Sleep Meds Linked to Hip Fractures in Nursing Home Residents

Researchers linked the class of sleeping pills that includes Ambien, Lunesta, and Sonata to a higher risk for hip fractures in a new study, but experts say insomnia and a poor sleep environment may be to blame, not the sleep drugs.

Some sleep-inducing medications may be tied to an increased risk of hip fractures, according to a study published today in the the Journal of the American Medical Association (JAMA).

A research team led by Sarah D. Berry, M.D., M.P.H., of Harvard Medical School examined the medical records of 15,528 long-term nursing home residents aged 50 or over with documented hip fractures. They found that 11 percent, or 1,715 of the residents, had been given a nonbenzodiazepine hypnotic drug — a class of sleeping pills that includes Ambien, Lunesta, and Sonata — within 150 days of their fracture. They found that those who had the highest risk of breaking a hip were residents who had been prescribed nonbenzodiazepine hypnotic drugs within the previous 30 days.

According to the study, nursing home residents have trouble falling asleep, a problem researchers attribute to a “high prevalence of primary sleep disorders” such as sleep apnea and an environment that “pays little attention to sleep quality and structure.” They cited the 2004 National Nursing Home Survey, which estimated that 13 percent of nursing home residents were given a benzodiazepine hypnotic to induce sleep. Benzodiazepine hypnotics are a fast-acting class of drugs, including Halcion, Dalmane, and Restoril, that calm brain activity to promote sleep. But researchers noted that studies tied these medications to difficultly maintaining balance, in addition to falls and fractures.

Nonbenzodiazepine hypnotics are now used more often in nursing homes, and as a class they are believed to have a lower risk of dependency.

Researchers question whether hypnotics independently put nursing home residents at greater risk of hip fractures, or whether poor sleep is to blame. The authors of the JAMA report cited a 2005 study published in the Journal of the American Geriatrics Societyassociated untreated insomnia in nursing home residents with a greater risk of falls, which often cause hip fractures in the elderly. Other studies have demonstrated that balance impairments may be a direct result of a lack of sleep.

An October 2012 report presented at the annual meeting of the American Society for Bone and Mineral Research found that residents taking non-benzodiazepine hypnotics for insomnia had a 70 percent increased risk of hip fractures.

Researchers who worked on the JAMA study concluded that both insomnia and the use of sleep-inducing medications may put nursing home residents at risk. While they concluded that minimizing use of hypnotics would help, they also suggested that the implementation of a better sleep environment may help prevent insomnia, and ultimately falls, over the long-term.

“Residents, staff, and nursing home administrators need to collaborate to create a culture change within the nursing home that increases daytime activity, improves social engagement, avoids daytime naps, and minimizes awake time in bed for residents. Physicians must also have amore active role to ensure that sleep quality and structure are not impaired by treatable medical or psychiatric conditions and that other sleep disorders commonly seen in the frail elderly (eg, central sleep apnea) are promptly diagnosed and treated,” they wrote in JAMA.

By Alysha Reid