Doctors wrote nearly 60 million prescriptions (including refills) for Ambien, Lunesta and other prescription sleep aids in 2012, according to IMS Health, a health care technology and information company. That makes sleeping pills some of the most popular medications around.
The pills can help encourage sleep — at least in the short run — but older users should know that the medications come with some risks, says Michael J. Sateia, M.D., chief of sleep medicine at Dartmouth-Hitchcock Medical Center in Lebanon, N.H.
According to Sateia, people in their 50s, 60s and beyond tend to be more sensitive to the drugs and may be more likely to experience side effects such as drowsiness and confusion. "Older people should approach these medications with an extra dose of caution," he says.
In extreme cases, sleeping pills can send people to the hospital. In fact, more than 19,000 people ended up in the emergency room in 2010 after taking Ambien or other drugs with the active ingredient zolpidem, according to a recent report by the Substance Abuse and Mental Health Services Administration (SAMHSA). That's about a 200 percent increase in ER visits since 2005, a dramatic rise that mirrors America's growing reliance on sleeping pills. About three-quarters of the ER patients were 45 or over, and one-third were 65 or over, underscoring the dangers to older patients.
"Even if they're taking the drug exactly as prescribed, the dose can be more than they can handle," says Peter Delany, director of SAMHSA's Office of Applied Studies.
What's more, sleeping pills are often prescribed, especially to people over 50 because so many of them have trouble going to sleep or staying asleep, Sateia says. "Doctors will first try to reassure them," he says. "If reassurance doesn't work, doctors often resort to medication rather than alternative, non-pharmacological treatments."
A long and checkered past
Sleeping pills have a troublesome record. Older drugs known as benzodiazepines (such as Dalmane or Halcion) are infamous for causing drowsiness, sedation and addiction. As reported in a 2005 issue of the BMJ, people taking benzodiazepines for sleep problems are about twice as likely to be harmed by the drugs than helped.
Doctors and sleepless patients alike hoped that newer-generation drugs such as Ambien and Lunesta could promote sleep without so many side effects, but that hope has largely faded, says Nicole Brandt, associate professor of pharmacy at the University of Maryland.
Not only can Ambien and Lunesta leave people groggy and disoriented, but a few people taking the drugs end up walking, eating or even driving when they aren't fully awake. "There's a perception that these drugs are safer, but the potential for harm is still there," she says.
Sleeping pills and advancing age aren't a good mix for many reasons, Brandt says. Older bodies tend to break down the drugs relatively slowly, she says, which means the medication lingers longer than it should. That makes it more likely that a user will wake up feeling confused, groggy or unsteady on the feet — exactly the kinds of problems that many older people already face even without sleeping pills.
Beware drug-drug interactions
Complicating the problem is that people in their later years often take other medications that can potentially clash with sleeping pills, Delany says. In the SAMHSA study, over half of the ER visits were chalked up to combinations of zolpidem with other drugs such as narcotic pain relievers. He says patients can avoid such dangerous combinations by using a single pharmacy and talking to their doctor about all of the medications they take, including over-the-counter products.
Ambien and similar drugs work by increasing the brain's supply of GABA, a brain chemical that causes drowsiness.
Most people can handle tiny amounts of the drugs, but the risk jumps up dramatically with larger doses. In January of this year, the Food and Drug Administration halved the recommended starting dose of Ambien for women to 5 milligrams instead of the previous 10 mg. The recommended starting dose for men is now either 5 mg or 10 mg. And in May the FDA warned that people taking zolpidem extended-release (Ambien CR) should not drive or engage in other activities that require complete mental alertness the day after taking the drug.
Sateia suggests that older people of either gender generally start at 5 mg — or even less — and only after a long conversation about the risks involved. He adds that if they notice any worrisome side effects — such as sleepwalking or extreme grogginess — they should stop taking the pills immediately and discuss it with their provider.
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