Appropriate Use of Sleeping Pills

Choosing Wisely Canada Recommendation: Don’t use benzodiazepines and/or other sedative–hypnotics in older adults as the first choice for insomnia, agitation or delirium.

*Recommended by the Canadian Geriatrics Society and the Canadian Society of Hospital Medicine

Why is it important?

Older adults who use benzodiazepines or other sedative–hypnotics are at an increased risk for motor vehicle accidents, falls and hip fractures and daytime fatigue. Thinking can also be affected.

Benzodiazepines effectively manage anxiety and insomnia but with age, people become more sensitive to their effects and are at risk of side effects that typically outweigh any potential benefit. Chronic use of benzodiazepines is of particular concern because experts recommend only 2 to 4 weeks of continuous use by seniors (CIHI, 2017).

Patient Resources:

Insomnia and Anxiety in Older People: Sleeping pills are usually not the best solution

Sedative-hypnotics: You may be at risk

Physician Resources:

Long Term Care Project: York Care Centre Benzodiazepine and Sedative-Hypnotic Optimization Project

Project Lead: Carole Goodine, BSc (Pharm), ACRP, Pharm D, AGE-WELL/NBHRF Fellow

York Care Centre (YCC) is committed to excellence through safe and effective evidence-based care. After successful implementation of an antipsychotic reduction program, it was time to take what they had learned and apply it to another class of medications.

Benzodiazepines and sedative hypnotics (BSH) were chosen as the next class based on usage, risk and evidence to support deprescribing.  Current evidence indicates that the risks of sleeping pills are generally greater than the benefits for older adults. BSH medications are associated with impaired memory and attention, confusion, delirium, falls and hip fractures.

The goal of the project is to safely decrease the use of sleeping pills such as BSH medications that older adults living in nursing homes may no longer need. This has been a collaborative effort between the YCC research department, nurses, pharmacist, residents, families and physicians.

Implementation is underway and final results are expected in late 2018 or early 2019.