Can a sleep monitor make patients and their relatives feel safer during the discontinuation of detrimental sleeping pills?
Strongly addictive sleeping pill use is highly prevalent today. This blog article details the use of Somnofy to fade out and discontinue the use of detrimental sleeping pills.
As a nursing home doctor, I see many newly arrived residents receive very detrimental prescription sleeping pills of the type z-hypnotics; Zopiklone (Imovane) or Zolpidem (Stilnoct) [brand names may differ]. This type of medication is not recommended for prolonged use because they act on the same GABA receptors in the brain as for example alcohol. Through inhibition of nerve cell activity, those pills induce a calming and sedative effect. Due to the nature of this medication, side-effects include drowsiness the next day, confusion, unrest, reduced cognitive functionality, and night terrors. Dosage quickly increases since the body tolerates higher concentrations rapidly which makes it especially difficult to discontinue the use. Many elderly have been sedated with this type of medication for years on end.
The burden of bad sleep often has such a profound effect on the quality of life of the patient as well as their relatives, that this can be an additional factor for the final decision to place the individual in a nursing home.
Sleeping pills are often the last medication residents want to «give up» when I go through their prescription list together with them. The fear of not being able to sleep is palpable and the addictive nature of the drug is difficult to withstand.
Relatives to our residents get to hear frequently that they barely closed their eyes at night. This is often contrasted by observations from medical personnel about actual good sleep during nightly inspection rounds.
Subjective sleep quality vs. objective sleep monitoring
User participation is important in today’s healthcare. By utilizing a new sleep monitor like Somnofy, personnel can measure sleep quality and quantity as well as register which sleep phase the user is in in real time. Using Somnofy in the above mentioned situations has given me a stronger basis for evaluating — together with patient and relatives — how their sleep feels compared to what is actually recorded.
The example below shows the sleep of a woman in her 90s who moved into our nursing home with a 20-year sleeping medication prescription and clear signs of cognitive side-effects from the drugs as well as addiction symptoms: her main focus during the day is all about the sleeping pill while even a double dose is no longer enough to produce a feeling of good sleep. Her relatives are tired, too.
We agreed on measuring her sleep with Somnofy while we faded out the detrimental sleeping pills (Zopiklone) to replace them with the body’s own sleep hormone melatonin.
Picture 1: Sleep quality measurements continuously over 52 days.
This graph shows her sleep day-to-day with commentary where changes in her medication have been initiated. There is no negative development of sleep quality — rather the opposite is happening.
Picture 2: A typical night under the influence of Imovane
The graph shows a representative night after the discontinuation of Imovane. The red bars indicate several short awakenings during the night. The resident herself feels «not having slept one second», while her total sleep time is actually 8h 32min — probably more than most of us get on average.
Picture 3: A typical night after the discontinuation of Imovane
The graph shows a night after Imovane has been discontinued. The resident now gets a melatonin capsule for falling asleep quickly and a melatonin depot to stay asleep during the entire night. Her sleep is now continuous throughout the entire night with more deep sleep. She now describes her sleep as good.
Picture 4: Sleep quality without using z-hypnotics
Two weeks later her sleep has further consolidated with sleep times around 10 hours per night. The withdrawal effects from Imovane have disappeared. Deep sleep has further increased. The resident has more energy during the day, experiences a better mood and is more social. Her relatives are very thankful that we together managed to break through the downward spiral which has been impacting their loved one for too many years.
Results
Subjective sleep can differ substantially from objectively measured sleep. This is especially challenging in dementia patients who might not remember how the night actually felt.
Short and frequent awakenings during the night gave the feeling of minimal sleep despite good total sleep time.
Monitoring sleep made both resident and her relatives feel safe about the changes in sleeping medication.
Objective sleep monitoring can build a better basis for the right decisions to take when sleep problems are being reported.
Remi is a medical doctor educated from Oslo University (1999). He has been an elite cross-country skier and has worked with professional athletes and the elderly for 20 years. He is currently employed as a lead nursing home doctor. In addition, he is working as the MD for the junior-, recruit-, and para national team of Norway in cross-country skiing and as a consultant for VitalThings.