Many older adults use sleep medications every night

Older adults frequently used medication to treat sleep difficulties, according to study results presented at Psych Congress.

“Utilizing a one-time mailed survey of patients aged 65 and older who were prescribed common sleep medications and identified using administrative claims data, we found that patients reported frequent medications to treat sleep difficulties, with the majority of those surveyed using a sleep medication every night,” Maureen Carlyle, MPH, senior project manager for Optum Health Economics and Outcomes Research (HEOR) in Minnesota, said during a virtual presentation.

According to Carlyle and colleagues, older adults may be particularly vulnerable to insomnia, which is linked to increased comorbidity and polypharmacy and contributed to chronic physical and behavioral health conditions. In the current analysis, they sought to outline experiences with insomnia symptoms and treatments in a real-world setting among older patients. They used administrative claims data included in the Optum Research Database, which represents more than 73 million patients in the U.S.

Specifically, they analyzed data of patients who were insured with commercial plans or Medicare Advantage with Part D who had recent sleep medication history. They implemented a cross-sectional survey but administered no treatments or interventions. Included participants (n = 205; mean age, 73.2 years; 70.2% women; 97.6% insured by a Medicare Advantage plan) were aged 65 years or older, had 12 months of continuous health insurance coverage and had pharmacy claims for common insomnia treatments, including eszopiclone, suvorexant, trazodone and/or zolpidem, between November 2016 and June 2017. The researchers oversampled patients with suvorexant claims because of differences in time available in the U.S. at survey fielding. They excluded patients who likely had profound cognitive or mental impairment, chronic pain disorders, restless leg syndrome or a sleep-related breathing disorder.

Results showed common comorbid conditions, such as hypertension (70.7%), heart disease (41%) and mood disorders (27.3%). Most (56.2%) patients experienced sleep difficulties every night, and 61.6% had difficulties lasting 5 years or longer. Difficulty falling asleep (37.8%) represented the most common symptom. Patients had moderate insomnia symptoms on average, although 68.6% reported medication use every night. More than 2 weeks before survey completion, 68.8% of participants used suvorexant, 19% used zolpidem, 14.6% used trazodone, and 2% used eszopiclone. Common non-medication sleep treatments among half of patients included limiting caffeine, alcohol or nicotine use, maintaining a regular bedtime and avoiding naps.

“Only half of respondents reported discussing how those medications worked with their provider, suggesting that high use paired with low patient education may represent an opportunity to improve care for older patients,” Carlyle said.