The Pharmaceutical Journal
Vol 275 No 7376 p626
19 November 2005

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Risks of sedatives may outweigh benefits in over 60s

In patients over 60 years the risks of sedatives may outweigh their benefits, a review published on BMJ Online First this week suggests.

Researchers examined 24 studies, involving 2,417 participants, of pharmacological treatment for insomnia in people aged over 60 years. They found that, compared with placebo, sedative hypnotics improved sleep quality (mean effect size 0.14, P<0.005), increased total sleep time (mean 25.2 minutes, P=0.001) and reduced the number of night time awakenings by 0.60 (P<0.0001). However, adverse cognitive events were 4.78 times more common with sedative hypnotics than with placebo (95 per cent confidence interval 1.47–15.47, P<0.01) and reports of daytime fatigue were 3.82 times more common (1.88–7.80, P<0.001).

“Although the improvements in sleep variables obtained from prescription sedative hypnotics are statistically significant, the effect size is small, and the clinical benefits may be modest at best. The added risk of an adverse event may not justify these benefits, particularly in a high risk elderly population,” they say.

David Taylor, chief pharmacist, South London and Maudsley NHS Trust, commented that, although such effects have been observed before, the paper is an important reminder of them. However, a number of methodological weaknesses confound its findings, he said.

For instance, short-, medium- and long- acting compounds, benzodiazepines and “z” hypnotics are grouped together, but the findings probably only apply to a few of the drugs.

“In treating insomnia, it is important to educate people about expectations around sleep, particularly since people sleep for less time as they become older. Older people also need to adhere to good sleep hygiene avoiding daytime naps and caffeine-containing beverages later in the day. These aspects need to be examined before we consider drug treatment,” Dr Taylor said.

Appropriate use of hypnotics should include avoiding long-term use or situations where non-pharmacological interventions are preferable, Peter Pratt, chief pharmacist at Doncaster and South Humber Healthcare NHS Trust, commented. “Pharmacists should be alert to the drift of short-term prescribing into long-term, but at the same time it is also important to be alert to the fact that insomnia may signal the presence of other treatable disorders such as depression or even pain,” he added.