Many drugs commonly prescribed to older adults for a variety of common medical conditions including allergies, hypertension, asthma, and cardiovascular disease appear to negatively affect the aging brain causing immediate but possibly reversible cognitive impairment, including delirium, in older adults according to a clinical review now available online in the Journal of Clinical Interventions in Aging, a peer reviewed, open access publication.

Drugs, such as diphenhydramine, which have an anticholinergic effect, are important medical therapies available by prescription and also are sold over the counter under various brand names such as Benadryl®, Dramamine®, Excederin PM®, Nytol®, Sominex®, Tylenol PM®, and Unisom®. Older adults most commonly use drugs with anticholinergic effects as sleep aids.

While it is known that these medications do have an effect on the brain and in the case of sleeping pills, are prescribed to act on the brain, the study authors suggest the amount of cognitive impairment caused by the drugs in older adults is not well recognized.

“The public, physicians, and even the Food and Drug Administration , need to be made aware of the role of these common medications, and others with anticholinergic effects, in causing cognitive impairment. Patients should write down and tell their doctor which over-the-counter drugs they are taking. Doctors, who often think of these medications simply as antihistamines, antidepressants, antihypertensives, sleep aids or even itching remedies, need to recognize their systemic anticholinergic properties and the fact that they appear to impact brain health negatively. Doing so, and prescribing alternative medications, should improve both the health and quality of life of older adults,” said senior study author Malaz Boustani, M.D., Indiana University School of Medicine associate professor of medicine, Regenstrief Institute investigator, and research scientist with the IU Center for Aging Research.

Dr. Boustani and colleagues conducted a systematic evidence-based analysis of 27 peer reviewed studies of the relationship of anticholinergic effect and brain function as well as investigating anecdotal information. They found a strong link between anticholinergic effect and cognitive impairment in older adults.

“One of the goals of our work is to encourage the Food and Drug Administration to expand its safety evaluation process from looking only at the heart, kidney and liver effects of these drugs to include effects of a drug on the most precious organ in human beings, our brain,” Dr. Boustani said.

“Many medications used for several common disease states have anticholinergic effects that are often unrecognized by prescribers” said Wishard Health Services pharmacist, Noll Campbell, Pharm.D., first author of the study, noting that these drugs are among the most frequently purchased over the counter products. “In fact, 50 percent of the older adult population use a medication with some degree of anticholinergic effect each day.”

“Our main message is that older adults and their physicians should have conversations about the benefits and harms of these drugs in relation to brain health. As the number of older adults suffering from both cognitive impairment and multiple chronic conditions increases, it is very important to recognize the negative impact of certain medications on the aging brain,” said Dr. Boustani.

The brain pharmacoepidemiology group of the IU Center for Aging Research currently is conducting a study of 4,000 older adults to determine if the long term use of medications with anticholinergic effects is linked to the irreversible development of cognitive impairment such as Alzheimer disease.

Authors of the JCIA study are Noll Campbell, Pharm.D., Wishard Health Services; Malaz Boustani, M.D., MPH; Tony Limbil, M.D., MPH, of University of Illinois; Carol Ott, Pharm.D. of Wishard and Purdue University; Chris Fox, MRCPsych and Ian Maidment, B.Pharm., of Kent Institute of Medicine and Health Sciences University of Kent and Medway NHS Trust, United Kingdom; Cathy C. Schubert, M.D. of the IU School of Medicine; Stephanie Munger, B.S., of Regenstrief and IUCAR; Donna Fick, R.N., Ph.D., of Pennsylvania State University; David Miller, M.D., of the IU School of Medicine and Rajesh Gulati, M.D., of IU Medical Group - Primary Care. The study was funded by the John A. Hartford Foundation, the Atlantic Philanthropies, the Starr Foundation, and the National Institute on Aging.

Source:
Cindy Fox Aisen

Indiana University

Getting addicted to sleeping pills is an easy option when you can’t seem to snooze off at bed-time but falling asleep naturally can be easier if you just know how to do it. Here are some tips on how to fall asleep naturally.

Regulate your bed-time: If you intend to be working late every day or watching television way into the night, don’t expect to be getting a good night’s sleep. Decide upon a bed-time and get into bed at that time even if you are not feeling sleepy. Also, set a waking-up time, at least eight hours later and stick to that as well. Don’t get lazy and into the habit of putting off the alarm clock. Ensuring that you go to bed at the same time every day and jump out of bed at the same time will regulate your body clock and soon, you will be feeling sleepy at the appointed hour. You will automatically wake up refreshed as well.

Find some good music and books: It is always a good idea to read a good book, not necessarily fiction, to tire you a bit and put you into the drowsy state. Lot of melodious, slow, romantic type of music is available in the market that you can put on as you get into bed. Many types of CDs with subliminal auto suggestions interwoven with healing music will relax you and make you go to sleep naturally every day after a bit of practice.

Meditation: Meditation is considered a sure way of making you fall asleep naturally. Whether you have learnt how to meditate in an American psychiatry clinic or with an Easter mystic, mediation relaxes both your mind and body. It automatically clears toxic thoughts which helps in drifting off for a good night’s sleep.

Shower and sahaja yoga: Many practitioners of different variants of yoga suggest a light, soothing, aromatic shower before going to bed. A stream of sahaja yoga suggests taking a salt-water foot bath by soaking only your feet in a tub-full of water to help you get rid of the negative chi collected during the day. These will help you fall asleep naturally.

Infants and young toddlers with obstructive sleep apnea and sleep disordered breathing experience significant improvement following surgical treatment of the ailment, according to an invited article in the June 2009 issue of Otolaryngology-Head and Neck Surgery.

The study evaluated 73 cases in which children younger than two years old were treated for obstructive sleep apnea through the removal of the adenoids, tonsils, or both (adenotonsillectomy). Those treated through surgery experienced significant improvement on the apnea-hypopnea index (AHI), an index that measures the severity of sleep apnea. Those treated medically, but not surgically, exhibited no improvement after treatment. The study’s authors also concluded that the rate and types of post-surgical complications were within acceptable levels.

Sleep disordered breathing (SDB) in children, from infancy through puberty, while similar to adult sleep apnea, actually has different causes, consequences, and treatments. A child with SDB does not necessarily have this condition when they become an adult. The consequences of pediatric obstructive sleep apnea include snoring; sleep deprivation (which can cause moodiness and behavioral issues); abnormal urine production; slowed growth and development; and attention deficit and attention deficit hyperactivity disorders.

Source:
Matt Daigle

American Academy of Otolaryngology — Head and Neck Surgery .