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DEAR MAYO CLINIC: I am 79 years old. Lately I have had trouble sleeping, and I would like to try a sleeping pill. Are they safe for someone my age?
ANSWER: An inability to sleep can be exhausting and frustrating. It saps your energy and goes hand in hand with problems such as depression, chronic pain, susceptibility to illness, high blood pressure and increased risk of accidents. Sleeping pills can at times be an effective component of sleep therapy. However, they need to be used cautiously, especially among older adults.
Often, the inability to get to sleep or stay asleep is a symptom of an underlying disease or condition contributing to poor sleep. This can include chronic pain, coughing, heart problems, difficulty breathing, digestive problems, acid reflux, thyroid problems and sleep disorders such as obstructive sleep apnea or leg movement disorders. Alcohol or medications such as certain antidepressants, caffeine, decongestants, asthma drugs or pain medications also can contribute to insomnia. Because of this, it’s important that you first have a thorough medical evaluation.
When considering taking any sleeping pill, it’s crucial for you and your doctor to weigh the benefits against the risks. Certainly, good sleep is important. However, taking a drug to assist with sleep can cause side effects such as dizziness or lightheadedness and a risk of dependence. Sleeping pills also suppress breathing — which can worsen breathing problems such as sleep apnea — and may increase infection risk.
Problems with thinking and body movement also can occur. You may remain drowsy after waking up or have daytime memory and physical performance problems. These side effects may be annoying, unsettling or even dangerous. Sleeping pill use may increase the risk of falling and fracturing bones or causing head injuries — particularly at night. Sometimes, sleepwalking — or even driving, shopping, eating or making phone calls while not fully awake — can occur.
When a sleeping pill is prescribed, short-acting, newer generation drugs are common first line choices. Side effects with these drugs are still relatively common, but they tend to occur less frequently and with less severity than with older generation sleep medications. A longer acting drug also may be considered, but its effect on older adults can be much longer lasting. Low doses of antidepressant drugs that cause sleepiness may be an option for those who also have depression, or as a second line option for those who don’t.
Due to increased risk of side effects, many doctors recommend avoiding older generation benzodiazepines, and triazolam (Halcion) in particular. Benzodiazapines, especially the longer acting ones, are generally not recommended for older adults. In addition, a 2014 study found that risk of developing Alzheimer’s disease increased by up to 51 percent in those who have used benzodiazepines, with highest risk among those who used them more frequently or who used the long-acting ones.
The choice to use sleeping pills is a nuanced decision to be made in close cooperation with your doctor. In general, Mayo Clinic sleep experts recommend that older adults keep sleeping pill use to a minimum, as an occasional sleep aid or over the short term of a few weeks while other avenues to improved sleep are explored. Regular follow-up with your doctor is important. (adapted from Mayo Clinic Health Letter) — Eric Olson, M.D., Center for Sleep Medicine, Mayo Clinic, Rochester, Minn.