More About Medication Use
In all, 14 percent of the poll respondents said they regularly took a prescription sleep medication, prescription pain medication, over-the-counter sleep aid or herbal supplement to help them sleep. An additional 23 percent took one of these options occasionally most of the occasional users said they chose over-the-counter sleep aids.
The most recent Beers Criteria established by the American Geriatrics Society, which guides the use of medications among older people, gives a strong warning against use of prescription sleep drugs, which are sold under such names as Ambien, Lunesta and Sonata.
Meanwhile, even though over-the-counter sleep aids do not require a doctors guidance or prescription to purchase, they still carry health risks for older people, Malani notes. Most of them contain diphenhydramine, an antihistamine that can cause side effects such as confusion, urinary retention and constipation.
Among poll respondents with frequent sleep problems who took something occasionally to help them sleep, over-the-counter sleep remedies were the most common choice. But for those with frequent sleep issues who took something regularly to try to sleep, prescription sleep medications were the most common option, with 17 percent reporting use.
Doxepin Side Effects And Risks
Overall, doxepin is a very safe medication, particularly when its used at a low dose for difficulty sleeping. However, a small percentage of doxepin users may experience side effects.
According to FDA trial data, the most common side effects of doxepin are sedation, nausea and nasopharyngitis . Unlike many other prescription sleeping pills, doxepin typically does not cause next-day drowsiness or sedation.
Although uncommon, like other sleeping pills, doxepin may cause insomnia and certain forms of unusual nighttime behavior, such as sleep-walking or sleep-driving.
As a tricyclic antidepressant, doxepin is prescribed at significantly higher doses to treat anxiety and depression than insomnia.
At the doses used to treat depression and anxiety, side effects from doxepin may potentially be more common and severe.
Studies of doxepin have found that it has a lower potential for abuse or dependence than other, older sleep medications.
Overall, doxepin is a safe, effective sleep medication. Since its less likely to cause drowsiness the next day than other prescription sleeping pills, its worth considering if you often need to be awake, alert and active early in the morning.
How To Use Doxepin Oral
Take this medication by mouth, usually once nightly within 30 minutes before bedtime on an empty stomach, or as directed by your doctor. Do not take it within 3 hours of a meal because the effect of the medication will be delayed.
Do not take this medication unless you are able to get a full night of sleep before you must be active again.
Dosage is based on your medical condition, age, and response to therapy. Do not take more than 6 milligrams per day.
Use this medication regularly to get the most benefit from it. To help you remember, take it at the same time each day.
Tell your doctor if your condition lasts or gets worse after 7-10 days.
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How To Use Ramelteon 8 Mg Tablet Hypnotics
Take this medication by mouth with or without food as directed by your doctor, usually 30 minutes before bedtime. Do not take ramelteon with or immediately after a high-fat meal because fat can affect how well this drug works.
The manufacturer directs not to break the tablet before taking it. However, many similar drugs can be broken. Follow your doctor’s directions on how to take this medication.
Do not take a dose of this medication unless you have time for a full night’s sleep that lasts at least 7 to 8 hours.
Your dosage is based on your medical condition and response to therapy. Do not increase your dose or take it more frequently than prescribed.
Inform your doctor if you have any changes in mood , if you continue to have trouble falling asleep, or if your insomnia worsens.
Avoiding Working Or Watching Television In Bed
The elderly are more susceptible to the effects of noise and light, which can disrupt their sleep. Watching television or working in bed can keep them from getting the rest they need. Television and other electronic devices emit light, which can interfere with the production of melatonin, a hormone that helps regulate sleep.
Working in bed can also be disruptive, as it can increase anxiety and make it difficult to relax. It’s important to create a space that is dedicated to sleep, where people can feel relaxed and comfortable.
These treatments can be very effective, but it’s important to work with a doctor to find the best approach for each individual. In some cases, behavioral changes may be all that’s needed to improve sleep quality.
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Over The Counter Sleep Medications
There is a wide variety of over-the-counter sleep aids available. The Mayo Clinic provides examples of OTC sleep aid options that members of the geriatric community commonly use, some of which include the following:
- Diphenhydramine : Diphenhydramine is a sedating antihistamine. Side effects might include daytime drowsiness, dry mouth, blurred vision, constipation, and urinary retention.
- Doxylamine: Doxylamine is also a sedating antihistamine. Side effects are like those of diphenhydramine.
- Melatonin: The hormone melatonin helps control ones natural sleep-wake cycle. Side effects can include headaches and daytime sleepiness.
- Valerian: Supplements made from this plant are sometimes taken as sleep aids. The efficacy remains controversial as few studies indicate therapeutic benefits, while other studies have not found the same benefits.
Most OTC sleeping aid medications contain antihistamines to produce their sedative effects.
The Dangers Of Sleeping Pills For Seniors
This article was published more than 7 years ago. Some information may no longer be current.
Dr. Rachel Morehouse, a psychiatrist and the medical director at Saint John Regional Hospitals Atlantic Sleep Centre in New Brunswick.Dale Preston/The Globe and Mail
This is the second of a nine-part print and online series looking at the science of sleep and the vital role of sleep in maintaining overall health.
There’s a reason no one ever wakes up after a restful night in bed and says: “I slept like a senior citizen.”
As people age, their ability to get a good night’s sleep becomes more elusive. And, to add insult to injury, those who might have reached for a sleeping pill to get through the night when they were younger are no longer good candidates for doing so after age 65 or 70.
“There’s no question that sleeping pills that are prescribed or taken over the counter are more hazardous to the senior population,” said Rachel Morehouse, a psychiatrist and the medical director at Saint John Regional Hospital’s Atlantic Sleep Centre in New Brunswick.
The most common prescription sleeping pills are benzodiazepines, also known as the “pam” drugs, such as lorazepam and diazepam. In the 1980s new nonbenzodiazepine “z drugs,” such as zopiclone, were marketed as having fewer side effects and being less likely to cause dependence. But they’re still risky, especially for seniors.
The biggest risk, according to Dr. Morehouse, is falls.
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Final Thoughts On The Best Sleeping Pill For The Elderly
There is no one best sleeping pill for elderly people. The best sleeping pill for an elderly person is the one that works best for them. There are a number of different sleeping pills on the market, and each one works differently for different people.
It is important to talk to your doctor about your options before you start taking any medication. Sleeping pills can have side effects, and it is important to make sure that the benefits outweigh the risks. If you are an elderly person who is having trouble sleeping, there are a number of different options available to you. Talk to your doctor about what is best for you.
Sleep Aids Arent Safe For Older Adults But 1 In 3 Still Take Them
A new national poll finds that many people 65 and older take prescription sleep aids even though guidelines warn against it. What the findings mean for patients and providers.
Sleep doesnt come easily for nearly 50 percent of older Americans, and more than a third have resorted to medication to help them doze off at night, according to new results from the National Poll on Healthy Aging.
But most poll respondents said they hadnt talked to a doctor about their sleep, even though more than a third said their sleep posed a problem. Half of those surveyed believe incorrectly that sleep problems are simply a part of growing older.
The poll was conducted by the University of Michigan Institute for Healthcare Policy and Innovation and is sponsored by AARP and Michigan Medicine, U-Ms academic medical center.
People who turn to medications may not realize that prescription, over-the-counter and even natural sleep aids carry health risks, especially for older adults, either alone or in combination with other substances. In fact, national guidelinesstrongly warn against prescription sleep medicine use by people over age 65.
Despite this, the nationally representative poll of people ages 65 to 80 found that 8 percent of older people take prescription sleep medicine regularly or occasionally.
Thats why doctor-patient conversation is crucial.
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Burden Of Insomnia In The Elderly
Insomnia incurs a significant direct and indirect burden on society. Direct economic costs of insomnia were calculated to be $13.9 billion in 1995,12 and a 1996 review indicated that total direct, indirect, and related costs may run as high as $30 to $35 billion annually.13
While the overall economic costs of insomnia specifically in the elderly population have not been assessed to date, several studies14,15 have provided data on segmented direct and indirect costs and on adverse effects on quality-of-life parameters in the elderly. Insomnia may precipitate injuries, such as falls, and aggravate existing health conditions. In a survey of 1526 community-dwelling older adults aged 64 to 99 years, difficulties with falling asleep at night,waking during the night, and waking up in the morning were significantly related to the number of reported falls.6 Subsequent fall-related injuries are an important factor for nursing home placement.4 Estimates indicate that of the $158 billion of lifetime economic costs of injury in the United States, fall-related injuries will contribute a total of $10 billion.6
What Older Adults Can Do
Before medication, try sleep habit changes to foster healthy sleep, Malani says.
Research backs these tips:
Keep the same sleep schedule every day, even on weekends and when youre traveling.
Stick to a bedtime routine: Use reading, soothing music or a warm bath or face-washing to cue your body and brain that its time to wind down.
Keep gadgets and screens out of the bedroom: From smartphones to TVs to laptops, both what they show you and how their blue light influences your brain can interfere with sleep.
Limit or stop consuming caffeine in the afternoon and evening: It can interfere with your ability to get to sleep later in the day, so swear off coffee, tea or caffeinated soda at dinner.
Try not to nap during late afternoon or evening: This can throw off your sleep cycle.
Dont use alcohol to help you get to sleep: When its effects wear off in the middle of the night, you may wake up and have a hard time getting back to dreamland.
Cut back on all liquids late in the day: A full bladder can wake you up in the night.
Talk it out: Research has shown that a form of talk therapy can help people with serious sleep issues. You can get insomnia-related cognitive behavioral therapy from psychologists and clinical social workers trained to provide it.
Before you turn to medication or supplements, talk to your doctor about your sleep, Malani says.
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What Are Treatments For Disorders That Cause Excessive Daytime Sleepiness
Other appropriate treatments for EDS depend on the underlying disorder. Work with your physician to accurately identify the cause of your EDS rather than making assumptions. As the disorders or causes are addressedoften using a combination of treatmentsdaytime sleepiness improves.
When it comes to treating EDS, physicians commonly identify one or more of the following underlying disorders and recommend the corresponding treatments:
Sleeping Pills Dont Work For Everyone
Sleeping pills dont work for everyone and, in fact, for those who use regularly they may stop working as your body becomes accustomed to the drug. This means you may need higher and higher doses overtime to achieve the same effect. This is known as tolerance. Professor David Gardner, from Dalhousie University , writes that sleeping pills may lose their sedating effect with nightly use. When this happens, some people try to stop their sleeping pills which can lead to withdrawal effects. One common withdrawal effect is trouble sleeping, called insomnia. This insomnia gets better for a short while when they restart the sleeping pill. This starts an endless cycle of increasing the dose of sleeping pills, stopping them and then restarting. Meanwhile, youre still at risk of harms from the sleeping pills.
You can prevent withdrawal effects by talking with your doctor, nurse or pharmacist about slowly lowering the dose over time. This is called tapering. Learn more about tapering in this brochure.
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Side Effects Of Prescription Sleeping Pills
Always ask your health care provider about potential side effects before deciding which sleeping pills to consider taking. Depending on the type, prescription sleeping pills may include side effects such as:
- Dizziness or lightheadedness, which may lead to falls
- Prolonged drowsiness, more so with drugs that help you stay asleep
- Severe allergic reaction
- Sleep-related behaviors, such as driving or eating when not fully awake
- Changes in thinking and behavior, such as hallucinations, agitation, trouble remembering events, suicidal thoughts and bizarre behavior
- Daytime memory and performance problems
Zolpidem Side Effects And Risks
Zolpidem considered is a safe, effective medication. However, as with many other prescription medications, there are some potential side effects and risks that you should be aware of if youre considering zolpidem to treat sleep difficulties.
During short-term trials of zolpidem, the most frequently reported side effects were headache, dizziness, drowsiness and diarrhea. In longer-term testing, patients given zolpidem reported a wider range of side effects, although most of these only affected a small percentage of users.
A small percentage of people who use zolpidem report abnormal nighttime behavior, such as sleep-walking, sleep-driving or unusual dreams. Zolpidem can also cause some feelings of drowsiness in the morning, especially if its taken very late at night.
Zolpidem does come with an increased risk of abuse and dependence. If youre prescribed zolpidem, follow your healthcare providers instructions carefully to avoid overusing or abusing this medication.
You should also speak to your healthcare provider if you have a history of depression. You should also not take zolpidem with alcohol. Taking zolpidem with food also isnt recommended, as food can slow down the effects of the medication.
Overall, zolpidem is widely used for a reason it works. However, its typically only used as a short-term treatment for insomnia and may cause next-morning impairment.
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Ramelteon Side Effects And Risks
Ramelteon is a safe and effective medication. Serious side effects are extremely rare, and the few common side effects that can occur are relatively minor.
According to FDA trial data, the most common side effects of ramelteon are fatigue, dizziness, drowsiness, nausea and exacerbated insomnia. Like other sleeping pills, ramelteon may cause abnormal nighttime behavior such as sleep-driving, sleepwalking and more.
Although many studies of ramelteon have found that it produces few to no morning drowsiness, a 2011 study found that ramelteon can produce some level of next-day impairment in cognition, memory and psychomotor performance.
Overall, studies of ramelteon show that it works well, with relatively few side effects compared to older sleeping pills. It appears to be especially effective at reducing sleep onset latency, making it worth considering if you find it difficult to fall asleep.
Epidemiology Of Insomnia In The Elderly
In 1982, the National Institute on Aging conducted a multicenter, epidemiologic study to assess the prevalence of sleep complaints among more than 9000 non-institutionalized elderly persons aged 65 years and older. Over half of these elderly people reported some form of chronic disruption of sleep, while only 12% reported no sleep complaints.7 Among all participants , the prevalence of chronic sleep complaints included difficulty in initiating or maintaining sleep , nocturnal waking , insomnia , daytime napping , trouble falling asleep , waking too early , and waking not rested .7 A 3-year follow-up study reported an annual incidence rate of approximately 5%, with roughly 15% of elderly insomniacs resolving their symptoms each year.10 Chronic insomnia is also more common in this population. A 1991 National Sleep Foundation poll of a representative sample of 1000 Americans aged 18 years or older, who were divided by age into 6 groups , found that 9% of the sample reported chronic insomnia, while 20% in the group 65 years reported chronic insomnia, the highest among all age groups.11
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