Relying on sleeping pills for a good a night rest has its negative effects. In this report by SADE OGUNTOLA, experts warn individuals, especially the elderly, that people regularly using it may end up needing more medications to control their blood pressure.
Sleep complaints, including difficulty in falling asleep or waking up repeatedly during sleep, is very common, and often many adults reach out to medicines to help sleep.
Experts for long have warned that persons with chronic health conditions are particularly at risk of new-onset, as well as the persistence of sleep difficulties or insomnia. Now, in a study, experts also warn against taken medicine to sleep, especially in the elderly.
The recent study suggested that older people who regularly use sleeping pills may end up needing more medications to control their blood pressure.
High blood pressure is a common condition among older or aged people. Fortunately, blood pressure medications can reduce blood pressure and its associated problems such as stroke and heart attack.
A report from one of the largest synchronised standardised multinational screening campaigns on hypertension, May Measurement Month (MMM) 2017, showed that 36.2 per cent of adult Nigerians were hypertensive, 12.9 per cent of all the participants were on treatment and almost 60 per cent of those receiving antihypertensive treatment had uncontrolled blood pressure.
In Nigeria, the Ibadan Study of Aging (ISA) group, in 2011, reported an incidence of 8.0 per cent and 25.7 per cent for insomnia syndrome and insomnia symptoms, respectively, among the community-dwelling elderly people. What is more, it said that elderly women were twice as likely as men to report difficulty falling asleep.
Among the elderly, widowhood, a variety of chronic health problems such as heart disease, stroke, and diabetes, as well as depressive mood and self-perceived poor health have been identified as risk factors for both incidence and persistence of insomnia.
In this study published in Geriatrics & Gerontology International, researchers in Spain examined whether regular use of sleeping pills in older-aged adults was linked to increased use of blood pressure medications.
A random sample of 752 older adults with hypertension, aged 60 years and older, was followed from 2008 to 2010 through 2012 to 2013. Data on sleep and blood pressure medication usage was self-reported by the participants.
The study found that sleeping pills on a regular basis was linked to the use of an increasing number of blood pressure medications over time. This was regardless of sleep duration and quality, body mass index, diet, physical activity, and hypertension control.
The study found that 20.7 per cent of patients had increased doses of blood pressure medications during follow-up. These patients often had a higher average number of other diseases, slept fewer hours per day and used sleeping pills more frequently.
In addition, they were on a lower average number of blood pressure medications and had a higher frequency of uncontrolled blood pressure at baseline compared to patients who had no change or a fewer number of blood pressure drugs being taken during the follow-up period.
According to them, sleeping pill use may be an indicator of a future need for greater hypertension treatment and asked that doctors should recognize that regular use of sleeping pills in older-aged adults warrant further investigation into unhealthy lifestyles or underlying sleep disorders.
Howbeit, the idea of an individual who persistently combine a sleeping pill and an antihypertensive, requiring a higher dose over time, Dr Lawrence Adebusuyi, a geriatrist at the Chief Tony Anenih Geriatric Centre (CTAGC), University College Hospital, Ibadan, said is possible if the dose of blood pressure medication given initially was not enough.
What is more, he said that an individual persistently taking a sleeping pill alongside blood pressure medication is against good clinical practice.
Prescription and over-the-counter sleep aids are meant to be used occasionally, but people are depending on them more and more for nightly relaxation.
“Relying on sleeping pills for longer periods of time or in higher doses increases the likeliness that the person will experience negative side effects including headaches, dizziness and light headedness, sleepwalking, hallucinations and depression.
“It is only a few people that doctors will ask to take a sleeping pill. So the possibility of these occurring in Nigerian patients is low, except in persons that abuse such drugs,” the expert added.
Dr Adebusuyi declared that “a person that is healthy based on the World Health Organisation’s standard does not need a sleeping tablet in the night to sleep, so it is possible that these people have other problems which have same causative factor with the genesis of hypertension.
“For example, somebody that is stressed, worried or anxious may take sleeping pills to sleep. These are factors that can lead to poor sleep as well as a rise in blood pressure.”
Dr Adebusuyi stated that sleep problem is common in the elderly and is caused by a multiple problems, adding, “doctors will not say because you cannot sleep, start taking sleeping tablets. We give sleeping pills after ruling out other things that could cause a sleeping problem and it is usually for a period of time.”
He declared that sleeping difficulty in the elderly is varied. It could be a difficulty in initiating sleep (DIS), difficulty in maintaining sleep (DMS), early morning awakening (EMA), and non-restorative sleep (NRS).
These, Dr Adebusuyi added, are treated differently. He declared: “So, for somebody with excessive daytime sleepiness, you do not prescribe sleeping tablet. Such only needs an increased level of activity during the day.
“So anybody that has a sleep issue should come to the hospital and let it get investigated. Let’s know what is exactly is the problem. Some drink coffee, tea or even beer in the evening. Definitely, they will wake up multiple times to pass urine.
“Some of them may have difficulty in maintaining sleep because they wake up at night frequent to urinate because of medications such as antihypertensive medicine that are taken.
“So, it is not sleeping tablet that is the first option. It is to look holistically for the cause of the sleeping problem and then take care of it. That is the way it should be managed.”
Dr Adebusuyi, however, said that poor sleep has been associated with an increase in blood pressure and as such the likelihood of uncontrolled hypertension if poor sleep is persistent over a long period of time.
Undoubtedly, he declared that uncontrolled hypertension in the elderly is a real challenge just like in other age groups.
“When you ask why their blood pressure was slightly high, some will say it is because they did not sleep well the previous night,” he added.
According to Dr Adebusuyi, “if despite the initial blood pressure medication, the blood pressure is not going down, you now have to look for a possible secondary cause- the kidney, hormonal issues and so on.”
Previously, researchers at the Olabisi Onabanjo University Teaching Hospital, Sagamu Campus, Ogun State in 2009 edition of the Postgraduate Medicine had shown that patients with hypertension often suffer from insomnia or excessive daytime sleepiness.
The study involved Alebiosu O.C; Ogunsemi O.O, Familoni O.B; Adebayo P.B and Ayodele O.E. It examined the quality of sleep among Nigerian hypertensive patients in a semi-urban Nigerian community and suggested that the severity of hypertension can directly influence the quality of sleep, and poor quality of sleep may worsen hypertensive conditions.
This is not the first time sleeping pills have been linked to health problems. A 2012 study published in the British Medical Journal found that the medication may increase cancer and death risk, even if taken no more than 18 times a year.