Sleep Health and Appropriate Use of OTC Sleep Aids in Older Adults

Recommendations of a Gerontological Society of America Workgroup

Steven M. Albert, PhD; Thomas Roth, PhD; Michael Toscani, PharmD; Michael V. Vitiello, PhD; Phyllis Zee, MD, PhD

Disclosures

Gerontologist. 2017;57(2):163-170. 

In This Article

Abstract and Introduction

Abstract

Getting a good night's sleep can be challenging for older adults with chronic medical conditions, which often interfere with sleep. As a result, many older adults turn to over-the-counter (OTC) sleep aids, that is, products with diphenhydramine or doxylamine. However, these products are indicated only for occasional difficulty with sleep, not for chronic use; and their safety and efficacy has not been well established in general and in older adults specifically. To engage national stakeholders in a discussion of OTC sleep aids in older adults, the Gerontological Society of America (GSA) convened a multidisciplinary workgroup. The Workgroup examined differences between younger and older adults in sleep health and use of OTC sleep aids using data from the National Health and Wellness Survey; assessed the pharmacologic properties and medication effects of OTC sleep aids; and worked with stakeholders to promote strategies for safe and effective use. Older adults are more likely to take diphenhydramine or doxylamine products 15 or more days in a month, an indicator of inappropriate use. The Workgroup recommends research to investigate the ways older people use OTC sleep aids. The goal should be reduction in inappropriate use and associated risks, such as daytime sedation, compromised cognitive function, and falls. In addition, the Workgroup recommends a greater role for community pharmacists in counseling older adults on appropriate use of OTC sleep aids.

Introduction

Getting a good night's sleep can be challenging for older adults with chronic medical conditions or pain, which often interfere with sleep. As a result, many older adults and their caregivers turn to over-the-counter (OTC) sleep aids to promote sleep. However, these products are indicated only for occasional difficulty with sleep, not for chronic use; and their safety and efficacy has not been well established in general and in older adults specifically. In older adults, currently available OTC sleep aids may result in daytime sedation, compromised cognitive function, and falls and car crashes. They may also increase the risk of anticholinergic-related adverse events, such as blurred vision, constipation, dry mouth, urinary retention, and increased intraocular pressure.

To engage national stakeholders in a discussion of safe and effective use of OTC sleep aids in older adults, the Gerontological Society of America (GSA) convened a multidisciplinary workgroup and organized a series of national summits. The first summit took place in October 2013. It brought together experts from a number of fields to review data on sleep health and use of OTC sleep aids among older adults. The group recommended several policy initiatives to support sleep health in older adults and a multipronged effort to improve sleep health modeled on other successful public health campaigns. A follow-up national summit, convened by GSA in June 2014, opened the discussion to include stakeholders from a variety of professions involved in sleep health and aging, including psychologists, sleep medicine physicians, pharmacists, injury researchers, and Food and Drug Administration (FDA) regulatory staff.

Results from the OTC Sleep Aids Workgroup have appeared in a number of GSA publications: Sleep Health and the Appropriate Use of OTC Sleep Aids in Older Adults (GSA, 2013), Sleep Health and the Appropriate Use of OTC Sleep Aids in Older Adults: Update (GSA, 2014), and Spotlight on OTC Sleep Aids and Sleep Health in Older Adults (2013) in the What's Hot series. GSA also sponsored two webinars to disseminate Workgroup efforts.

In this Forum contribution, we build on these efforts to examine the challenges posed by OTC sleep aid use among older adults. We focus on three key issues: (a) What is different about sleep disturbance and OTC sleep aid use among older and younger adults? (b) What is different about the activity of OTC sleep aids in older and younger adults? And (c) given such differences, what kinds of education or policy changes would increase safe and effective use of OTC sleep aids among older adults?

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