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Posted: September 30, 2008

Older Women Who Get Little Sleep May Have Higher Risk of Falling

Older women who sleep five hours or less a night have an increased risk of falling, and their use of medications to help them sleep better does not seem to reduce their likelihood of falling, according to a medical journal report.

“Falls pose a major health risk among older adults and are a leading cause of mortality [death], morbidity [illness] and premature nursing home placement,” according to background information in the article published in the Archives of Internal Medicine.

About one-third of adults older than age 65 experience at least one fall each year. Insomnia and disturbed sleep as well as the use of hypnotic medications to treat insomnia (called benzodiazepines) are increasingly common in older adults. “It is not established whether it is poor sleep or medications used to treat sleep disturbances that explain the increased risk of falls in those who are prescribed such medications,” according to the article.

Katie L. Stone, Ph.D., of the California Pacific Medical Center Research Institute in San Francisco, and colleagues used wristwatch-like devices called actigraphies and sleep diaries to measure sleep, sleep efficiency (the percentage of time in bed spent sleeping) and frequency of falls in 2,978 women age 70 and older. Questionnaires were used to determine demographic information and use of benzodiazepines.

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Participants averaged 6.8 hours of sleep per night and spent an average 77.2 minutes awake after initial sleep onset. The average number of falls one year after the collection of sleep data was just under one -- 0.84. “A total of 549 women (18.4%) had two or more falls during the year after the sleep assessments,” the authors wrote. 

The risk of having two or more falls during the following year was higher for women who slept five hours or less per night compared with women who slept more than seven to eight hours per night. Compared with those who averaged at least 70% of the sleep they required, those who got less than 70% were 1.36 times more likely to experience a fall. 

Similarly, women who had trouble staying asleep and experienced two hours or more a night of being awake after first falling asleep 1.33 times more likely to fall than those who spent less than 120 minutes awake after sleep onset. 

The use of sleep medications did not appear to reduce the likelihood of falls in the research findings. “In all, 214 subjects (7.2%) reported current use of benzodiazepines,” the authors wrote. “Use of any benzodiazepine (short and long combined) was associated with a 1.34-fold increase in risk of falls, whereas short- and long-acting benzodiazepine use was associated with increased odds of 1.43 and 1.18, respectively.”

“Future studies, in particular randomized trials, are needed to determine the effects of newer pharmaceutical interventions for insomnia (e.g., benzodiazepine receptor agonists) or cognitive behavioral therapy for insomnia on risk of falls,” the authors conclude. “In addition, future studies using comprehensive and objective measures of sleep should examine the interrelationships between specific sleep characteristics (e.g., sleep-related breathing disorder, hypoxia and measures of sleep duration and fragmentation) to determine if these disorders contribute independently toward risk of falls.”

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