Daily Editors' Notes

Becoming wide awake about the dangers of sleeping pills

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Elizabeth Newman, McKnight's Senior Editor
Elizabeth Newman, McKnight's Senior Editor

There are some people who are able to fall asleep as their head is hitting the pillow.

Then there are the rest of us. Like many of those who have periodically fought insomnia, I have occasionally tried a sleeping pill, both over-the-counter and prescribed. Most of the time, the next morning I wake up feeling drowsy and unwilling to talk to anyone who isn't holding out coffee for me to drink. 

Turns out I'm not alone. Last week, the Food and Drug Administration said it wanted manufacturers of sleeping pills containing zolpidem to cut back on recommended current dosages. You might not know zolpidem, but you definitely know it by another name — Ambien — likely either because you've taken it or know someone who has taken it, including some of your residents. It's estimated Ambien is the most popularly prescribed sleeping pill in the U.S.

One of the main reasons the FDA issued the new rule is that zolpidem leaves the body of women more slowly than it does men. The new guidelines recommend the dosage for women taking the drug be 5 milligrams, down from 10. For those of you who hate math, that means a lot of women were taking twice of what science says they should be taking in order to sleep.

Sleeplessness is a problem for many long-term care residents, and it can be caused by a number of factors. Pathway Health Services Director of Education Susan LaGrange, RN, BSN, NHA, points out that residents might not be receiving a good night's sleep because of pain, hunger, a roommate snoring, staff talking too loudly, or the need to use a toilet.

But a need solved by a sleeping pill can then cause impaired motor function. Most stories have focused on the FDA changing its tune because of driver impairment, or, in the celebrity case of Tom Brokaw, needing medical care due to the side effects of Ambien. Brokaw was hospitalized after slurring his words on Joe Scarbough's show, Morning Joe, although it was unclear whether the Ambien influenced his decision to appear on the show to begin with.

For your residents, the impairment from zolpidem can lead to falls or other movement problems.

The good news, LaGrange says, is that she's seen many facilities cut down on administering sedatives and hypnotics, including Ambien/Zolpidem. As with any recommendation, she notes it's only a matter of time before surveyors look at facility percentages of residents on these medications, if they aren't already.

“If I were the DON, I would audit my charts, download the updated CMS Form number 803 to identify residents on sedatives/hypnotics and ask the pharmacy to pull a current list of residents on Ambien to cross-reference,” she wrote me. “Look to ensure the assessments are updated and accurate and that they have ruled out any other reason for insomnia, attempted non-pharmacological interventions and are following the individualized care plan.”

Sleeping pills are far more powerful than many first thought, including federal regulators. The FDA recommendations offer an opportunity to reassess the use of sedatives in your facilities, before they become as reviled as antipsychotics.

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Daily Editors' Notes

McKnight's Daily Editor's Notes features commentary on the latest in long-term care news. Entries are written by Editorial Director John O'Connor on Monday and Friday; Staff Writer Tim Mullaney on Tuesday, Editor James M. Berklan on Wednesday and Senior Editor Elizabeth Newman on Thursday.

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