The elderly take a lot of pills compared to younger folks. The elderly also have high rates of insomnia. Secondary insomnia is common in seniors - where the insomnia is a symptom of other health problems (more common in the elderly) or a side effect of drugs the patients may be taking for other reasons.
Although we recommend avoiding medication for insomnia if possible, it is a viable treatment option with your doctor’s approval, and an estimated 20% of older Americans end up taking sleep aids on a regular or semi-regular basis.
The most common insomnia drugs are fall into the classifications of sedatives, minor tranquilizers, and antianxiety drugs. These drugs are risky for older people and for people with breathing problems because they suppress the areas of the brain that control breathing. Modern sleep aids are much safer than the barbituates of decades past, but there is still some risk. Most hypnotics are respiratory depressants and given that seniors often have sleep-related problems like apnea and nocturnal myoclonus, medical authorities advise doctors to take caution in prescribing hypnotics for older patients with sleep complaints.
Prescription insomnia medications are often habit-forming. Their addictivity varies from person to person, so it pays to err of the safe side and watch yourself. Further, taking more than one drug – prescription and/or over-the-counter – is a concern in people of all ages, but of particular concern for the elderly because they tend to take more medication than younger people. Make sure your doctor knows all the drugs you take.
The new drug ramelteon mimics melatonin in the body and reports are that it is especially good for seniors. Melatonin is an important hormone in the regulation of the circadian cycle. Ramelteon’s success in elderly patients may point to the etiology of primary insomnia in old people – that their bodies lose the ability to respond to circadian cues and sync the melatonin cycle with the environment. In any case, ramelteon is also reported to be a particularly mild drug and not cause excessive sleep inertia in the morning. Of course, drugs affect people in different ways, but you may wish to ask the doctor about ramelteon.
The other common prescription drugs are the Z-drugs, which are also called non-benzodiazepine sleeping pills. Popular brands such are Ambien and Lunesta are the most commonly prescribed sleep aids for older people. The Beer's List published by the American Geriatric Society includes zolpidem, zalepelon, and eszolpidem.
Another major classification of medicines is the benzodiazepines, which are sold under the names librium, valium, and dalmane, among others. These drugs are used for many mental conditions, including anxiety and insomnia. Doctors are sometimes reluctant to prescribe these to seniors as older people cannot metabolize and breakdown drugs as efficiently as younger people. The drugs may work fine, but they might not wear off the next day. The medical literature says these drugs are not “well tolerated” by the elderly. A systematic meta-review and analysis concluded that benzodiazepine hypnotics had an unfavorable risk to benefit ratio. Old people tend to fall more often when they are taking sleeping drugs.
Over-the-counter drugs available at the supermarket or drug store contain sleep-inducing anti-histamines (such as diphenhydramine and dimenhydrinate). These can relieve occasional or mild sleeping problems.
A meta-study of sedative efficacy found they work, but the magnitude of sleep time increase is small. The authors point out that the dangers and risks of sleeping pills can be worse for older people, so the calculus of whether to prescribe or not may be changed.
Seniors experience the same side effects as younger people, but their bodies may be less apt to cope with the effects. The other prescription drugs can make the side effects worse. Sleep inertia can be tougher for old people to overcome and daytime sleepiness can be work.
Nursing home staff unfortunately relies on sleep pills too often to manage their residents. This is understandable as they have to manage a large group of people, and it is easier if most of the people in the building sleep and wake at the same time. Nursing homes are also tailor-made to produce insomnia as they have the lights on all night and are frequently noisy and because residents don’t get enough exercise. Many nursing homes turn to long-acting benzodiazepine hypnotics.
The chronic use of the older sleeping pills in the elderly, however, can produce undesirable side effects, such as impaired memory and alertness, incontinence, daytime sleepiness, and imbalance, which are already problems for many old people. This is another reason ramelteon and melatonin agonists are exciting for geriatric care.
Behavioral therapy is useful even in older adults and, as in younger people, should be tried first. Light therapy may be particularly beneficial for nursing home residents.
Whatever medication you take, be sure to employ good sleep hygiene practices.
Some people, with or without the approval of doctors, use melatonin to get over temporary insomnia. Melatonin is an important hormone in sleep physiology; it is produced in the brain and levels rise and fall through the circadian cycle. Older people’s bodies don’t produce as much of the hormone, and many seniors buy supplements at the health store or drug store. The supplements contain synthetic melatonin, and it functions in the body the same way natural melatonin does.
Like other dietary supplements, melatonin pills are not regulated
nearly as closely as prescription drugs. The dosing may different
from what the package says, and the other material besides melatonin
in the supplement can vary from product to product. We hate to
recommend a prescription drug when a cheaper generic is available, but
in this case you are probably better off asking your doctor about