Good news for (yawn) shift workers and residents

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Tim Mullaney
Tim Mullaney

Long-term care professionals around the country cheered wildly last week when the Food and Drug Administration approved Belsomra, a new sleep drug. Shift workers applauded the addition to their medicine cabinets, already well-stocked with sleep aids. “I've tried melatonin and Ambien, but I didn't feel great on either one of those dr—” said certified nursing assistant Susie Sleepless, interrupted by a yawn.  

Okay, I exaggerate. But the FDA did indeed approve Belsomra last week, and a research paper came out showing that many shift workers rely on medications to regulate their sleep cycles. Or that's what workers hope for, but the jury's still out on how well these medications actually perform.

“There isn't good evidence that these drugs can be considered for more than temporary use and some may have quite serious side effects," review author Juha Liira, of the Finnish Institute of Occupational Health in Helsinki, stated in a news release.

Liira and co-investigators with the Cochrane Occupational Safety and Health Group analyzed findings of 15 clinical trials of shift workers taking sleep or alertness drugs. Nine found that over-the-counter melatonin helped workers sleep longer, but did not help them fall asleep faster. Hypnotic drug zopiclone (Imovane) was no more effective than a placebo at helping workers sleep during the day, another trial found.

Belsomra is the first drug of its type, and it combats sleeplessness by altering the action of a brain chemical called orexin, according to the FDA. Perhaps future trials will show Belsomra is more effective than other sleep aids. If so, it might benefit nursing home residents as well as workers.

In yet other sleep-related news to come out last week, a JAMA Psychiatry article tied suicide risk to disturbed sleep in older adults. People 65 and older had a 1.4 times greater chance of death by suicide within the 10-year study period if they reported poor sleep, the study authors determined.

In fact, poor sleep was a better predictor of suicide than depressive symptoms, the investigators found. The strongest predictor was a mix of poor sleep and depression.

Granted, putting a nursing home resident on a pill likely is not the ideal choice for addressing restless sleep, given the chances that he or she already is on multiple medications. But statistics indicate that hypnotics and sedatives already are being administered at a fairly high rate in nursing homes. Even if this rate could come down, it appears that there's still a need for these pharmacological interventions in some cases.

It's likely that shift workers themselves know that behavioral and environmental modifications alone sometimes just don't do the trick. As Liira noted, "For lots of people who do shift work, it would be really useful if they could take a pill that would help them go to sleep or stay awake at the right time."

Belsomra doesn't appear to be a silver bullet by any stretch — the FDA warns that it has side-effects similar to other sleep drugs. But as a new option to help residents and caregivers get some shuteye, its approval is good snooze, er, news.

Tim Mullaney is McKnight's Senior Staff Writer. Follow him @TimMullaneyLTC.

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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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