Should Your Doctor Know You Are Not Sleeping?

Are you sleeping enough, or are you missing out? Sleep scientist Matthew Walker says that skimping on sleep can shorten your life. That poses a real dilemma for seniors, since medications to overcome insomnia can have negative consequences for health. Even melatonin might be risky. Read on to learn more.

The Effects of Sleeping Less Than Six Hours Nightly:

Dr. Matthew based his conclusion on an analysis of 20 different studies. One study showed that people over 45 were twice as likely to have a heart attack or stroke at some point if they slept fewer than 6 hours most nights instead of 7 to 8 hours. Sleep deprivation also hampers immune system activity, which could make you more vulnerable to infection or cancer.

Those who pride themselves on sleeping fewer hours a night may be setting themselves up for dementia or obesity, or at least an increased risk of those disorders. Concentrating on getting a good night’s sleep may be as important as adequate exercise and a healthy diet in boosting well-being and longevity.

Here is a link to an article about his research:

https://www.theguardian.com/lifeandstyle/2017/sep/24/why-lack-of-sleep-health-worst-enemy-matthew-walker-why-we-sleep

Older People with Trouble Sleeping:

Given that sleep problems are common and troublesome, it’s not surprising that many older people take over the counter or prescription sleep medicine on a regular basis. Almost one seventh of those who report difficulty sleeping at least three nights a week take prescription sleeping pills.

Often, people rely on such drugs for many years although the medications are labeled for short term use only. We worry about the potential negative effects of both prescription pills and over-the-counter PM-type medications. The “PM” indicates diphenydramine, also known by its brand name Benadryl. This sedating antihistamine has anticholinergic activity, which can lead to confusion and memory problems.

Don’t Be Silent About Not Sleeping:

Other older people who don’t sleep well don’t talk with their doctors about this problem, even though some of them reported that pain was a factor keeping them awake. These results are based on a poll of more than 1,000 people by researchers at the University of Michigan.

http://www.healthyagingpoll.org

What About Melatonin to Ease Sleeping Troubles?

Q. You wrote recently about the dangers of taking melatonin for insomnia, especially in large doses. In the study you cited, more people taking this pill had heart failure.

The dose might not be quite as high as it seems, though. According to a study of bioavailability, the amount of melatonin actually absorbed by the body is only about 3 percent (BMC Pharmacology & Toxicology, Feb. 19, 2016).  In that light, the large oral tablet doses are not quite as scary as you implied.

People take melatonin because they have difficulty sleeping. Those who don’t sleep well are at significantly higher risk of heart attacks or death. That alone might explain the higher rates of heart failure among people taking melatonin.

A. Thank you for highlighting the study of oral melatonin bioavailability. We didn’t appreciate that only a small amount of melatonin is absorbed from a pill.

The research you cited shows that there is tremendous variability from one person to another. The authors report that prior studies found absorption between 9 and 33 percent.

A common dosing regimen is 3 mg of melatonin taken about one hour before bedtime. If people only absorb 3 percent, that equals a dose of 90 micrograms, roughly three times more than our bodies normally make in a day.

At least one randomized controlled trial found that melatonin (at a dose of 10 mg, which we think is too high) helped people with sleep apnea and insomnia (Journal of Pharmaceutical Health Care and Sciences, May 30, 2024). We surely hope scientists will continue to search for a safe way to help people having trouble sleeping.

The People’s Pharmacy Perspective:

We should be prioritizing sleep. That may mean turning off computers, televisions, mobile phones and other screens at least half an hour before bedtime. The light given off by those screens can delay melatonin production.

You may also need to be active during the day. Research shows that people who move around more usually sleep better.

But we think that sleeping pills, if needed, should be used rarely rather than on a regular basis “just in case.” Finding nondrug options (such as a magnesium supplement) is usually preferable to taking pills.

Learn More:

To learn more about melatonin and other ways to overcome insomnia, you may wish to read our eGuide to Getting a Good Night’s Sleep. In it, we discuss many different approaches for combating insomnia. Pleasant dreams!