Why Are Sleeping Pills Not Helpful
Nearly one third of older people in Canada take sleeping pills. These drugs are called sedative-hypnotics or tranquilizers. They affect the brain and spinal cord.
Health care providers prescribe the drugs for sleep problems. The drugs are also used to treat other conditions, such as anxiety or alcohol withdrawal.
Usually older adults should try non-drug treatments first. There are safer and better ways to improve sleep or reduce anxiety.
Sleeping pills may not help much.
Many ads say that sleeping pills help people get a full, restful nights sleep. But studies show that this is not exactly true in real life. On average, people who take one of these drugs sleep only a little longer and better than those who dont take a drug.
Efficacy And Safety Of Otc Sleep Aid Use
Similarly, the risks and benefits of OTC sleep aids for the treatment of disturbed sleep in elderly adults have not been systematically examined in randomized controlled trials. There are no published controlled trials examining the use of doxylamine for the treatment of sleeplessness. Small controlled trials of diphenhydramine 50mg are available but the results are equivocal. The most positive published trial supporting the use of diphenhydramine as a sleep aid found that diphenhydramine 50mg significantly improved patient reports of disturbed sleep, including sleep latency and reports of feeling more rested the following morning. Patients in the trial also reported that they preferred diphenhydramine to placebo despite experiencing more side effects . Other published data using both patient reports and objective measures of sleep, however, are less positive . This limited efficacy should be considered in light of the negative residual and anticholinergic side effects associated with diphenhydramine use. For example, in a nursing home population, diphenhydramine was associated with significant psychomotor and cognitive function impairments compared with placebo . While diphenhydramine improved sleep latency relative to placebo, there were no other significant benefits.
Intervening To Address Sleep Disturbance And Otc Sleep Aids: Key Role Of Pharmacy Professionals
The workgroup singled out pharmacists as being uniquely positioned to provide education to older adults about OTC sleep aids. They may be the only health care providers who interact with patients regarding these OTC purchases. While consumers can purchase OTC sleep aids without consulting pharmacists, greater involvement of pharmacists at the point of sale may reduce unintentional misuse.
Pharmacists are also guided to interview patients considering use of OTC products. In the case of a patient purchasing or asking for an OTC sleep aid, the pharmacy professional queries the patient about sleep hygiene practices, the nature and duration of the sleep disturbance and other current medication use, both prescription and OTC, including supplements, along with use of alcohol. For the patient considering an OTC sleep aid with known anticholinergic side effects, the pharmacy professional queries the patient about prescription and OTC products with anticholinergic properties that the patient may already be taking.
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What Are The Potential Risks Or Complications Of Prescription Sleeping Pills
Some prescription sleep medicines may bring on parasomnia. This disruptive sleep disorder can cause dangerous behaviors while youre still mostly asleep. People who take Z-drugs, in particular, may sleepwalk or eat, take medications, talk or even drive, all while unaware that theyre doing these things. You may appear to be awake, but your brain is not fully alert. Most people dont remember doing these things after they wake up.
Benzodiazepines can be addictive and lead to substance abuse. To lower this risk, healthcare providers only prescribe these sleeping pills for short-term use. Youre more likely to get a prescription for Z-drugs instead.
What Is The Most Effective Natural Sleep Aid
Many popular natural sleep aids, such as CBD, valerian root and lavender, are lacking in large, peer-reviewed studies and trials, making it difficult to confirm efficacy. Depending on your individual sleep concerns, some natural sleep remedies may be more effective than others.
To find the most effective natural sleep aid for you, speak with your doctor about any difficulty sleeping, and to rule out any other conditions. Keep in mind that some natural sleep aids can have interactions with certain medications or contraindications based on health history. Medical professionals can also guide you when it comes to which sleep aid is appropriate for you, and with doses and timing.
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What Are Natural Sleep Aids
Natural sleep aids are over-the-counter supplements intended to help you fall asleep faster or stay asleep throughout the night. They are usually plant-based, a vitamin or mineral already present in our diets, or supplemental amounts of something produced by the body. There are not strict guidelines surrounding the use of the word natural for supplements, and many natural supplements, such as melatonin, tend to be synthetically derived.
Many customers prefer natural sleep supplements because they tend to have fewer side effects than prescription sleep medications. They also appeal to people who prefer natural products, or are concerned about the addictive potential of prescription sleep aids.
Reputable Sleep Supplements
Medications For Sundown Syndrome
There are several medications used in the treatment of sundowning including melatonin, antipsychotics, antidepressants, benzodiazepines, and cannabinoids. While commonly used, there is little evidence to suggest benefits associated with the use of benzodiazepines and cannabinoids, and due to the significant negative side effects associated, the use of these agents should be avoided. Antipsychotics are commonly used and are recommended as possible treatments in national guidelines, yet there are only limited data that show minimal benefits for these patients. There have been few double-blind, randomized controlled trials evaluating the use of exogenous melatonin. Overall, these studies show some behavioral improvement with extended use. Melatonin dosage widely varied in these studies between 1.5 mg and 10 mg. Several non-pharmacological strategies have been used and have shown to have some beneficial impact on circadian rhythm and possibly nighttime behavioral disturbances in patients with dementia including physical exercise, aromatherapy, music therapy, and bright light therapy. Three treatment principles are suggested when considering treatments for sundown syndrome: the treatment process is a trial-and-error approach, start with lower dosages and slowly titrate upwards, and multi-component therapy may be indicated. Further investigation of non-pharmacological and pharmacological-targeted strategies would be of benefit.
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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.
Are Sleeping Pills Safe For Older Adults
- Typically, non-drug therapy for older persons should be tried first.
- According to the American Geriatrics Society, there are safer and more effective methods of improving sleep or reducing anxiety than prescription medications.
- The reason behind this is as follows: Its possible that sleeping medications wont help much.
- Many advertisements claim that sleeping medications assist consumers in getting a complete and comfortable nights sleep.
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Pharmacokinetics Of Otc Sleep Aids
Data describing the pharmacokinetics of OTC sleep aids are scarce. Available data are limited to diphenhydramine. Because older adults may have slower metabolism and clearance than younger adults, medication half-lives tend to be prolonged, and peak concentrations tend to be higher in older adults. Data suggest this is the case for diphenhydramine as well. An early study reported that diphenhydramine has a half-life of 9.2hr in adults , rising to 13.5hr in elderly adults . However, another study found the half-life to range from 4.1hr in young adults to 7.4hr in older adults . A review published in 1986 found a reported half-life range for diphenhydramine from 3.3 to 9.3hr .
How To Promote Better Sleep As We Age
We all should be paying attention to our sleep as we age. Fortunately, poor-quality sleep is not a certainty, as there are several lifestyle changes we can make, as well as changes to our regular sleep routine that can mitigate a lot of the problems that come with aging.
A lot of these tips are not exclusive to older people theyll work for anybody who wants to develop good sleep hygiene.
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Q: Which Melatonin Supplement Should I Choose
With so many melatonin supplements out there, deciding on the right one for you comes down to how high of a dosage you need and your preferred type of supplement.
There are melatonin capsules, sprays, gummies, lozenges, and liquid supplements, so whatever makes you feel most comfortable, you should go for.
Also, keep in mind there are unflavored and flavored options, plus different dosages, usually ranging from 0.5mg to 5mg.
When in doubt, its best to start with a low dosage and work your way up from there if you are still having trouble falling and staying asleep.
How Effective Are Sleeping Pills
Studies show that sleeping pills arent that helpful in promoting a good nights rest. Most people who take sleep aids fall asleep about eight to 20 minutes faster than those without medicine. On average, you might get an additional 35 minutes of shuteye.
Generally, sleep aids should be for short-term use. They may be most helpful if a stressful life event, such as a divorce or death in the family, is keeping you awake.
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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.
What Are The Risks
Sleeping pills can have serious, or even deadly side effects.
All sedative-hypnotic drugs have special risks for older adults. Seniors are likely to be more sensitive to the drugs effects than younger adults.
And these drugs may stay in their bodies longer.
The drugs can cause confusion and memory problems as well as changes in balance that:
- More than double the risk of falls and hip fractures. These are common causes of hospitalization and death in older people.
- Increase the risk of car accidents.
The new Z drugs also have risks.
Z drugs include Zolpidem and Zopiclone . Studies suggest they have as much or more risk than the older sleep drugs. There are also concerns they may be as addictive as other sedatives.
Try non-drug treatments first.
Get a thorough medical exam. Sleep problems can be caused by depression or anxiety, pain, restless leg syndrome, and many other conditions.
Even if an exam does not turn up an underlying cause, you should try other solutions before you try drugs .
Kinds of sleeping pills .
All of these pills have risks, especially for older adults:
Benzodiazepines
Sometimes medications under the class antipsychotics or antidepressants are prescribed primarily for sleep including:
Over-the-counter drugs may not be a good choice.
Side effects of some drugs can be especially bothersome for seniors: next-day drowsiness, confusion, constipation, dry mouth, and difficulty urinating. Avoid these over-the-counter sleep drugs:
- Diphenhydramine
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What Are The Potential Risks Or Complications Of Sleeping Pills
When you take sleeping medicines night after night, your body may start to depend on them. When you stop the medicine, your insomnia may come back worse than before. This effect is called rebound insomnia.
If youve used sleep aids for a long time, talk to your healthcare provider about how to stop safely. It may take months to stop taking the pills.
You also shouldnt mix sleep aids with other sedatives or alcohol. Theres a possibility of overdosing.
Common Causes Of Insomnia And Sleep Problems In Older Adults
Poor sleep habits and sleep environment. These include irregular sleep hours, consumption of alcohol before bedtime, and falling asleep with the TV on. Make sure your room is comfortable, dark and quiet, and your bedtime rituals are conducive to sleep.
Pain or medical conditions. Health conditions such as a frequent need to urinate, pain, arthritis, asthma, diabetes, osteoporosis, nighttime heartburn, and Alzheimers disease can interfere with sleep. Talk to your doctor to address any medical issues.
Menopause and post menopause. During menopause, many women find that hot flashes and night sweats can interrupt sleep. Even post menopause, sleep problems can continue. Improving your daytime habits, especially diet and exercise, can help.
Medications. Older adults tend to take more medications than younger people, and the combination of drugs, as well as their side effects, can impair sleep. Your doctor may be able to make changes to your medications to improve sleep.
Lack of exercise. If you are too sedentary, you may never feel sleepy or feel sleepy all the time. Regular aerobic exercise during the day can promote good sleep.
Stress. Significant life changes like retirement, the death of a loved one, or moving from a family home can cause stress. Nothing improves your mood better than finding someone you can talk to face-to-face.
Sleep disorders.Restless Legs Syndrome and sleep-disordered breathingsuch as snoring and sleep apneaoccur more frequently in older adults.
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More Holistic Strategies To Help Seniors Sleep Better
Keep a Consistent Sleep Schedule. Try to avoid going to bed early on some days while playing the night owl on the weekends. Instead, practice getting into bed and going to sleep at the same, set time each day.
Create a Bedtime Routine. Set the mood for sleep by developing a soothing nighttime routine. For example, you might take a warm bath, light a candle, play some soft soothing music, or read in bed to get your brain ready to wind down.
Track Your Sleep. Consider tracking your sleep with a Fitbit or smartwatch to identify sleep patterns and try to assess where your sleep schedule is getting thrown off. Are you tossing and turning after nighttime bathroom breaks? Or perhaps you have sleep apnea without being aware. Some trackers can even record your breathing or snoring and can help you evaluate if youre getting enough deep REM sleep or are only getting light sleep, which can make you feel drowsy throughout the day.
Get a White Noise Machine. Some people find white noise helpful in drowning out nighttime distractions, such as outside traffic, barking dogs, or a snoring partner that may otherwise keep you up at night. Comfortable earplugs may be worth a try too!
Adjust Your Lighting for Sleep. Try switching to low-watt bulbs with soft, warm lighting in your bedroom and avoid bright overhead lighting.
Dont Deny Yourself. While you dont want to be eating a heavy meal before bed, its still important to make sure you dont starve yourself and eat a healthy, filling dinner.
Good Genes Are Nice But Joy Is Better
In a small study of healthy adults aged 55 and older, 5 mg of melatonin increased total sleep time compared to a placebo.
Researchers from Brigham and Womens Hospital conducted the study in 24 healthy, older adults to evaluate whether a high-dose or a low-dose melatonin supplement could improve sleep. The team found that the higher dose had a significant impact, increasing total sleep time compared to placebo by more than 15 minutes for nighttime sleep and by half an hour for daytime sleep. Results are published in The Journal of Pineal Research.
Sleep deficiency becomes more common as people age, and, given the drawbacks to many prescription sleep aids, many older adults report taking melatonin, said senior author Charles Czeisler, chief of the Brighams Division of Sleep and Circadian Disorders. But weve had little evidence on the effects of melatonin on the sleep health of older adults. Our study provides new evidence and insight, and points to the importance of considering dosage and timing when it comes to the effects of supplements like melatonin, especially in older people.
The body naturally produces the hormone melatonin, which helps regulate a persons sleep-wake cycle with night and day. Melatonin levels peak at night. But among older people, levels of the hormone are often lower. Exogenous melatonin is sold over the counter and can be taken before bedtime as a dietary supplement, usually in the form of a pill or capsule.
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Is Kava A Safe Natural Sleep Remedy
Kava, also known as kava kava, is an herbal remedy that’s used for stress and anxiety relief and insomnia. Kava acts by way of a different mechanism. Some say that it may induce relaxation without hindering memory or motor function, though the research findings have been conflicting..
While kava has some sedative properties, it is now considered unsafe. Reports in Europe of more than 20 cases of cirrhosis, hepatitis, and liver failure suggest the possibility of liver toxicity associated with its use.