Sleep Pills May Do More Harm Than Good in Elderly

NEW YORK (Reuters Health) - While sedative drugs, such as Restoril and Ambien, may improve sleep in older people with insomnia, the risks of such therapy may outweigh the benefits, according to investigators in Canada.

The findings are based on a review of 24 trials that included 2417 subjects aged 60 or older who were treated with so-called sedative hypnotic pills or inactive placebo pills for insomnia. The subjects received the assigned pills for at least five consecutive nights.

Compared with placebo, sedative use was associated with statistically significant improvements in sleep quality, total sleep time, and the number of nighttime awakenings, Dr. Usoa Busto, from the Centre for Addiction and Mental Health in Toronto, and colleagues note. However, the actual improvements were modest in scope.

Several adverse effects were more common with sedative hypnotics than with placebo, Busto's group reports in the British Medical Journal. Sedative use greatly increased the odds of thinking difficulties and daytime fatigue.

The likelihood of an untoward event was even greater in subjects who were at high risk for falls or mental impairments, the report indicates.

"Although the improvements in sleep variables obtained from prescription hypnotics are statistically significant ... the clinical benefits may be modest at best," the authors conclude. Behavioral therapies may be a better option for older people with insomnia, they add.

SOURCE: British Medical Journal, online November 11, 2005.