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3 Reasons to Skip Sleeping Pills as You Get Older

Use of sleep medication is on the rise but can come with dangerous effects for older adults

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The share of adults who use medication to help them sleep at night is on the rise, the latest national numbers show, and more adults 65 and older are taking pills at bedtime than those 64 and younger.

new report from the Centers for Disease Control and Prevention (CDC) found that in 2020, 8.4 percent of adults regularly took prescription or over-the-counter sleep medication to help them fall or stay asleep, up from 4 percent about a decade ago. When it comes to those 65 and older, 12 percent regularly took something to help get shuteye.

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“Frankly, the news is really not surprising to those of us working in sleep medicine,” says Robert Satriale, M.D., a clinical adjunct professor and sleep medicine specialist at Temple Health in Philadelphia.

Studies show about 1 in 3 adults don’t get enough sleep (about 7 hours a night for adults 50 and older, Satriale says) on a regular basis, and an estimated 50 million to 70 million Americans have chronic sleep disorders. “And these patients are often in the older age groups,” says Satriale, who explains that sleep quality tends to decline with age.

It’s no surprise, then, that older adults are more likely to turn to medications for an assist. But there are a few things you need to know before you do.

1. Medications can come with dangerous side effects

Newer sleep medications like zolpidem (Ambien) and eszopiclone (Lunesta) have a “somewhat safer” profile than older drugs prescribed for sleep troubles, says K. Ashley Garling-Nañez, clinical assistant professor at the University of Texas at Austin College of Pharmacy. Still, “anything that’s going to be sedating or make you sleepy is going to put you at risk for dizziness, falls, that sort of thing,” Garling-Nañez says.

Research shows that both these newer drugs and the older benzodiazepines can impair mental and physical function in older adults, leading to an increased risk for falls and confusion. “And then of course, combined with other medications — especially anything for pain, mood, anxiety — could possibly put you at a higher risk of suppressing your breathing and respiratory depression,” Garling-Nañez adds.

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It’s not just prescription medicines that demand caution. Over-the-counter options come with a list of unpleasant and potentially dangerous side effects, too. For example, diphenhydramine, the active ingredient in many over-the-counter sleep aids like Advil PM, Tylenol PM and ZZZQuil, has been linked to an increased risk for cognitive decline and confusion in older adults, as well as urinary retention, constipation and next-day grogginess, which can interfere with driving ability, Satriale points out. More than 6,000 fatal crashes each year involve a drowsy driver, according to the CDC.

Melatonin’s Popularity

A 2022 study published in the journal JAMA tracked a fivefold increase in melatonin use among U.S. adults over the past few decades. An increasing number of Americans are also taking more than the recommended amount of the supplement, the researchers found.

Supplements deserve a similar level of scrutiny. For example, valerian root, an herbal supplement often marketed to improve sleep, can cause dizziness, dry mouth and mental dullness. Garling-Nañez warns that this product may also be mixed in with other sleep supplements, such as melatonin, which comes with its own list of possible side effects. So it’s always a good idea to have a pharmacist go through ingredients with you before purchasing an over-the-counter product, Garling-Nañez says.

2. You may be masking underlying health issues

Taking something to help you sleep may be a quick fix, but it could be causing you to overlook an underlying health condition that’s behind your insomnia.

Take, for example, anxiety. “When you’re lying there and your mind’s turning over and over and you can’t shut your brain off to go to bed, that can sometimes be a form of anxiety,” Garling-Nañez says.

It’s not uncommon for a condition known as restless leg syndrome to keep older adults up at night, Satriale says. “And this is a condition that is easily treatable and something [patients] should discuss with their physicians, if present,” he adds.

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An overactive thyroid, sleep apnea, diabetes and chronic pain have also been linked to sleep problems. So have prescription medications, including certain antidepressants and treatments for asthma and high blood pressure, which your doctor may be able to adjust.

3. There are better treatments than pills

Having trouble sleeping? It’s important to talk to your doctor, especially given the links between poor sleep and other health problems like heart disease, diabetes and depression.

Your primary care provider may be able to help you or may refer you to a sleep specialist or therapist trained in cognitive behavioral therapy for insomnia (CBT-I), which experts in the field say is the first line of treatment for sleep problems. This form of therapy helps patients identify and address the habits and behaviors that keep them from getting the sleep they need. It also equips them with stress reduction and relaxation techniques.

review of research published in Annals of Internal Medicine found CBT-I to be effective in the general population and in older adults with chronic insomnia disorder. And unlike medication, CBT-I “is likely to have fewer harms,” the researchers note.

Don’t discount lifestyle tweaks that can lead to improved sleep. “Exercise is extremely important in helping people sleep,” Satriale says. “People who exercise on a regular basis will attain sleep quicker and they will stay asleep longer than those people with sedentary lifestyles.” Current guidelines recommend that older adults aim for about 30 minutes a day of moderate-intensity activity, like brisk walking. Caffeine intake and late meals can also affect your slumber.

A few other tips: Keep the TV off and the lights low a few hours before bed, Satriale advises. White or brown noise and a weighted blanket can also help.

Editor's note: This story, originally published March 1, 2023, has been updated. 

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