Sleep Medication in Older Adults: Identifying the Need for Support by a Community Pharmacist

Many older adults take benzodiazepines and sedative-hypnotics for the treatment of sleep disorders. With a view to considering the possible discontinuation of hypnotics, the objectives of the present study were to describe bedtime habits and sleep patterns in older adults and to identify the sleep medications taken. An expert group developed a structured interview guide for assessing the patients’ bedtime habits, sleep patterns, and medications. During an internship in a community pharmacy, 103 sixth-year pharmacy students conducted around 10 interviews each with older adults (aged 65 or over) complaining of sleep disorders and taking at least one of the following medications: benzodiazepines, benzodiazepine derivatives (“Z-drugs”), antihistamines, and melatonin. A prospective, observational study was carried out from 4 January to 30 June 2016. The pharmacy students performed 960 interviews (with 330 men and 630 women; mean ± standard deviation age: 75.1 ± 8.8). The most commonly taken hypnotics were the Z-drugs zolpidem (n = 465, 48%) and zopiclone (n = 259, 27%). The vast majority of patients (n = 768, 80%) had only ever taken a single hypnotic medication. The median [interquartile range] prescription duration was 120 (48–180) months. About 75% (n = 696) of the patients had at least 1 poor sleep habit, and over 41% (n = 374) had 2 or more poor sleep habits. A total of 742 of the patients (77%) reported getting up at night—mainly due to nycturia (n = 481, 51%). Further, 330 of the patients (35%) stated that they were keen to discontinue their medication, of which 96 (29%) authorized the pharmacist to contact their family physician and discuss discontinuation. In France, pharmacy students and supervising community pharmacists can identify problems related to sleep disorders by asking simple questions about the patient’s sleep patterns. Together with family physicians, community pharmacists can encourage patients to discuss their hypnotic medications.

Objective Assessment of Sleep Patterns among Night-Shift Workers: A Scoping Review

In this scoping review of the literature, we identified the types and the parameters of objective measurements to assess sleep patterns among night-shift workers. We conducted a literature search using electronic databases for studies published from 1991 to 2020 and charted and summarized key information. We included 32 studies in the review. Polysomnography was used in 6 studies and wearable sleep detection devices were utilized in 26 studies. The duration of sleep assessment using the wearable devices ranged from 1 day to > 4 weeks, and more than half of the studies collected data for > 2 weeks. The majority of the studies used subjective questionnaires, such as the Karolinska Sleepiness Scale, Epworth Sleepiness Scale, and Pittsburgh Sleep Quality Index, in addition to objective sleep measurements. Total sleep time was the most common parameter, followed by sleep efficiency, sleep onset latency, and time or frequency of being awake. As the utilization of wearable devices to assess the sleep patterns of night-shift workers is expected to increase, further evaluation of device accuracy and precision, optimal data collection period, and key parameters is warranted.

When Non-Suicidal Self-Injury Predicts Non-Suicidal Self-Injury and Poor Sleep—Results from a Larger Cross-Sectional and Quasi-Longitudinal Study

Poor sleep is associated with a higher risk of non-suicidal self-injury (NSSI) as a proxy of unfavorable emotion regulation. In the present study, we tested the hypothesis that past non-suicidal self-injury was associated with current non-suicidal self-injury and with current subjective sleep patterns. To this end, a larger sample of young adults were assessed. A total of 2374 adults (mean age: 27.58 years; 39.6% females) completed a series of self-rating questionnaires covering sociodemographic information, past and current NSSIs, suicide attempts, and current sleep patterns, including experiencing nightmares. Past NSSIs predicted current NSSIs. Current sleep patterns had a modest impact on the association between past and current NSSIs. Compared to male participants, female participants did not report more sleep complaints or more current NSSIs, but more past NSSIs. Past NSSIs predicted the occurrences of nightmares and suicide attempts. The best predictor of current NSSI was the remembered past NSSI, while current poor sleep was only modestly associated with current NSSI. Further indicators of current NSSI and poor sleep were suicide attempts and nightmares within the last six months. Overall, it appears that poor emotion regulation should be considered as underlying factor to trigger and maintain non-suicidal self-injury-related behavior and poor sleep. Further, unlike previous studies, which focused on the possible influence of sleep patterns on NSSIs, the aim of the present study paradigm was to investigate NSSIs on sleep patterns.

The Association between Insomnia-like Sleep Pattern Changes and Cognitive Dysfunction: Possible Mechanism and Therapeutic Strategy

: The prevalence of sleep disorders and cognitive dysfunction has overwhelmingly increased, with insomnia and Alzheimer’s disease (AD) being the most common form. A multitude of studies have linked the alterations in sleep continuity or sleep architecture with cognitive impairment bilaterally, but the management of disrupted sleep patterns in preclinical AD could be more beneficial since there is no cure for AD. This review mainly focuses on the altered sleep patterns in insomnia, and summarizes potential pathways underlying the relationship between insomnia and cognitive impairment, aiming to establish certain sleep pattern changes as biomarkers for cognitive decline and explore potential therapeutic targets based on evidence from research advances.

The Association Between Regular Physical Exercise, Sleep Patterns, Fasting, and Autophagy for Healthy Longevity and Well-Being: A Narrative Review

This narrative review of the literature assessed whether regular physical exercise and sleep patterns, fasting and autophagy, altogether can be an adequate strategy for achieving healthy longevity and well-being within different stage of life. There are a large number of studies dealing with well-being and healthy longevity; however, few of them have given us a specific formula for how to live long and healthy. Despite all the advances that have been made to create adequate physical exercise programs, sleep patterns or nutritional protocols, the relation between different types of fasting, nutritional supplementation as well as regular physical exercise and sleep patterns have not yet been satisfactorily resolved to cause the best effects of autophagy and, therefore, well-being and healthy longevity. In this way, future studies should clarify more efficiently the relationship between these variables to understand the association between regular physical exercise, sleep patterns, fasting and autophagy for healthy longevity and well-being.