Dr. Philip Westbrook, director of the Sleep Disorders Center at Cedars Sinai Medical Center in Los Angeles, thought his mother-in-law had Alzheimer`s disease. She was confused and anxious. She seemed demented. But, Westbrook discovered, the real problem was overdoses of several mind-altering prescription drugs. His mother-in-law, Betty Cleminson, was taking three kinds of benzodiazepines, which are sleeping pills and anti-anxiety compounds that can lead to drowsiness, amnesia and, paradoxically, more anxiety.
When the drugs made Mrs. Cleminson agitated, ”her husband thought she needed a little more sedation, so he gave her more sleeping pills,” Westbrook said. But that only made her symptoms worse. When she stopped taking the pills, she returned to normal.
What happened to Mrs. Cleminson is all too typical, experts say. By overdosing on sleeping pills and similar drugs, older people can set themselves up for a devastating chain of events that can land them in a nursing home.
But because sleep deteriorates in the elderly, many think they need sleeping pills for a quick fix. They may be unaware that the pills can cause side effects that resemble psychosis or dementia.
This is especially so when the pills are taken for long periods in high doses, which is what often happens with the elderly. Side effects also are more likely in older people, who are less able to metabolize drugs and who often are taking other medications that can interact with sleeping pills and heighten their effects.
When older people start acting senile because of sleeping pills, ”a portion of them are sent to nursing homes,” said Dr. Marshall Folstein, a psychiatrist and Alzheimer`s disease specialist at Johns Hopkins University School of Medicine.
Sleep researchers and sleeping pillmakers agree that the pills should be used only in crisis situations-when a spouse dies, for example, and the survivor can`t sleep. They most definitely should not be used for months or years on end as a crutch to fall asleep.
Dr. Robert Butler, a professor of geriatrics at Mt. Sinai School of Medicine in New York, said it has been hard to know the extent of sleeping pill abuse because data are hard to come by. But a recent report from the Pennsylvania Department of Aging provides a window on a nationwide problem, experts say.
Because Pennsylvania uses money from its lottery to pay for prescription drugs for low-income people older than 65, it is in a unique position to monitor sleeping pill use by the elderly. According to statistics, the typical person in the program is a 79-year-old white widow who lives alone.
By analyzing records of all prescriptions filled by the 375,000 people in the program, the state uncovered evidence that sleeping pills are not only overused by many older people but also abused-taken for far too long and in alarmingly high doses.
According to the study, 14,578 people in the program were taking Halcion, a sleeping pill made by Upjohn Co. And 85 percent of them had exceeded the maximum cumulative dose.
More than 70 percent had far exceeded the recommended duration of no more than two to three weeks, with some taking the drug for a year or longer.
Dr. William Dement, director of the sleep disorders clinic at Stanford University, said there is no medical justification for the chronic use of sleeping pills. He said he usually prescribes them for ”one to two nights, and rarely more than 10 nights.”
But sleep researchers say that older people may demand the pills for longer use.
”The reason the elderly take more sleeping pills is that they don`t sleep well,” Westbrook said. ”They tend to lose very deep sleep, their sleep is more fragmented, and they have a lot more arousals during the night.”
But, Westbrook said, although ”sleeping pills certainly give you sleep, they do not give you normal sleep.” In fact, they deprive people of the deep sleep that already is diminished in the elderly. The elderly may think they need the pills, Westbrook said, but ”for most patients, they are not the long-term answer.”
Too often, said Dr. Gene Cohen, director of the National Institute of Aging, sleeping pills ”are treating the symptom, not the cause” of insomnia. Depression or anxiety or even something as simple as drinking coffee late in the evening can interfere with sleep, he said.
Westbrook suggested that many have exaggerated expectations of what sleep should be like. The elderly ”tend to spend too much time in bed chasing sleep,” he said. In addition, they often nap during the day, which further throws their nighttime sleep out of kilter.
Another problem with sleep in the elderly, Folstein said, is that many are trying to use it as an escape from boredom.
”The real problem is, they don`t have anything to do when they`re awake, so they want to be asleep” he said. ”They wake up early in the morning and say, `This is no good. I`m awake.` ” Some ask their doctors for sleeping pills so they can prolong the time when they are asleep.
Despite the widespread use of sleeping pills by the elderly, Folstein said, ”it`s extraordinarily rare to find an old person who actually requires them.”
