Researchers have long known that parts of Atlantic Canada聽have聽the highest rates of chronic prescription sedative use among older adults聽in the country,聽with numbers聽roughly two聽to three times the Canadian average.
New Brunswick聽leads聽with聽the聽highest聽rates聽nationally聽with聽no decline聽in聽a聽decade,聽unlike the rest of Canada.
,聽a professor in 9 1免费版下's鈥疍epartment of Psychiatry and College of Pharmacy, explored the phenomenon and recently outlined the findings of a clinical trial called鈥�. The program,鈥痺hich stands for聽鈥淵our Answers When Needing Sleep in New Brunswick,鈥澛爐ested the鈥痚fficacy鈥痮f receiving a written information package聽in聽the聽mail聽about聽sleep and sleeping pill use,聽including聽ways to reduce the reliance on them.鈥�
Pictured right: Dr. David Gardner (submitted photo)
Dr. Gardner presented the results,聽along with聽new epidemiological data on sedative use in鈥痶he province,鈥痑t public forums鈥痠n Atlantic Canada. Some of the findings:
- The strongest predictor of prescription sedative use in New Brunswick is where you live. Heat maps show a distinct pattern of where use is highest in the province. While the rate is 1.5x higher in women than聽men聽broadly, the rate is聽five聽to six times higher in some聽New Brunswick聽communities compared with others, for both men and women. Among women 85 years and older (who are the group with the highest risk for falls & fractures), the聽proportion聽that take聽prescription聽sedatives聽chronically聽exceed 50 per cent in some parts of the province.鈥�
- New Brunswick聽datashow聽a 70聽to聽90 per cent increase in the risk of hospitalizations for falls, fractures, and hip fractures in association with the use of sedatives鈥痠n older adults.
Dr. Gardner describes the findings聽of the research initiative and how聽preferred聽strategies, like聽Cognitive Behavioural Therapy for聽Insomnia聽(CBT-I) can be聽effective聽for those struggling with insomnia.
How do the rates of sedative use in this region compare to the rest of Canada?
Prior to releasing our most recent findings this fall, it was already known that Atlantic Canada had the highest rates of chronic prescription sedative use among older adults,聽roughly two聽to three times the Canadian average of about聽8聽per cent. New Brunswick ranked highest, followed by Newfoundland and Labrador and Nova Scotia. Interestingly, use of sedatives on P.E.I.聽is lower, close to the national average.
What did you discover about sedative use in Atlantic Canada in your research?
Our latest findings focus on New Brunswick. We completed YAWNS NB, an interventional study evaluating a direct-to-patient mailed package that shares information about sedatives and non-medication approaches to treat insomnia. The聽objectives聽were to reduce sedative use while improving sleep. Using linked health records, we then assessed the durability of the intervention's effects and, in parallel, conducted a province-wide study of sedative use among community-dwelling adults aged 65 and older.
We found that over one year,聽36,480 of 171,639 individuals (21.3聽per cent) took sedatives long-term. Rates were 55聽per cent聽higher in women and 50聽per cent聽higher in those aged 85 and older compared with ages 65聽to聽69. However, the strongest predictor was place of residence, with some regions showing several-fold higher use than others within the same age and sex groups.
Importantly, the聽Sleepwell聽mailed intervention did not lose its impact聽for our study participants聽after the trial ended. Dispensary data showed reduced sedative use during the six-month trial and further reductions over the following 12 months, a surprisingly durable effect for a low-effort,聽easily聽scalable聽intervention.
Why are sedative use rates so much higher in Atlantic Canada?
While it is聽a difficult question聽to answer, it seems unlikely to be explained by differences in rates of insomnia across the country or by differences in access to non-medication therapies. Most people are unfamiliar with聽CBT-I, the recommended first-line therapy for insomnia, regardless of where you live in Canada.
It is more likely explained based on sociological norms, medical practice,聽and public expectations of how to manage insomnia. In places where sedative use is prevalent, it becomes normalized and routinized. Their use is further reinforced because of their pharmacological effects聽that聽cause聽withdrawal-related insomnia when abruptly stopping sedatives.聽Normalizing their use and the vicious cycle of reinforced use聽likely explains, in part, why some regions have聽very high聽rates of use compared to others.
What are the dangers associated with the overuse of sedatives?
Sedatives, when used short and long-term, carry well-documented risks, which vary from one type of sedative to the other. Considering all commonly used sedatives, we are concerned about next-day drowsiness, memory and concentration problems, falls and fractures, motor vehicle collisions, complex sleep behaviours,聽and dependence. We describe these and other concerns as well as how to safely reduce sedative use at Sleepwell ().
Insomnia is often treated with sedatives without a聽clear plan. Medications meant for short-term relief are聽frequently聽continued for years, even though the risks increase with age and the benefits often fade. This makes it especially important to raise awareness of preferred, effective, short-term behavioural and psychological treatments that improve sleep long-term and reduce ongoing reliance on medication.
What can be done to address the overuse of sedatives in Atlantic Canada?
We developed鈥疭leepwell聽()鈥痶o increase awareness of CBT-I and reduce reliance on sleeping pills. Available are resources and recommendations for the public and health care professionals. We work with sleep experts and researchers across Canada and internationally to ensure our approaches reflect the best available evidence. Our work includes public education events, training for health-care professionals, and collaboration with physicians, pharmacists, other health care professionals, and government and other organizational partners. Ultimately, addressing the overuse of sedatives in Atlantic Canada requires shifting insomnia care toward safer, evidence-based聽non-medication聽therapy.聽