Arousability and Fall Risk During Forced Awakenings From Nocturnal Sleep Among Healthy Males Following Administration of Zolpidem 10 mg and Doxepin 6 mg: A Randomized, Placebo-Controlled, Four-Way Crossover Trial.

Study Objectives: To examine and compare the arousability threshold and fall risk upon awakening of doxepin (6 mg) versus zolpidem (10 mg). Methods: A total of 52 healthy adult males were included in a double-blind, placebo-controlled, four-way crossover study. The experimental procedure included four nights with polysomnography in the lab (zolpidem, doxepin, and their respective placebo conditions). Arousability was measured using an auditory awakening threshold delivered at the peak-plasma concentration for the active hypnotics and at matched times for the respective placebo conditions. Fall risk during the night was measured following awakening using the Berg Balance Scale and the Tandem Walk Task. Results: Both arousability and fall risk were lower in the doxepin condition compared to the zolpidem condition. Furthermore, arousability and fall risk for doxepin did not differ significantly from the placebo conditions. A significantly greater proportion of participants in the zolpidem condition (63.5%) did not wake until receiving the loudest tone (110 dB) as compared to the doxepin (17.6%) and placebo conditions (17.3%, 5.8%). Conclusions: Results suggest that zolpidem has greater risks for balance and awakening threshold compared with low-dose doxepin. Future prospective studies should extend results to clinical samples with population-level risk of injury and arousability.

Sleep hygiene practices in two community dwelling samples of older adults.

STUDY OBJECTIVES: Common sleep hygiene practices were examined in 2 community-based samples of older adults to determine which practices differentiated 4 sleep subgroups: noncomplainers without insomnia symptoms, complainers without insomnia symptoms, noncomplainers with insomnia symptoms, and complainers with insomnia symptoms. DESIGN: Two weeks of sleep diaries provided napping and bed/out-of-bed time variability data. A retrospective questionnaire provided data on caffeine, cigarette, and alcohol usage. Recruitment involved random digit dialing (Sample 1) and advertisements (Sample 2). SETTING: Memphis, TN area (Sample 1); Gainesville, FL area (Sample 2). PARTICIPANTS: 310 individuals 60-96 years (Sample 1); 103 individuals 60-89 years (Sample 2). INVENTIONS: N/A. MEASUREMENTS AND RESULTS: Older individuals with sleep complaints did not report engaging in poorer sleep hygiene practices than those without complaints with the exception of frequency of napping. For Sample 1 only, complainers reported napping on 1.5-2.0 more days per week than noncomplainers. Sleep subgroups in both samples did not differ for the other sleep hygiene practices studied. CONCLUSIONS: Overall, sleep hygiene behaviors did not differentiate the 4 sleep subgroups. The efficacy of sleep hygiene as a therapy for late life insomnia appears questionable in this context. Both complaining sleep subgroups napped more frequently than both noncomplaining subgroups in Sample 1. Additional research is needed to clarify the clinical implications of nap frequency as these results did not replicate in Sample 2, and the impact of napping on nighttime sleep remains unclear. Inconsistencies with previous research in younger samples support the need for more research specifically targeting older individuals' sleep patterns and behaviors.