OCCULT CAFFEINE AS A SOURCE OF SLEEP PROBLEMS IN AN OLDER POPULATION

OBJECTIVE: To evaluate the impact of caffeine in medication on sleep c omplaints in a community population of persons aged 67 or older. DESIG N: Cross-sectional analysis. SETTING: Iowa 65+ Rural Health Study. PAR TICIPANTS: Those who completed their own interview, including a sectio n on the use of medications, during the third annual in-person follow- up in 1984-1985. MEASUREMENTS: Main outcomes: trouble falling asleep o r other sleep complaints. Covariates: use of caffeine-containing medic ation, spasmolytic, or sympathomimetic drug; number of drugs used; dep ressive symptoms; self-perceived perceived health; comorbidity, hip fr acture, arthritis, ulcer of stomach or intestines; and consumption of caffeinated beverages. RESULTS: The prevalence of caffeinated medicati on use by participants was 5.4%. Those reporting the use of any caffei ne-containing medication were at an increased risk of having trouble f alling asleep (Odds Ratio [OR] = 1.79, 95% confidence interval [CI] = 1.19-2.68). There was no significant risk of other reported nighttime or daytime sleep problems associated with use of caffeine-containing d rugs. Even after adjusting for other factors that could interfere with initiation of sleep, such as painful disease, depressive symptoms, po lypharmacy, use of specific medications known to interfere with sleep, and coffee consumption, the use of caffeine-containing medication sti ll presented a significantly increased risk of having trouble falling asleep (OR = 1.60, CI 1.04-2.46). Although those participants using ov er-the-counter analgesic medication containing caffeine had an increas ed risk of trouble falling asleep (OR = 1.88, CI = 1.22-2.90), there w as no significant risk of trouble falling asleep for those who took si milar noncaffeinated OTC analgesic drugs (OR = 1.26, CI = 0.87-1.83). CONCLUSIONS: The use of caffeine-containing medication is associated w ith sleep problems. Healthcare providers should be aware of potential problems associated with over-the-counter medications containing caffe ine and should counsel patients about the potential of sleep problems. Older patients should be encouraged to read the label on medications and to select drugs that are caffeine-free when that is possible.