Insomnia and sleep medication use connected to disability in older adults

UNIVERSITY PARK, Pa. — Insomnia is a significant health and quality of life concern for older adults, with up to half of all adults over the age of 65 experiencing insomnia symptoms. In a new study, researchers in the Penn State College of Health and Human Development and at Taipei Medical University analyzed five years of data from older adults in the United States. They found higher levels of both insomnia symptoms and sleep medication use were associated with higher risk of disability a year later. 

Every year a person experienced an incremental increase in insomnia symptoms, their risk for becoming disabled in some aspect of their daily life increased by 20%, according to the researchers. A similar level of risk was associated with increased usage of sleep medications. People who regularly experienced insomnia symptoms and used sleep medication were at the highest risk of disability affecting their daily activities. 

Results of the study, recently published in the journal Sleep, indicate the importance of properly treating insomnia, the researchers said.

“When we evaluated the relationships between disability, insomnia and sleep medication use, we found that as older people used more sleep medication or experienced more insomnia symptoms, they moved more rapidly towards greater disability,” said Orfeu Buxton, Elizabeth Fenton Susman Professor of Biobehavioral Health at Penn State, Social Science Research Institute co-funded faculty and co-author of the study.

The researchers analyzed data from 6,722 participants in the National Health and Aging Trends Study (NHATS), which captured a national sample of Medicare beneficiaries over the age of 65. The team used more than 22,000 individual observations from the first five waves of data collection — gathered between 2011 and 2015.

The NHATS data included annual measures of disability data using a validated questionnaire. The questionnaire asked about self-care activities including dressing, eating, using the toilet and showering. It also asked about mobility activities including getting out of bed, moving around indoors and going outside.

To quantify the relationship between these variables, participants’ data were measured on an established numeric scale for disability. For each self-care activity, participants were classified as “fully able” to complete the activity on their own; “vulnerable” to disability if they used accommodations, reduced their participation in the activity, or had difficulty with tasks; or “assistance” if they could not complete an activity without help. A classification of “fully able” was scored as one point; “vulnerable” was scored as two points; and “assistance” was scored as four, with higher scores representing higher levels of disability.

Any score increase of two or more on a person’s overall score represented a clinically meaningful level of disability related to self-care or mobility, according to a previous study by other researchers.

The NHATS data included five frequency levels of both insomnia symptoms and sleep-medication use — never, once a week, some nights, most nights, and every night. "Never" was scored as one point, and each level was worth one more point up to "every night" being scored as five points.

For every level of increase in the frequency of reported insomnia symptoms, the disability score was — on average — .2 higher the next year. For every level of increase in the frequency of reported sleep medication use, their disability score was — on average — .19 higher the next year.

“These results indicate that both insomnia and sleep medication use may be contributing to disability,” said Tuo-Yu “Tim” Chen, assistant professor in the program in global health and health security at Taipei Medical University in Taiwan and lead author of the study. “As an average example, these numbers suggest that an older adult who increased their sleep medication use from ‘never’ to ‘every night’ over the course of five years would be likely to develop a clinically significant disability. On an individual level, we cannot predict risk so specifically, but if an older adult has prolonged sleep problems and/or sleep-medication use over time, they are very likely to become disabled.”

According to a prior study by the same research team, sleep medication makes falling more likely for older adults. Buxton said they suspect falls are one important reason that sleep medication was associated with higher levels of disability.

Many studies have demonstrated the physical, mental and emotional harm that insomnia can cause, the researchers said. The connection they found between insomnia symptoms and disability confirmed their hypothesis.

Because both insomnia and sleep medication may contribute to disability, older people need to manage their insomnia safely and effectively, according to Soomi Lee, associate professor of human development and family studies at Penn State and co-author of the study.

“Insomnia can decrease a person’s quality of life both directly and indirectly,” Lee said. “Any older adult who experiences insomnia or uses sleep medication needs to talk to their physician about sleep. When physicians know about sleep problems, they can review the patients’ medications to make sure that drug interactions are not triggering insomnia. Physicians also can connect older adults with care that manages insomnia more safely than medication.”

Cognitive behavioral therapy, which helps people identify and modify thought or behavior patterns, is a safe and effective treatment for insomnia, the researchers said.

“Many older adults think sleep disruptions are a natural part of aging, but they are a real problem that must be addressed,” Lee explained. “And that problem is unlikely to improve unless people talk to their doctors. There are not enough sleep clinics, especially in rural areas, so older people may need to advocate for themselves to get proper treatment.”

The National Science and Technology Council of Taiwan helped support this work.