The Dangers Of Sleeping Pills For Older Adults

Sleep plays an important role in living healthily, but many older adults in the US have trouble sleeping.

Some may believe the myth that you need less sleep as you age. Others may rely on over-the-counter (OTC) sleep supplements, like melatonin, to help them fall asleep.

Very few older adults speak to a doctor about difficulty sleeping. Doing so could help you determine the root cause and re-establish a better sleep routine.

Your doctor may prescribe sleeping pills to help improve your sleep. However, there are risks to be aware of with these medications.

Why older adults have a hard time getting a good night’s sleep

The master clock in your brain’s hypothalamus controls your circadian rhythm — the 24-hour daily cycle that reminds you when you’re hungry, alert, or sleepy. The suprachiasmatic nucleus (SCN) that controls the hypothalamus ages as you do. Its function naturally deteriorates with age.¹ ²

Cues from the SCN are responsible for regulating your circadian rhythm. Light exposure via the eyes is the SCN’s primary source.

Healthy aging is related to reduced sensitivity to sunlight. This leads to less input for the SCN, primarily due to ocular issues, such as clouding and yellowing of the lens. Hormone production slows with decreased photic input, meaning you can’t rely on sleep-inducing melatonin and cortisol as much as you did in the past.

However, insomnia in older adults may also be related to poorer health rather than the aging process.

Anxiety- and depression-related insomnia in older adults

Up to 75% of people with generalized anxiety disorder (GAD) have insomnia. Depression is also a known risk factor for insomnia.³ ⁴

Anxiety and depression can form a vicious circle of sleep struggles. It’s a bit like the chicken and the egg: your anxiety may contribute to your difficulty sleeping, which can worsen your anxiety.

Research indicates that people with “low sleep efficiency” wake frequently, feel sleepy during the day, and generally feel tired all the time. Taking psychotropic drugs to combat insomnia places people at greater risk of developing mental disorders as a side effect.⁵

It’s important to understand that causes of poor mental health and difficulty sleeping often overlap. Your doctor may be able to help you understand the underlying cause.

Other causes of sleeplessness in seniors

The following things could explain your sleeplessness:

• Drowsiness and napping during the day

• Nighttime trips to the bathroom

• Pain

• Sleep apnea

• Restless leg syndrome (RLS)

• Medications

• Neurodegenerative diseases, such as Alzheimer dementia or Parkinson’s disease

• Chronic obstructive pulmonary disease (COPD)

• Heart failure

Sleeping pills might not help you

Preeti Malani, a geriatric medicine specialist, conducted a poll in conjunction with the AARP to survey how older adults in the US manage their sleep problems. The study found that over half of older adults have problems sleeping, about 30% take a sleeping pill, and 8% take prescription medication.⁶

Numerous medications can help manage insomnia. They have classically been grouped as hypnotics and non-hypnotics.

Hypnotics may be especially risky for older adults compared to non-hypnotics. Furthermore, a recent network meta-analysis looking at 154 placebo-controlled randomized trials of 30 medications in over 45,000 patients demonstrated that most drugs produced scarce data of efficacy, especially in the long term.⁷

Sleeping pills can have deadly side effects

Ever since barbiturates were introduced to the medical profession in 1904 by Farbwerke Fr Bayer and Co (the producers of aspirin), experts have warned these “miracle drugs” should be used with extreme caution.

These sedatives were initially used to treat mental disorders and epilepsy. They paved the way for modern anesthesia. Doctors found these same drugs could help with sleep problems and started prescribing low doses in the 1920s.⁸

Any sedative-hypnotic drug carries additional risks for over 65s.⁹

You’re probably more sensitive than you were 20 years ago to any drugs’ effects. These drugs may also linger in your body for longer, which exacerbates your risk of falling. You’re also more likely to have an auto accident after you’ve taken a sleeping pill. 

Observational and case control evidence in older adults also demonstrates an increased hypnotics-associated risk of dementia, fractures, and major injuries.

Other side effects of hypnotic sleeping pills

Taking a pill for sleep can have other side effects, including the following:¹⁰

• Daytime drowsiness

• Dizziness

• Hallucinations

• Sleepwalking and sleep-eating

• Dependence on sleeping pills

• Motor incoordination

• Respiratory depression

Do sleeping pills really help?

Hypnotics are known to reduce sleep latency and reduce wakefulness after sleep onset depending on the type of insomnia you have. However, their long-term safety is unclear. Most guidelines suggest short-term use for up to 5–6 weeks.

Are over-the-counter supplements safer?

OTC sleep supplements carry some of the same risks as prescription drugs.

A 2017 study found older adults do not read the labels of OTC sleep aids. It also discovered that some take the drugs consistently, which can lead to other side effects.¹¹

Some seniors are even taking OTC medications that contain diphenhydramine (Benadryl) or doxylamine as primary ingredients. When taken with prescription sleep drugs, this could result in central nervous system depression. Excessive use of diphenhydramine can lead to seizures, coma, cardiovascular problems, and even death.

Research also indicates that melatonin should not be taken with fluvoxamine (Luvox), a common selective serotonin reuptake inhibitor (SSRI), to help treat depression. Combining the two can cause dangerously high melatonin serum concentration.¹²

Types of sleeping pill

Sleeping pills are prescribed for difficulty sleeping or insomnia. These are the most common medications prescribed in the US:¹³

For sleeping

• Phenobarbital (Luminal)

• Non-benzodiazepine benzodiazepine receptor agonists (BZRAs) — eszopiclone (Lunesta), zaleplon (Sonata), and zolpidem (Ambien, Edluar, and Zolpimist)

• Older benzodiazepine hypnotics — estazolam, flurazepam, temazepam (Restoril), triazolam (Halcion), and quazepam (Doral)

• Dual orexin receptor antagonists (DORAs) — lemborexant (Dayvigo), suvorexant (Belsomra), and daridorexant (QUVIVIQ)

• Histamine receptor antagonists — low-dose doxepin (Silenor)

• Melatonin receptor agonists — ramelteon (Rozerem)

For insomnia

• Flurazepam (Dalmane)

• Quazepam (Doral)

• Estazolam

• Triazolam (Halcion)

• Temazepam (Restoril)

Z-drugs and their risks

Commonly prescribed Z-drugs — non-benzodiazepines — are eszopiclone, zaleplon, and zolpidem. They were introduced to the market in the 1990s and are approved by the Food and Drug Administration (FDA) for use as sleep aids.¹⁴

However, the FDA warns people who use these drugs about their potential risks.

Common side effects of these drugs include the following:¹⁵

• Nervous system effects

• Dizziness

• Drowsiness

• Headache

The FDA has added a boxed warning (the most prominent safety warning on medication labeling) to these drugs. The agency warns prescribers and users about the risk of complex sleep behaviors and advises against the use of this drug in people who have experienced an episode of such behaviors.¹⁶

These behaviors include sleepwalking, sleep-driving, and other activities that are carried out while a person is not fully awake. These activities can result in serious injuries sustained from falls, contact with hot objects, gun use, and exposure to cold temperatures.

The FDA warns you might not know you did any of these things, as you may wake up the next morning without any recollection. However, complex sleep behaviors are possible even after one dose of any strength.

Taking Z-drugs safely

Before using a Z drug, you should speak to your doctor about the potential risks and adverse effects. Tell them about any other drugs you are currently taking. It is not safe to take a Z-drug at the same time as an opioid or sedative.

Z-drugs have other contraindications. Caution is recommended in older adults and people with kidney or liver dysfunction. If you have depression and suicidal thoughts, your doctor will assess you and monitor you closely during treatment.

Read your doctor’s and pharmacist’s instructions carefully. Don’t take more or less than what you have been prescribed.

If you know you engaged in a complex sleep behavior, stop taking the drug immediately and inform your doctor.

Avoid alcohol consumption while taking a Z-drug. Drinking alcohol can increase your risk of adverse effects.

Note that these drugs can cause drowsiness. Do not drive or operate heavy machinery while taking this medication until you know how it affects you. It may not be safe for you to carry out one of these activities the morning after taking a Z-drug.

Tips for falling asleep naturally

Here are some helpful tips that can help you get better sleep without needing to take sleeping pills.

Have a nighttime drink

Some people find that a cup of chamomile tea or warm milk helps them relax before bedtime.

There’s some evidence to back this up. Warm milk may mimic tryptophan in the brain, which helps to build up serotonin levels. What’s more, a 2017 study found that chamomile extract significantly improved sleep in older adults.¹⁷ ¹⁸

Exercise

Moderate aerobic exercise during the day helps foster deep sleep at night. However, researchers are not entirely sure why. Exercise is thought to improve sleep through increased energy consumption, endorphin secretion, and body temperature adjustment.¹⁹

Don’t exercise at night because activity raises both your core body temperature and endorphin levels, which may keep you awake.

Stay cool

Lower your thermostat to between 65 and 72 degrees. Wear breathable fabric pajamas to bed. Keep your room as dark as possible. If you need to get up in the night to use the bathroom, use the flashlight on your phone instead of keeping a nightlight on.

The lowdown

The first step in solving your sleep problems is to figure out why it’s so hard for you to fall asleep. Is there an underlying physical cause, such as restless leg syndrome, heartburn, or sleep apnea? Are you anxious or depressed? Or do you have difficulty sleeping due to changes in your physiology?

Speak to your doctor if you have trouble sleeping — it could mean something else is going on in your body.

Although many older adults take sleeping pills, it is not known how effective they are — especially in the long term.

Furthermore, using sleeping pills — whether you obtain them over the counter or with a doctor’s prescription — can potentially lead to serious adverse effects and even death in some cases.

Be sure to use your sleeping pills according to the usage instructions printed on the medication’s label and your doctor’s and pharmacist’s advice.

Remember that prescription Z-drugs are not safe for everyone. They are contraindicated in people who have experienced a complex sleep behavior episode and in other groups of people.