To Sleep: Perchance to Break A Hip

To sleep: perchance to dream.
Shakespeare in Hamlet

Of late, much has been made of our need to get adequate sleep.  We generally quote an average of 7-8 hours/night as being the minimum necessary for proper function.  However, there are also studies suggesting that our sleep requirements change as we age.  And yet, for many of our retired or institutionalized, they still adhere strictly to this dogma, despite having no absolute need to meet a schedule.  And if they can't fall asleep at a time they consider "normal" or if they wake up earlier than they'd like, they take on the label of insomnia and demand some sedative-hypnotic, whether benzodiazepine or non-benzodiazepine.  We generally look askance at the former with its potential for addiction & confusion.  Yet, the non-benzodiazepines are not without fault.

In fact, a case-crossover study was published early online last week in JAMA Internal Medicine in which the authors noted that among nursing home residents, hip fracture risk was linked to non-benzodiazepine use.  Let's be clear at the outset: this study cannot prove cause & effect, just an association.  Specifically, the authors found 15,528 institutionalized patients (3 out of 4 of whom were female w/avg 81yo) who'd already sustained a hip fracture of which 1,715 had been given a non-benzodiazepine sedative hypnotic prior to the fracture.  These participants served as cases while controls were located in the cohort.  The authors noted also that greatest risk for hip fracture within the 1st 2 weeks of starting this medication & continued out through the quarter, especially in those with cognitive impairment and/or functional impairment.

Bottom line: focus on sleep hygiene first (try to avoid napping during day which can upset sleep cycle).  Then inquire as to a need to keep to a strict schedule, especially in those who've walked away from an 8A-5P job.  Without that need for a strict schedule, there's no reason why our patients can't turn into nightowls if they so choose, staying up late & waking up late, too.  So let them be, rather than increase their rate for hip fracture by sedating them.

Follow @alvinblin
Tweet
This site complies with the HONcode standard for trustworthy health information:
verify here.