Prescription and Nonprescription Sleep Product Use Among Older Adults in the United States

• Published in: The American journal of geriatric psychiatry 2019-01, Vol.27 (1), p.32-41
• Main Authors: Maust, Donovan T., Solway, Erica, Clark, Sarah J., Kirch, Matthias, Singer, Dianne C., Malani, Preeti
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Cross-Sectional Studies; Drug Prescriptions - statistics & numerical data; Female; Humans; insomnia; Male; medication; Nonprescription Drugs - therapeutic use; older adult; Older people; over-the-counter; Prescription drugs; Prescription Drugs - therapeutic use; Sleep; Sleep Initiation and Maintenance Disorders - drug therapy; Sleep Initiation and Maintenance Disorders - epidemiology; United States - epidemiology
• ISSN: 1064-7481; 1545-7214
• DOI: 10.1016/j.jagp.2018.09.004

•What is the primary question addressed by this study?A variety of prescription medications and over-the-counter products taken by older adults could be used for sleep, though the prevalence of use specifically for sleep complaints is unknown. It has been 30 years since the last nationally-representative estimate.•What is the main finding of this study?The authors find such products are used by 35.4% of older adults aged 65-80. Over-the-counter and herbal aids are most commonly used, while few patients discuss sleep concerns with their providers.•What is the meaning of the finding?Sleep product use may account for a significant proportion of potentially inappropriate medication used by older adults, who may be unaware of potential safety risks, especially from over-the-counter products. Older adults commonly use products that may be used to promote sleep, such as benzodiazepines and over-the-counter medications, but the current extent of use of both prescription and nonprescription products specifically for sleep in the United States is unknown. Respondents in this cross-sectional, nationally representative survey (the National Poll on Healthy Aging) of community-dwelling older adults aged 65–80 (n = 1,065) reported difficulty initiating sleep or early awakening (“sleep symptoms”) and use of prescription medication or nonprescription aids to promote sleep (“sleep product”), including prescription sleep medication, over-the-counter (OTC) sleep aids, prescription pain medication, and herbal/natural sleep aids. Logistic regression was used to determine the association of respondent sociodemographic and clinical characteristics with the use of sleep products. Sleep symptoms were endorsed by 67.7% of respondents (95% confidence interval [CI] 64.7%–70.7%). Use of a sleep product was reported by 35.4% (95% CI 32.4%–38.6%), with 21.9% (95% CI 19.4%–24.7%) using OTC sleep aids, 12.5% using herbal/natural aids (95% CI 10.6%–14.8%), 8.3% using prescription sleep medication (95% CI 6.7%–10.3%), and 5.0% using prescription pain medication (95% CI 3.8%–6.7%). Self-reported fair/poor mental health (relative to excellent/very good) was associated with increased odds of sleep product use (adjusted odds ratio 2.28, 95% CI 1.10–4.72, p = 0.03). More than a third of older adults use medications or aids to help with sleep—most commonly OTC aids. Clinicians should routinely ask older patients about sleep-related difficulties and the use of nonprescription sleep aids.