risk of
• Driving accidents 2-4
• Cardiovascular mortality 5
• Falls6
• Depression7
• Cognitive deficits 8

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Insomnia-associated Mortality

• Nursing home study of 272 patients
• 2 year follow-up
• Adjusted for ADLs, age, gender
• Manabe et al., Gerontology 2000

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Insomnia-associated Cognitive Impairment Results

• EPESE dataset, 3 year follow-up, n6,444
• Adjusted for demographic and health factors

Cricco et al., JAGS 2001
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Introduction

• Despite the significant prevalence of sleep
  disorders, many older adults do not seek
  evaluation or treatment of their sleep problems
• Instead engage in a number of self-treatment
  activities 9, 10

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Study Methods

• Purpose of this study was to explore
• Different types of self-treatment strategies
• Determine their perceived efficacy

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Study Methods

• Cross-sectional survey study consisting of a
  mailed questionnaire
• Adults over the age of 65 recruited from the
  greater Philadelphia area
• Penn Partners in Healthy Living Program Data Base
  which is an elder outreach program affiliated
  with the University of Pennsylvania Health System

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Results

• A total of 242 study questionnaires were
  completed
• Average of 4.8 treatments used per study
  participant (SD 2.9, range 0-13)
• Correlation between the number of treatments
  attempted and the PSQI sleep quality score
  (r0.37, plt0.0001)
• Suggested that study participants who had worse
  sleep quality had attempted more sleep treatments.

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Results
Bar graph showing the number of treatments used
by subjects
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Results
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Results
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Efficacy of Different Types of Self-treatment
Strategies
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Efficacy of Different Types of Self-treatment
Strategies
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Results

• Prescription sleeping pills were felt to be the
  most effective treatment option (2.5)
• Ear plugs (1.0) were felt to be the least
  effective
• Prescription medications had a perceived efficacy
  that was significantly larger than the other
  methods (p-value 0.0024)

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Results

• In our study, most commonly used interventions
  were watching TV or listening to the radio, or
  reading
• Pain medications were the most commonly used form
  of medication highlighting the impact of pain as
  a contributing factor to insomnia in the elderly
• Of particular concern, nearly half of all
  subjects who used alcohol or over-the-counter
  sleeping aids had not told this to their health
  care provider

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Results

• Women are more likely to engage in broad range of
  activities to improve their sleep when compared
  to men
• Caucasians tended to rely on pharmacotherapy
  while African Americans tended to use social
  tools

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Discussion

• Wide array of treatment options used by elders
  for the management of their insomnia
• High usage rates of several treatments highlights
  the importance of inquiring about the broad range
  of treatment choices made by older adults as they
  seek to address their sleep complaints

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Discussion

• Some elderly patients are trying up to 13
  different treatments

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Discussion

• Response rate may be affected by participants may
  have become discouraged by the end and chosen not
  to fill out additional questionnaire
• Patients may have underreported negatively viewed
  activities or treatments such as alcohol,
  smoking, or even medications

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Discussion

• Self treatment can be dangerous
• Patients are unaware of the interplay between
  aging and physiology, chronic diseases and drugs
• Polypharmacy can result in adverse drug-drug
  interactions which can lead to confusion, falls,
  and incontinence
• Over-the-counter sleep aids

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Discussion

• As Healthcare providers we must be asking our
  patients about their sleep patterns
• If they are having disturbances we must ask what
  if any self-treatment activities they are
  engaging in

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References