Sleep of Medically Ill Hospitalized Older Adults: Do Sleep Medications Make a Difference?

TL;DR

Hospitalized older adults experience worse sleep in the hospital compared to home, with sleep medications offering little benefit while physical symptoms significantly impact sleep quality.

Contribution

This study is the first to demonstrate that sleep medications have minimal impact on sleep parameters in hospitalized older adults, while physical symptom burden strongly affects sleep outcomes.

Findings

Hospitalized older adults had reduced total sleep time, lower sleep efficiency, and poorer sleep quality compared to at home.

Sleep medication use was not associated with improved sleep parameters, but higher medication burden correlated with increased awakenings.

Physical symptom burden significantly affected sleep efficiency, sleep quality, and awakenings, with the strongest effect on total sleep time early in hospitalization.

Abstract

Sleep disturbances are common among medically ill older adults during acute hospitalization, often leading to adverse outcomes. Despite frequent use of sleep medications, their effectiveness remains uncertain. This study examined changes in sleep parameters from home to hospital and evaluated the impact of physical symptom burden and sleep medications burden daily trajectories as key factors. A prospective multicenter study was conducted across four Israeli hospitals. The study included 683 cognitively intact older adults who completed an admission interview and at least one follow-up. Sleep parameters—including total sleep time (TST), sleep efficiency (SE), sleep quality (SQ), and number of awakenings (NOA)—were assessed daily, along with sleep medication use and burden (dosage and quantity). Physical symptom burden and additional covariates were analyzed using a repeated measures mixed models approach. Participants (54% male, mean age 77.31±6.60) experienced reduced TST (329.73±111.94 vs. 377.03±101.06 minutes), lower SE (71.49±19.28% vs. 76.14±15.53%), and poorer SQ in the hospital compared to home. Sleep medication use was not associated with any sleep parameter, while sleep medication burden correlated with increased NOA. Physical symptom burden had significant effects on SE, SQ, and NOA. A time-dependent interaction showed that higher symptom burden was most strongly linked to reduced TST at the first in-hospital follow-up, stabilizing thereafter. Sleep deteriorates during hospitalization, with minimal benefit from sleep medications, however stronger effect of physical symptoms severity. Prioritizing symptom management may be key to improving sleep in hospitalized older adults.