A study of 30 rural elderly caregivers of patients with dementia found 13 (43%) used OTC psychotropics (such as diphenhydramine) for sleep disturbances, compared with only one of 30 noncaregivers. Seven caregivers were taking prescription psychotropics, such as diazepam. The proportion of caregivers taking psychotropics rose to 63% when the OTC and prescription-drug categories were combined.
Part of the problem, of course, is the taxing nature of around-the-clock responsibility for care, particularly in an isolated situation. Thirteen of the caregivers spent 24 hours a day, seven days a week providing care; 11 others said they spent between 24 and 167 hours a week. Only six caregivers said they felt they received sufficient support.
All the caregivers were using caffeine (which can compound sleep difficulties), perhaps in an attempt to counteract daytime sedation caused by the sleeping aids. Eight caregivers reported consuming at least one to two alcoholic drinks a week. Four had been directed by physicians to have a glass of wine to help them sleep. However, like caffeine, alcohol can disturb sleep, especially in the elderly, who may already sleep restlessly because of age-related changes.
The researchers cite several concerns based on their data:
• Self-treatment of sleep problems can leave the underlying cause, such as depression, undiagnosed.
• The user may not be aware of other, safer ways to improve sleep.
• OTC sleep aids can have serious consequences, such as anticholinergic effects, anterograde amnesia, and daytime sedation.
• OTC sleep aids are less effective than other hypnotic agents.
• Patients may unknowingly duplicate therapy.
Source: Ann.Pharmacother. 30:583-585, June 1996