Sleep medicines and falls

Dear Dr. Si

We are working to reduce the number of falls in our facility and are wondering about the role of hypnotic agents. Can all sleep medicines result in falls? – WS, Portland, OR

Dear WS,

The sleep medicines that were used in the past such as the barbiturates Nembutal® and Seconal® were tremendously sedating and not only resulted in sleep, but also caused general depression of the central nervous system, resulting in numerous serious complications, including falls.

Classes of medications developed more recently also contributed to falls with the long-acting benzodiazepine Dalmane® (flurazepam) being one of the biggest culprits. Falls have also been attributed to other benzodiazepines including Halcion and Restoril.

Whether the sleep medications commonly used today such as Lunesta®, Rozerem®, Sonata® and Ambien® contribute to falls is unclear but they certainly seem to be safer than the older products.

A 2005 study of more than 34,000 nursing home residents looked at medication use and falls and found that the use of sleep medicines did not contribute to falls but that insomnia alone was found to be a significant risk factor for falls. These data might indicate that allowing residents to get the sleep they need, perhaps through the use of newer and safer medicines, might actually protect them from falls.

This relationship will have to be studied in more detail to come to firm conclusions but in the meantime, consider sleep hygiene first, including important steps like avoiding caffeine just before bedtime, before considering the use of sleep-inducing medications. And, if a drug is used, it should be at the appropriate “geriatric dose,” with close monitoring of the patient for side effects, such as confusion or sedation that could possibly lead to falls, and, of course by making sure that the product is used according to its instructions. Avoid chronic use and also, avoid using sedating medications such as Elavil® (amitriptyline) and Benadryl® (diphenhydramine) to induce sleep because of multiple side effects that can contribute to falls. ***