Insomnia Symptoms, Sleep Medication Use Tied to Disability Risk in Older Adults

Older adults who frequently experience insomnia symptoms or take sleep medications are at greater risk of developing disability over time, according to the findings of a study published in Sleep.

For the study, researchers used data from the National Health and Aging Trends Study between 2011 and 2015, analyzing 6722 community-dwelling adults aged 65 years and older. The researchers sought to determine whether the frequency of insomnia symptoms and sleep medication usage were independently associated with worsening disability and whether the use of sleep medications modified the relationship between insomnia and disability.

The researchers surveyed participants annually over a period of 5 years. Disability was measured using a validated index that assessed difficulty, accommodation, and assistance across key daily activities such as eating, dressing, toileting, mobility, and indoor navigation. Insomnia symptoms were measured by self-reported frequency of delayed sleep onset and difficulty returning to sleep after awakening. Sleep medication use was assessed based on frequency of use in the prior month.

At baseline, the mean age of the cohort was 76.9 years. Most participants were women (57.3%) and identified as White (69.3%), with others identifying as Black (24.7%) or Hispanic/Other (6%). Educational attainment varied, with 25% reporting less than a high school education. The prevalence of chronic conditions, pain, and frailty was high, and 14% met criteria for probable depression at baseline.

Multilevel modeling revealed that for every single-unit increase in insomnia symptom frequency, disability scores rose by 0.20 points per year (standard error [SE]=0.02; P < .001). Similarly, each single-unit increase in sleep medication usage frequency was associated with a 0.19-point annual increase in disability (SE=0.02; P <.001), even after adjusting for covariates including chronic health conditions, depression, and frailty.

An interaction was observed between insomnia symptoms and sleep medication usage. Participants who reported higher frequencies of both had significantly steeper increases in disability over time than those with insomnia symptoms alone (interaction β=0.03; P <.01). Even minimal use of sleep medication amplified the adverse effects of insomnia on disability.

The researchers emphasized that the use of sleep medication not only failed to alleviate the negative effects of insomnia symptoms but actually worsened them. This aligns with existing literature on the side effects of sleep medications in older adults, such as balance impairment and cognitive dulling, which can contribute to functional decline.

Study limitations included the reliance on self-reported sleep behaviors and lack of information regarding the type or dosage of sleep medications used.

“Improving insomnia symptoms and managing sleep medication properly could help prevent disability in the older adult population,” the researchers concluded.

This research was supported by Mobile Sleep Technologies, New York University, Tufts School of Dental Medicine, University of Utah, University of Arizona, University of Miami, Georgia State University, and Harvard Chan School of Public. One study author declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.